Nelson Suchitra, Lerner Edith, Needlman Robert, Salvator Ann, Singer Lynn T
Department of Community Dentistry, School of Dentistry, Case Western Reserve University, Cleveland, Ohio 44106-4905, USA.
J Dev Behav Pediatr. 2004 Feb;25(1):1-9. doi: 10.1097/00004703-200402000-00001.
This longitudinal study investigated the rates of iron-deficiency (ID) and iron-deficiency anemia (IDA) among prenatally cocaine-exposed and nonexposed two- and four-year-old children and assessed their relationships to neurodevelopmental outcomes. The sample consisted of 143 two-year-old (70 exposed and 73 nonexposed) and 274 four-year-old (139 exposed and 135 nonexposed) low socioeconomic status children recruited from an ongoing longitudinal study. Hematological assessments included hemoglobin, serum ferritin, mean corpuscular volume, transferrin saturation, and blood lead levels. The neurodevelopmental outcomes consisted of the Bayley Mental (MDI) and Motor (PDI) Development indices at two years, and the Wechsler Preschool and Primary Scales of Intelligence (WPPSI) and the Peabody Developmental Motor Scales (PDMS) at four years. The rate of IDA in four-year-old children was significantly greater among the cocaine-exposed compared to the nonexposed group (p =.026), while the rates at two years were not significant. Exposure to IDA at two years was associated with a significant decrease in concurrent motor scores (p =.011) after adjustment for relevant covariates. Peak exposure to IDA, defined as being anemic at 2 and/or 4 years of age, was associated with a significant (p <.05) decrease in Full Scale IQ after adjustment. Cocaine exposure was not a significant predictor of Full Scale IQ with the inclusion of peak IDA and lead in the model. These findings indicate the need for greater pediatric surveillance of IDA and lead in cocaine-exposed infants, in order to reduce long-term neuropsychological deficits.
这项纵向研究调查了产前暴露于可卡因和未暴露于可卡因的2岁及4岁儿童的缺铁（ID）和缺铁性贫血（IDA）发生率，并评估了它们与神经发育结果的关系。样本包括从一项正在进行的纵向研究中招募的143名2岁儿童（70名暴露组和73名非暴露组）和274名4岁儿童（139名暴露组和135名非暴露组），这些儿童社会经济地位较低。血液学评估包括血红蛋白、血清铁蛋白、平均红细胞体积、转铁蛋白饱和度和血铅水平。神经发育结果包括2岁时的贝利智力发展指数（MDI）和运动发展指数（PDI），以及4岁时的韦氏学前和小学智力量表（WPPSI）和皮博迪发育运动量表（PDMS）。与未暴露组相比，暴露于可卡因的4岁儿童中IDA发生率显著更高（p = 0.026），而2岁时的发生率无显著差异。在调整相关协变量后，2岁时暴露于IDA与同时期运动评分显著降低相关（p = 0.011）。IDA的峰值暴露定义为在2岁和/或4岁时贫血，在调整后与全量表智商显著降低相关（p < 0.05）。在模型中纳入IDA峰值和铅后，可卡因暴露不是全量表智商的显著预测因素。这些发现表明，有必要对暴露于可卡因的婴儿进行更严格的IDA和铅监测，以减少长期神经心理缺陷。
