母亲孕期被动吸烟和补充叶酸与其子女孤独症行为的交互作用

Interaction between passive smoking and folic acid supplement during pregnancy on autism spectrum disorder behaviors in children aged 3 years

目的 探讨母亲孕期被动吸烟和补充叶酸与儿童孤独症行为的交互作用。方法 以2014年深圳市龙华新区新入园的小班（3岁）儿童为研究对象，由家长填写问卷，询问儿童年龄、性别、早产、低出生体重、父母学历、父母生育年龄、家庭收入等，用孤独症行为量表评估儿童孤独症行为，按筛检界值31分和诊断界值62分将儿童分为正常组（〈31分）、亚临床组（31～61分）和疑似临床组（≥62分）。控制混杂因素后，采用多分类logistic回归模型，分析孕期母亲被动吸烟和补充叶酸对儿童孤独症行为的主效应和交互作用。结果 孕期母亲被动吸烟与儿童孤独症行为呈正相关（亚临床组：OR=1.48，P〈0.05；疑似临床组：OR=2.85，P〈0.05），孕期母亲补充叶酸与儿童孤独症行为的关联无统计学意义（亚临床组：OR=1.04，P〉0.05；疑似临床组：OR=0.75，P〉0.05）。分层分析显示，孕期母亲未被动吸烟的儿童中，孕期母亲补充叶酸与儿童孤独症行为呈负关联（疑似临床组：OR=0.30，P〈0.05）；孕期母亲补充叶酸的儿童中，孕期母亲被动吸烟与儿童孤独症行为显著正关联（亚临床组：OR=1.52，P〈0.05；疑似临床组：OR=4.45，P〈0.05）。进一步交互作用分析显示，孕期母亲被动吸烟和补充叶酸对儿童孤独症行为疑似临床组的交互作用明显（OR=5.30，P〈0.05）。结论 孕期母亲被动吸烟和补充叶酸与儿童孤独症行为关联，且存在交互作用。

Objective To explore the interaction between passive smoking and folic acid supplement during pregnancy on children autism spectrum disorder （ASD） behaviors. Methods Children aged about 3 years were enrolled at kindergarten entrance in Longhua district of Shenzhen in 2014. Self-administered questionnaires were completed by their primary caregivers and the information about children＇s age, gender, history of preterm birth and low birth weight, parents＇ education level, parents＇reproductive age and family income were collected. The children ASD behaviors were assessed with Autism Behavior Checklist （ABC）. According to the cut point of ABC, the children were divided into normal group with score less than 31, sub-clinical group with score ranging from 31 to 61 and suspect clinical group with score no less than 62. After controlling for potential confounders, multivariate logistic regression analysis was performed to evaluate the main effects and the interaction between passive smoking and folic acid supplement during pregnancy on children ASD behaviors. Results Maternal passive smoking during pregnancy was significantly associated with children ASD behaviors （sub-clinical group：OR=1.48; suspect clinical group：OR=2.85）, and maternal folic acid supplement during pregnancy was not related to children ASD behaviors （sub-clinical group：OR=1.04; suspect clinical group：OR=0.75）. Stratified analysis showed that folic acid supplement during pregnancy was negatively associated with children ASD behaviors （suspect clinical group：OR=0.30） among children without mothers＇passive smoking during pregnancy, and that mothers＇passive smoking during pregnancy was positively associated with children ASD behaviors （sub-clinical group：OR=1.52; suspect clinical group：OR=4.45） among the children whose mothers had folic acid supplement during pregnancy. Furthermore, an interaction effect on children ASD behaviors was found between passive smoking and folic acid supplement during pregnancy （suspect clinical group：OR=5.30）. Conclusion Passive smoking and folic acid supplement during pregnancy were related to children ASD behaviors and had an interaction on children ASD behaviors.