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从婴儿期到幼儿期的社会经济劣势与神经发育

Socioeconomic disadvantage and neural development from infancy through early childhood.

作者信息

Chin-Lun Hung Galen, Hahn Jill, Alamiri Bibi, Buka Stephen L, Goldstein Jill M, Laird Nan, Nelson Charles A, Smoller Jordan W, Gilman Stephen E

机构信息

Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan Department of Public Health, School of Medicine, National Yang Ming University, Taipei, Taiwan.

Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.

出版信息

Int J Epidemiol. 2015 Dec;44(6):1889-99. doi: 10.1093/ije/dyv303. Epub 2015 Dec 16.

Abstract

BACKGROUND

Early social experiences are believed to shape neurodevelopment, with potentially lifelong consequences. Yet minimal evidence exists regarding the role of the social environment on children's neural functioning, a core domain of neurodevelopment.

METHODS

We analysed data from 36 443 participants in the United States Collaborative Perinatal Project, a socioeconomically diverse pregnancy cohort conducted between 1959 and 1974. Study outcomes included: physician (neurologist or paediatrician)-rated neurological abnormality neonatally and thereafter at 4 months and 1 and 7 years; indicators of neurological hard signs and soft signs; and indicators of autonomic nervous system function.

RESULTS

Children born to socioeconomically disadvantaged parents were more likely to exhibit neurological abnormalities at 4 months [odds ratio (OR) = 1.20; 95% confidence interval (CI) = 1.06, 1.37], 1 year (OR = 1.35; CI = 1.17, 1.56), and 7 years (OR = 1.67; CI = 1.48, 1.89), and more likely to exhibit neurological hard signs (OR = 1.39; CI = 1.10, 1.76), soft signs (OR = 1.26; CI = 1.09, 1.45) and autonomic nervous system dysfunctions at 7 years. Pregnancy and delivery complications, themselves associated with socioeconomic disadvantage, did not account for the higher risks of neurological abnormalities among disadvantaged children.

CONCLUSIONS

Parental socioeconomic disadvantage was, independently from pregnancy and delivery complications, associated with abnormal child neural development during the first 7 years of life. These findings reinforce the importance of the early environment for neurodevelopment generally, and expand knowledge regarding the domains of neurodevelopment affected by environmental conditions. Further work is needed to determine the mechanisms linking socioeconomic disadvantage with children's neural functioning, the timing of such mechanisms and their potential reversibility.

摘要

背景

早期社会经历被认为会塑造神经发育,可能产生终生影响。然而,关于社会环境对儿童神经功能(神经发育的一个核心领域)的作用,现有证据极少。

方法

我们分析了美国围产期协作项目中36443名参与者的数据,该项目是1959年至1974年间开展的一个社会经济背景多样的妊娠队列研究。研究结果包括:医生(神经科医生或儿科医生)评定的新生儿期、4个月、1岁和7岁时的神经异常情况;神经硬体征和软体征指标;以及自主神经系统功能指标。

结果

社会经济地位不利的父母所生的孩子在4个月时[比值比(OR)=1.20;95%置信区间(CI)=1.06,1.37]、1岁时(OR = 1.35;CI = 1.17,1.56)和7岁时(OR = 1.67;CI = 1.48,1.89)更有可能出现神经异常,并且在7岁时更有可能出现神经硬体征(OR = 1.39;CI = 1.10,1.76)、软体征(OR = 1.26;CI = 1.09,1.45)和自主神经系统功能障碍。妊娠和分娩并发症本身与社会经济不利状况相关,但并不能解释弱势儿童神经异常风险较高的原因。

结论

父母的社会经济不利状况独立于妊娠和分娩并发症,与儿童生命最初7年的神经发育异常有关。这些发现强化了早期环境对神经发育总体的重要性,并扩展了关于受环境条件影响的神经发育领域的知识。需要进一步开展工作来确定将社会经济不利状况与儿童神经功能联系起来以及这种联系的时间及其潜在可逆性的机制。

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