Álamo-Junquera Dolores, Sunyer Jordi, Iñiguez Carmen, Ballester Ferran, Garcia-Esteban Raquel, Forns Joan, Turner Michelle C, Lertxundi Aitana, Lertxundi Nerea, Fernandez-Somoano Ana, Rodriguez-Dehli Cristina, Julvez Jordi
Teaching Unit, Parc de Salut Mar-Universitat Pompeu Fabra & Agéncia de Salut Pública de Barcelona, Barcelona, Spain.
Center for Research in Environmental Epidemiology, Barcelona, Spain; Centros de Investigación Biomédica en Red Epidemiologia y Salud Pública, Barcelona, Spain; Institut Municipal d'Investigació Mèdica-Hospital del Mar, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.
Am J Obstet Gynecol. 2015 May;212(5):661.e1-11. doi: 10.1016/j.ajog.2014.12.001. Epub 2014 Dec 10.
We sought to assess the association between prenatal head growth and child neuropsychological development in the general population.
We evaluated 2104 children at the age of 14 months from a population-based birth cohort in Spain. Head circumference (HC) was measured by ultrasound examinations at weeks 12, 20, and 34 of gestation and by a nurse at birth. Head growth was assessed using conditional SD scores between weeks 12-20 and 20-34. Trained psychologists assessed neuropsychological functioning using the Bayley Scales of Infant Development. Head size measurements at birth were transformed into a 3-category variable: microcephalic (<10th percentile), normocephalic (≥10th and <90th percentile), and macrocephalic (≥90th percentile) based on the cohort distribution. P values<.05 were considered statistically significant.
No overall associations were observed between HC or head growth and mental and psychomotor scores. In particular, no associations were found between HC at birth and mental scores (coefficient, 0.04; 95% confidence interval, -0.02 to 0.09) and between interval head growth (20-34 weeks) and mental scores (0.31; 95% confidence interval, -0.36 to 0.99). Upon stratification by microcephalic, normocephalic, or macrocephalic head size, results were imprecise, although there were some significant associations in the microcephalic and macrocephalic groups. Adjustment by various child and maternal cofactors did not affect results. The minimum sample size required for present study was 883 patients (β=2, α=0.05, power=0.80).
Overall prenatal and perinatal HC was not associated with 14-month-old neuropsychological development. Findings suggest HC growth during uterine life among healthy infants may not be an important marker of early-life neurodevelopment but may be marginally useful with specific populations.
我们试图评估一般人群中产前头部生长与儿童神经心理发育之间的关联。
我们对来自西班牙一个基于人群的出生队列的2104名14个月大的儿童进行了评估。在妊娠第12、20和34周通过超声检查测量头围（HC），并在出生时由护士测量。使用12 - 20周和20 - 34周之间的条件标准差分数评估头部生长情况。训练有素的心理学家使用贝利婴儿发育量表评估神经心理功能。根据队列分布，将出生时的头围测量值转换为一个三类变量：小头畸形（<第10百分位数）、头围正常（≥第10百分位数且<第90百分位数）和大头畸形（≥第90百分位数）。P值<0.05被认为具有统计学意义。
未观察到HC或头部生长与智力和精神运动评分之间存在总体关联。特别是，未发现出生时的HC与智力评分之间存在关联（系数为0.04；95%置信区间为 - 0.02至0.09），也未发现区间头部生长（20 - 34周）与智力评分之间存在关联（0.31；95%置信区间为 - 0.�6至0.99）。按小头畸形、头围正常或大头畸形的头围大小分层后，结果不精确，尽管在小头畸形和大头畸形组中有一些显著关联。通过各种儿童和母亲的协变量进行调整并不影响结果。本研究所需的最小样本量为883名患者（β = 2，α = 0.05，检验效能 = 0.80）。
总体产前和围产期HC与14个月大时的神经心理发育无关。研究结果表明，健康婴儿在子宫内生活期间的HC生长可能不是早期神经发育的重要标志物，但对特定人群可能略有帮助。
