孕前6个月父母生活、职业环境暴露对学龄前儿童执行功能影响

Effect of parents＇ occupational and life environment exposure during six months before pregnancy on executive function of preschool children

目的探索孕前6个月父母生活、职业环境暴露对学龄前儿童执行功能（EF）的影响。方法孕妇来自中国安徽省马鞍山市出生队列（The China-Anhui Birth Cohort Study，C．ABCS）人群，该队列于2008年10月至2010年10月在马鞍山市4家市级医疗卫生机构接受孕期保健的孕妇中招募研究对象，共计5084名孕妇及4669名单胎活产儿进入队列。于2014年4月至2015年4月对队列人群进行随访研究，共随访到学龄前儿童3803名，其中，32名学龄前儿童无EF评定结果，最终有3771名纳入本研究。采用自行设计的《孕产期母婴健康记录表》调查学龄前儿童父母一般人口学特征及孕前6个月父母生活与职业暴露情况。采用父母填写的《学龄前儿童执行功能量表》（BRIEF-P）调查学龄前儿童EF发育情况。运用多因素二分类非条件logistic回归模型分析孕前6个月父母生活、职业环境暴露与儿童EF的关系。结果3771名学龄前儿童自我抑制控制指数（ISCI）、认知灵活性指数（FI）、元认知指数（EMI）、总执行功能（GEc）异常检出率分别为4．8％（182例）、2．3％（88例）、16．5％（623例）、8．6％（324例）。孕前6个月父母居住环境嘈杂（OR=I．86，95％C!：1．36～2．54）、孕前6个月母亲接触农药（OR=3．60，95％CI：1．45～8．95）是学龄前儿童ISCI异常的危险因素；孕前6个月母亲接触农药（OR=6．72，95％CI：2．50～18．07）、孕前6个月父亲接触铅（OR=2．10，95％CI：1．25～3．54）是学龄前儿童兀异常的危险因素；孕前6个月父母居住环境嘈杂（OR=1．42，95％CI：1．18～1．71）、孕前6个月父亲接触铅（OR=1．30，95％CI：1．02～1．65）是学龄前儿童EMI得分异常的危险因素。孕前6个月父母居住环境嘈杂（OR=1．58，95％C1：1．24～2．01）和孕前6个月母亲接触农药（OR=2．39，95％CI：1．03～5．58）是学龄前儿童GEC异常的危险因素。结论孕前6个月父母居住环境嘈杂、母亲接触农药及父亲接触铅，其子女EF发育相对较差。

Objective To examine the effect of parents＇ occupational and life exposure during six months before pregnancy on executive function of preschool children. Methods Pregnant women involved in the study came from the Ma＇anshan Birth Cohort Study, a part of the China-Anhui Birth Cohort Study. Between October 2008 and October 2010, pregnant women who accepted pregnancy care in four municipal medical and health institutions in Ma＇anshan city were recruited as study objects. A total of 5 084 pregnant women and 4 669 singleton live births entered in this cohort. Between April 2014 and April 2015, a total of 3 803 pre-school children were followed up. Finally, except 32 preschool children did not have EF evaluation result, there were 3 771 children included in this study. By using self-designed ＂Maternal health handbook＂, we researched parents＇ general demographic characteristics, and life and occupational exposure during six months before pregnancy. To research preschool children＇s executive function, we used the Behavior Rating Inventory of Executive Function-Preschool Version （BRIEF-P）. Univariate and multivariate statistical method was used to analyze the association of parents＇ life and occupational exposure during six months before pregnancy and preschool children＇s EF. Results 3 771 preschool children＇s detected rate of inhibitory self-control index （ISCI）, flexibility index （FI）, emergent metacognition index （EMI） and global executive composite （GEC） dysplasia were 4.8%（182）, 2.3%（88）, 16.5%（623） and 8.6%（324） respectively. During six months before pregnancy, children whose parents were lived in a noise environment （OR=1.86, 95% CI： 1.36-2.54）, whose maternal were exposed to pesticides were the risk of ISCI dysplasia（OR=3.60, 95% CI： 1.45-8.95）. During six months before pregnancy, children whose maternal were exposed to pesticides （OR=6.72, 95%CI： 2.50-18.07） and whose father were exposed to occupational lead （OR=2.10, 95% CI： 1.25-3.54） were the risk of FI dysplasia. During six months before pregnancy, children whose parents were lived in a noise environment （OR=1.42, 95%CI： 1.18-1.71） and whose father were exposed to occupational lead （OR=1.30, 95%C1： 1.02-1.65） were the risk of EMI dysplasia. During six months before pregnancy, children whose parents were lived in a noise environment （OR--1.58, 95%CI： 1.24-2.01） and whose maternal were exposed to pesticides （OR=2.39, 95%CI： 1.02-5.58） were the risk of GEC dysplasia. Conclusion The development of executive function is worse among preschool children whose parents live in noise environment, mother exposed to pesticides, and father exposed to occupational lead during six months before pregnancy.