Hamadani Jena D, Fuchs George J, Osendarp Saskia J M, Huda Syed N, Grantham-McGregor Sally M
Centre for Health and Population Research, International Centre for Diarrhoeal Disease Research, Bangladesh.
Lancet. 2002 Jul 27;360(9329):290-4. doi: 10.1016/S0140-6736(02)09551-X.
Zinc deficiency is widely prevalent in developing countries. Zinc supplements given to Bangladeshi pregnant women have been shown to reduce infants' infectious disease morbidity. We assessed these infants at age 13 months to establish the effect of antenatal zinc supplementation on infant development and behaviour.
The study originally consisted of 559 pregnant women who were randomly allocated to zinc (30 mg daily) or placebo (cellulose) from 4 months' gestation to delivery. The effect of zinc supplementation on pregnancy outcome and on infant growth and morbidity in the first 6 months was assessed. We then randomly selected a subsample of 168 infants from 383 who completed the study at 6 months. When babies in this subsample reached age 13 months, we assessed mental development with Bayley scales of infant development-II, rated behaviour on a modified version of Wolke's scales, and measured weight and height.
When we controlled for differences between tested and non-tested participants, infants in the placebo group had higher scores on mental development index (regression coefficient=3.3, SE 1.6, 95% CI 0.2-6.5, p=0.04) and psychomotor development index (5.1, 2.4, 0.2-9.9, p=0.04) than those in the zinc-supplemented group. Zinc supplementation had no significant effect on behaviour or growth. The children's nutritional status was poor, and weight-for-age at testing was strongly related to developmental levels, which accounted for some of the treatment effect.
Prenatal supplementation with zinc alone in poor women from Bangladesh does not seem to confer benefit on infants' mental development. Such treatment should be considered with caution.
锌缺乏在发展中国家广泛存在。给孟加拉国孕妇补充锌已被证明可降低婴儿的传染病发病率。我们在这些婴儿13个月大时进行评估，以确定产前补充锌对婴儿发育和行为的影响。
该研究最初包括559名孕妇，她们从妊娠4个月至分娩被随机分配接受锌（每日30毫克）或安慰剂（纤维素）。评估了补充锌对妊娠结局以及婴儿头6个月生长和发病率的影响。然后我们从383名在6个月时完成研究的婴儿中随机抽取了168名婴儿作为子样本。当这个子样本中的婴儿达到13个月大时，我们用贝利婴儿发展量表-II评估其智力发育，用改良版沃尔克量表对行为进行评分，并测量体重和身高。
当我们控制测试组和未测试组参与者之间的差异时，安慰剂组婴儿的智力发育指数得分（回归系数 = 3.3，标准误1.6，95%可信区间0.2 - 6.5，p = 0.04）和心理运动发育指数得分（5.1，2.4，0.2 - 9.9，p = 0.04）高于补锌组。补充锌对行为或生长没有显著影响。儿童的营养状况较差，测试时的年龄别体重与发育水平密切相关，这在一定程度上解释了治疗效果。
在孟加拉国贫困妇女中单独进行产前补锌似乎对婴儿智力发育没有益处。这种治疗应谨慎考虑。
