Murray Elizabeth, Matijasevich Alicia, Santos Iná S, Barros Aluísio J D, Anselmi Luciana, Barros Fernando C, Stein Alan
Department of Psychiatry, Oxford University, Oxford, UK.
Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
J Child Psychol Psychiatry. 2015 Dec;56(12):1380-8. doi: 10.1111/jcpp.12422. Epub 2015 Apr 15.
Recent evidence suggests that impaired foetal growth may provide an early indication of increased risk of child attention problems. However, despite both foetal growth and child attention problems differing by sex, few studies have examined sex differences in this association. Furthermore, no studies have been conducted in low- and middle-income countries, where there are higher rates of perinatal problems. This study aimed to test for sex differences in the association between foetal growth indices and attention problems at age four, in a large, prospective birth cohort from a middle-income country.
A total of 3,749 neonates from the 2004 Pelotas birth cohort (Brazil) with foetal growth indices collected at birth [low birthweight (LBW), small-for-gestational age (SGA), head circumference (HC), head circumference-to-abdominal circumference ratio (HC/AC) and ponderal index (PI)], were assessed for attention problems using the Child Behaviour Checklist at age four. Ordinal logistic regression with successive adjustment for maternal, demographic, gestational, perinatal and child nutrition/mother-child morbidity, was conducted separately for girls and boys.
In girls, attention difficulties were associated with being born SGA (OR = 1.40, CI = 1.08-1.82, p = .012), with a small HC (OR = 1.52, CI = 1.11-2.08, p = .009), or with a low PI (OR = 1.29, CI = 1.08-1.54, p = .005). There were no associations identified between attention difficulties and any foetal growth indices in boys.
Our results show that girls with impaired foetal growth may be particularly at risk of attention difficulties in childhood. This is consistent with emerging research that female foetuses may be more vulnerable to certain suboptimal intrauterine environments, inducing epigenetic changes that lead to disturbed growth and long-term developmental impairment.
最近的证据表明，胎儿生长受限可能是儿童注意力问题风险增加的早期迹象。然而，尽管胎儿生长和儿童注意力问题都存在性别差异，但很少有研究探讨这种关联中的性别差异。此外，在围产期问题发生率较高的低收入和中等收入国家尚未开展相关研究。本研究旨在对一个中等收入国家的大型前瞻性出生队列中胎儿生长指标与4岁时注意力问题之间的关联进行性别差异检验。
对2004年佩洛塔斯出生队列（巴西）中的3749名新生儿进行研究，这些新生儿在出生时收集了胎儿生长指标[低出生体重（LBW）、小于胎龄儿（SGA）、头围（HC）、头围与腹围之比（HC/AC）和 ponderal 指数（PI）]，并在4岁时使用儿童行为检查表评估注意力问题。分别对女孩和男孩进行有序逻辑回归，并依次对母亲、人口统计学、妊娠、围产期和儿童营养/母婴发病率进行调整。
在女孩中，注意力困难与小于胎龄儿出生（OR = 1.40，CI = 1.08 - 1.82, p = 0.012）、小头围（OR = 1.52，CI = 1.11 - 2.08, p = 0.009）或低 ponderal 指数（OR = 1.29，CI = 1.08 - 1.54, p = 0.005）有关。在男孩中，未发现注意力困难与任何胎儿生长指标之间存在关联。
我们的结果表明，胎儿生长受限的女孩在童年时期可能特别容易出现注意力困难。这与新出现的研究一致，即女性胎儿可能更容易受到某些次优宫内环境的影响，从而引发表观遗传变化，导致生长紊乱和长期发育障碍。
