Tran Thach D, Tran Tuan, Simpson Julie A, Tran Ha T, Nguyen Trang T, Hanieh Sarah, Dwyer Terence, Biggs Beverley-Ann, Fisher Jane
Research and Training Centre for Community Development, 39/255 Vong Street, Hai Ba Trung District Hanoi, Vietnam.
BMC Pregnancy Childbirth. 2014 Jan 8;14:8. doi: 10.1186/1471-2393-14-8.
Antenatal anaemia, iron deficiency and common mental disorders (CMD) are prevalent in low- and middle-income countries. The aim of this study was to examine the direct and indirect effects of antenatal exposures to these risks and infant motor development.
A cohort of women who were pregnant with a single foetus and between 12 and 20 weeks pregnant in 50 randomly-selected rural communes in Ha Nam province was recruited. Participants provided data twice during pregnancy (early and late gestation) and twice after giving birth (8 weeks and 6 months postpartum). The Edinburgh Postnatal Depression Scale was used at all four data collection waves to detect CMD (score ≥ 4). Maternal anaemia (Hb < 11 g/dL) and iron deficiency (ferritin < 15 ng/mL) were evaluated at early and late gestation. Infants' motor development was assessed by the Bayley of Infant and Toddler Development Motor Scales (BSID-M) at the age of six months. Direct and indirect effects of the exposures on the outcome were examined with Path analysis.
In total, 497 of 523 (97%) eligible pregnant women were recruited and 418 mother-infant pairs provided complete data and were included in the analyses. The prevalence of anaemia was 21.5% in early pregnancy and 24.4% in late pregnancy. There was 4.1% iron deficiency at early pregnancy and 48.2% at late pregnancy. Clinically significant symptoms of CMD were apparent among 40% women in early pregnancy and 28% in late pregnancy. There were direct adverse effects on infant BSID-M scores at 6 months of age due to antenatal anaemia in late pregnancy (an estimated mean reduction of 2.61 points, 95% Confidence Interval, CI, 0.57 to 4.65) and CMD in early pregnancy (7.13 points, 95% CI 3.13 to 11.13). Iron deficiency and anaemia in early pregnancy were indirectly related to the outcome via anaemia during late pregnancy.
Antenatal anaemia, iron deficiency, and CMD have a negative impact on subsequent infant motor development. These findings highlight the need to improve the quality of antenatal care when developing interventions for pregnant women that aim to optimise early childhood development in low- and middle-income countries.
产前贫血、缺铁和常见精神障碍（CMD）在低收入和中等收入国家普遍存在。本研究的目的是探讨产前暴露于这些风险因素与婴儿运动发育之间的直接和间接影响。
招募了来自河南省50个随机选择的农村公社的单胎妊娠且孕周在12至20周之间的孕妇队列。参与者在孕期提供两次数据（孕早期和孕晚期），产后提供两次数据（产后8周和6个月）。在所有四次数据收集时使用爱丁堡产后抑郁量表来检测CMD（得分≥4）。在孕早期和孕晚期评估孕妇贫血（血红蛋白<11 g/dL）和缺铁（铁蛋白<15 ng/mL）情况。在婴儿6个月大时通过贝利婴幼儿发展运动量表（BSID-M）评估婴儿的运动发育。采用路径分析研究暴露因素对结局的直接和间接影响。
总共招募了523名符合条件的孕妇中的497名（97%），418对母婴提供了完整数据并纳入分析。孕早期贫血患病率为21.5%，孕晚期为24.4%。孕早期缺铁率为4.1%，孕晚期为48.2%。孕早期40%的女性和孕晚期28%的女性有明显的CMD临床症状。孕晚期产前贫血（估计平均降低2.61分，95%置信区间，CI，0.57至4.65）和孕早期CMD（7.13分，95%CI 3.13至11.13）对6个月大婴儿的BSID-M评分有直接不良影响。孕早期缺铁和贫血通过孕晚期贫血与结局间接相关。
产前贫血、缺铁和CMD对随后的婴儿运动发育有负面影响。这些发现凸显了在为低收入和中等收入国家的孕妇制定旨在优化儿童早期发育的干预措施时，提高产前护理质量的必要性。
