产前母亲压力与产前铅暴露对幼儿认知发展的影响之间的关系。
Prenatal maternal stress in relation to the effects of prenatal lead exposure on toddler cognitive development.
作者信息
Zhou Leilei, Xu Jian, Zhang Jinsong, Yan Chonghuai, Lin Yanfen, Jia Yinan, Hu Wenjing
机构信息
Xinhua Hospital affiliated with the Shanghai Jiao Tong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai 200092, China.
Xinhua Hospital affiliated with the Shanghai Jiao Tong University School of Medicine, MOE-Shanghai Key Laboratory of Children's Environmental Health, Department of Child and Adolescent Healthcare, Shanghai Institute for Pediatric Research, Shanghai 200092, China.
出版信息
Neurotoxicology. 2017 Mar;59:71-78. doi: 10.1016/j.neuro.2017.01.008. Epub 2017 Jan 31.
OBJECTIVE
To evaluate the effects of maternal lead exposure during pregnancy on toddler cognitive development and the potential effect modification by maternal stress.
METHODS
We conducted a prospective birth-cohort study in Shanghai from 2010 to 2012 and investigated 225 mother-infant pairs. The mothers were recruited in mid-to-late pregnancy and children were followed up until 24-36 months old. A self-administered Symptom Checklist-90-Revised Scale (SCL-90-R) was used to assess maternal emotional stress during pregnancy. Maternal whole blood lead levels were measured during gestational weeks 28-36. The toddlers' cognitive levels were assessed using the Gesell Development Scale. Multiple linear regression models were established to explore the main effects of prenatal lead exposure on toddlers' cognitive abilities and the modifying effects of maternal stress. Covariate information was collected through interviews, questionnaires and medical records.
RESULTS
The mean maternal blood lead concentration was 3.30 (95%CI: 3.05, 3.57) μg/dL. After adjusting for relevant confounders, no significant associations of maternal blood lead concentrations with toddlers' cognitive levels were observed in all five domains of the Gesell scale (P>0.05). However, the interaction between prenatal maternal blood lead and stress was significant in the domains of adaptive behavior, language and social behavior. When stratified by maternal stress levels, compared with non-significant associations (P>0.05) among low (P1-P75) prenatal stress group, adverse associations between maternal blood lead concentrations (log10-transformed) and toddlers' cognitive levels were observed among high (P75-P100) prenatal stress group in the domains of language (β=-33.82, 95%CI: -60.04, -7.59), social behavior (β=-41.00, 95%CI: -63.11, -18.89) and adaptive behavior (β=-17.93, 95%CI: -35.83, -0.03).
CONCLUSION
Prenatal maternal stress may exacerbate the deleterious effects of prenatal exposure to lead on toddler cognitive development.
目的
评估孕期母亲铅暴露对幼儿认知发育的影响以及母亲压力的潜在效应修正作用。
方法
2010年至2012年在上海进行了一项前瞻性出生队列研究，调查了225对母婴。母亲在孕中晚期入组，儿童随访至24 - 36个月龄。采用自填式症状自评量表90修订版（SCL - 90 - R）评估孕期母亲的情绪压力。在孕28 - 36周测量母亲全血铅水平。使用格塞尔发育量表评估幼儿的认知水平。建立多元线性回归模型以探讨产前铅暴露对幼儿认知能力的主要影响以及母亲压力的修正作用。通过访谈、问卷和病历收集协变量信息。
结果
母亲血铅浓度均值为3.30（95%CI：3.05，3.57）μg/dL。调整相关混杂因素后，在格塞尔量表的所有五个领域中均未观察到母亲血铅浓度与幼儿认知水平之间存在显著关联（P>0.05）。然而，产前母亲血铅与压力之间的交互作用在适应性行为、语言和社会行为领域显著。按母亲压力水平分层时，与低（P1 - P75）产前压力组之间无显著关联（P>0.05）相比，在高（P75 - P100）产前压力组中，在语言（β = - 33.82，95%CI： - 60.04， - 7.59）、社会行为（β = - 41.00，95%CI： - 63.11， - 18.89）和适应性行为（β = - 17.93，95%CI： - 35.83， - 0.03）领域观察到母亲血铅浓度（对数转换）与幼儿认知水平之间存在不良关联。
结论
产前母亲压力可能会加剧产前铅暴露对幼儿认知发育的有害影响。
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