孕期轻度贫血与18月龄儿童发育迟缓关联及其孕妇智商调节作用出生队列研究

Association of mild anemia during pregnancy with developmental delay in children aged 18 months and regulating effect of maternal IQ: a birth cohort study

目的探讨孕中、孕晚期轻度贫血对18月龄儿童发育行为的影响,阐明孕妇智商水平的调节作用。方法选取2013年5月—2014年9月在安徽省马鞍山市妇幼保健院进行产检的2826对母婴为研究对象,采用多因素logistic回归模型分析孕期贫血与儿童发育迟缓的关联。结果孕中期和孕晚期轻度贫血检出率分别为27.1%、26.0%。控制混杂因素后,与非贫血孕妇分娩的儿童相比,孕中期轻度贫血是儿童沟通能区发育迟缓的危险因素(RR=2.65,95%CI=1.35~5.19),孕晚期轻度贫血是儿童个人-社会能区发育迟缓的危险因素(RR=2.15,95%CI=1.24~3.73)。按孕妇智力分层,调整混杂因素后,与非贫血孕妇分娩的儿童相比,孕妇智力正常组孕中期轻度贫血(RR=3.61,95%CI=1.50~8.72)和孕中、晚期都轻度贫血(RR=2.60,95%CI=1.01~6.69)是儿童沟通能区发育迟缓的危险因素;孕晚期轻度贫血是儿童个人-社会能区发育迟缓的危险因素(RR=2.04,95%CI=1.05~3.95)。孕妇智力低下组孕期轻度贫血与儿童发育迟缓的关联无统计学意义。结论孕中、晚期轻度贫血可损害18月龄幼儿沟通和个人-社会能区的发育,孕妇智商水平起调节作用。

Objective To investigate the correlation between mild maternal anemia during the second(2 nd) and third(3 rd) trimester on behavioral development of the children aged 18 months, and to explore regulating effect of maternal intelligence quotient(IQ) on the correlation. Methods The participants of the study were 2 826 pairs of mothers and infants who underwent antenatal examination in Ma’anshan Maternal and Child Health Hospital from May 2013 through September2014. The relevance of maternal anemia during pregnancy to development delay among their children at the age of 18 months was analyzed with multivariate logistic regression analysis. Results The detection rate of mild anemia during the 2 nd and3 rd trimester were 27.1% and 26.0% among the mothers. After adjusting for confounding factors, mild maternal anemia during the 2 nd trimester was a risk factors for the children’s developmental delay in communication domain(relative risk[RR] = 2.65, 95% confidence interval [95% CI]: 1.35 - 5.19) and mild anemia in the 3 rd trimester was a risk factor for the children’s developmental delay in individual-social domain(RR = 2.15, 95% CI: 1.24 - 3.73) compared to the children without maternal anemia. Also compared to those without maternal anemia and adjusting for confounding factors, the children with normal maternal IQ and mild maternal anemia only during the 2 nd trimester and during both the 2 nd and the3 rd trimester had an increased risk of developmental delay in communication domain, with the RR of 3.61(95% CI: 1.50 -8.72) and 2.60(95% CI: 1.01 - 6.69);as for the children with normal maternal IQ and mild maternal anemia during the 3 rd trimester, the risk of developmental delay in individual-social domain increased, with the RR of 2.04(95% CI: 1.05 - 3.95);no significant correlation between mild maternal anemia and development delay of the children was observed among the children with low maternal IQ. Conclusion Mild maternal anemia in the 2 nd and 3 rd trimester could impair communication domain and individual-social domain development in 18 months old children, and maternal IQ plays a regulatory role on the impairment.