重度妊娠期高血压对胎儿听力及智能发育的影响

Effects of Severe Hypertensive Disorders of Pregnancy on Hearing and Intelligence Development of Fetuses

目的探讨重度妊娠期高血压(hypertensive disorders of pregnancy,HDP)对不同胎龄围产儿听力及婴幼儿期智能发育的影响。方法将552例母亲有HDP的围产儿,根据HDP的严重程度分为轻度组和重度组,再根据胎龄分为足月组、低危组和高危组,出生后2~32天行DPOAE和AABR联合筛查,3个月和6个月行全面听力学诊断,其中369例患儿参加丹佛发育筛查测试(denver development screen test,DDST),进行婴幼儿期智能发育情况随访。随机选择300例同期母亲无HDP的围产儿形成对照组,并将测试结果对比。结果重度HDP足月、低危及高危组的听力损失率均高于无HDP组和轻度HDP组(P<0.05),而轻度HDP组与无HDP组对比则无显著性差异;重度HDP足月、低危及高危组出生后2~32天、3个月和6个月听力均有显著差异(P<0.05);在足月儿中,重度HDP、轻度HDP及无HDP的智能发育异常及可疑率两两对比无显著差异;在低危儿及高危儿中,重度HDP的智能发育异常及可疑率均明显高于轻度HDP和无HDP(P<0.05),而轻度HDP和无HDP之间则无显著差异;在重度HDP中,有听力损失患儿的智能发育异常及可疑率显著高于听力正常的婴幼儿(P<0.05)。结论重度HDP对围产儿听力及对低、高危儿智能发育有影响;重度HDP中有听力损失患儿的智能发育异常及可疑率高,应加强此类患儿的听力与发育筛查和随访。

Objective To investigate the influence of severe hypertensive disorders of pregnancy(HDP)on hearing and intelligence development at different gestational ages.Methods Perinatal infants(n=552)were divided into groups based on the severity of maternal HDP and the their gestational ages.Hearing screening was completed within 2-32 days after birth using DPOAEs and AABRs,and comprehensive audiological diagnosis was performed in the first 3 to 6 months.The Denver Development Screen Test was administered in 369 children to survey infancy development.Another 300 perinatal infants without history of maternal HDP were randomly selected to serve as the control group.Results The rate of hearing loss in babies with severe maternal HDP was higher than in those with mild or no maternal HDP(P<0.05),while the rate showed no significant difference between babies with mild maternal HDP and those without.Hearing in babies with severe maternal HDP showed significant changes from first screening to 3 and 6 months(P<0.05).For full term babies,the rate of definite or suspected intelligence development abnormalities was similar regardless of history of severe,mild or no maternal HDP.Among low and high risk babies,this rate was higher in those with severe maternal HDP than in those with mild or no maternal HDP(P<0.05),but similar between those with mild maternal HDP and those without.In babies with severe maternal HDP,this rate was significantly higher in those with hearing loss than in babies with normal hearing(P<0.05).Conclusion Severe maternal HDP can impact hearing and intelligence development in perinatal babies,with intelligence development especially at risk in those with severe maternal HDP and hearing loss,warranting comprehensive screening and follow up in these children.