Lung F-W, Shu B-C, Chiang T-L, Lin S-J
Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Taiwan.
Child Care Health Dev. 2009 May;35(3):409-18. doi: 10.1111/j.1365-2214.2009.00963.x.
While studying the development of twins, gestational age and birthweight were suggested as two of the major mediators to be considered. In addition, maternal age, maternal education, parental income and assisted reproductive technologies (ART) also should be considered as moderators. Thus the purpose of this study was to investigate the mediators and moderators of twin and singleton development.
Being a national birth cohort study, 21 648 infants were randomly selected and developmental measures were assessed at 6 and 18 months post partum. Children's development at 6 and 18 months were measured using the high reliable Taiwan Birth Cohort Study instrument, which measures children's development in four domains of gross motor, fine motor, language and social development. Additionally, maternal sociodemographics including maternal age, maternal education and parental income; children's characteristics including gender, birthweight, gestational age, single or multiple births, ART or natural conception information were also collected. These data were analysed using a three-step multiple linear regression analysis and further validated using structural equation modelling.
Parental sociodemographics, children characteristics and being twin all had effect on children's development. Additionally, ART and twin were mediators between maternal age and children's development. Mothers aged over 40 were more likely to choose ART, thus increases their likelihood of having twins. Additionally, mothers aged over 40 were more likely to give birth to premature or low-birthweight babies, regardless if they were twin or not. Twins had a higher prevalence of prematurity or low birthweight, which also affected their development in all four domains at 6 and 18 months. Thus prematurity and low birthweight were mediating factors between twin and children's development; with these two mediating factors controlled, there were no difference between twin and singleton development.
The conceptual construct of structural equation modelling showed these factors interacted and influenced children's development through multiple pathways. Medical intervention may facilitate children's development through prenatal growth and premature care.
在研究双胞胎的发育情况时，胎龄和出生体重被认为是两个需要考虑的主要中介因素。此外，母亲年龄、母亲教育程度、父母收入和辅助生殖技术（ART）也应被视为调节因素。因此，本研究的目的是调查双胞胎和单胎发育的中介因素和调节因素。
作为一项全国性的出生队列研究，随机选取了21648名婴儿，并在产后6个月和18个月时评估发育指标。使用高度可靠的台湾出生队列研究工具测量6个月和18个月儿童的发育情况，该工具在大运动、精细运动、语言和社会发展四个领域测量儿童的发育。此外，还收集了母亲的社会人口统计学信息，包括母亲年龄、母亲教育程度和父母收入；儿童特征，包括性别、出生体重、胎龄、单胎或多胎、ART或自然受孕信息。这些数据采用三步多元线性回归分析进行分析，并使用结构方程模型进一步验证。
父母的社会人口统计学特征、儿童特征以及双胞胎身份均对儿童发育有影响。此外，ART和双胞胎身份是母亲年龄与儿童发育之间的中介因素。40岁以上的母亲更有可能选择ART，从而增加了她们生育双胞胎的可能性。此外，40岁以上的母亲更有可能生下早产或低体重婴儿，无论她们是否怀有双胞胎。双胞胎早产或低体重的患病率更高，这也影响了他们在6个月和18个月时在所有四个领域的发育。因此，早产和低体重是双胞胎与儿童发育之间的中介因素；在控制这两个中介因素后，双胞胎和单胎发育之间没有差异。
结构方程模型的概念结构表明，这些因素相互作用并通过多种途径影响儿童发育。医学干预可能通过产前生长和早产护理促进儿童发育。
