Santos Iná S, Barros Fernando C, Munhoz Tiago, Matijasevich Alicia
Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3o piso, Pelotas, RS, 96020220, Brazil.
Program in Epidemiology, Federal University of Pelotas and Postgraduate Program in Health and Behaviour, Catholic University of Pelotas, Pelotas, RS, Brazil.
BMC Pediatr. 2017 Aug 23;17(1):184. doi: 10.1186/s12887-017-0936-3.
Studies conducted mainly in high-income countries have shown that preterm births are associated with increased risk of behavioral problems and psychiatric disorders. The aim of this study was to assess the prevalence of behavioral problems from middle-childhood to early-adolescence according to gestational age at birth in a middle-income setting.
A population-based birth cohort (n = 4231) in Pelotas, Brazil, was followed-up in several occasions from birth to 11 years. Estimated GA was based on last menstrual period or, when unknown or inconsistent, on the Dubowitz method. Behavioral problems were assessed at 4 (Child Behavior Checklist - CBCL), and at 6 and 11 years (Development and Well-Being Assessment - DAWBA) tool. Maternal socio-economic characteristics and depression at 2, 4 and 6 years post-partum, child perinatal characteristics and breastfeeding duration were used as confounders. Analyses were run by linear and logistic regression.
Three thousand two hundred four children had full information on gestational age, CBCL and DAWBA. At 4 years, mean total (42.9 ± 24.0) and mean externalizing (18.8 ± 9.1) CBCL scores were higher among preterm girls born at <34 weeks than among full term girls (33.2 ± 15.1 and 15.0 ± 6.6, respectively). After controlling for confounders the association was no longer significant. At the age of 6 years there was no association between gestational age and behavior, neither in crude nor in adjusted analyses. Odds ratio for any psychiatric disorders at 11 years was 60% (1.6; 1.1-2.1) higher among those born at 34-36 weeks than in full-term children, but the association disappeared in adjusted analyses.
At this large cohort, behavioral problems from middle-childhood to early-adolescence are more related to family socio-economic characteristics and to other child perinatal conditions than to gestational age at birth.
主要在高收入国家开展的研究表明，早产与行为问题和精神疾病风险增加有关。本研究旨在评估在中等收入环境中，根据出生时的孕周，从中童年到青春期早期行为问题的患病率。
对巴西佩洛塔斯一个基于人群的出生队列（n = 4231）从出生到11岁进行了多次随访。估计的孕周基于末次月经日期，或者在末次月经日期未知或不一致时，基于杜波维茨方法。在4岁时使用儿童行为检查表（CBCL）评估行为问题，在6岁和11岁时使用发育与幸福感评估（DAWBA）工具评估。将母亲在产后2年、4年和6年的社会经济特征和抑郁情况、儿童围产期特征和母乳喂养持续时间作为混杂因素。通过线性回归和逻辑回归进行分析。
3204名儿童有关于孕周、CBCL和DAWBA的完整信息。在4岁时，孕周小于34周的早产女孩的平均总分（42.9±24.0）和平均外化问题得分（18.8±9.1）高于足月女孩（分别为33.2±15.1和15.0±6.6）。在控制混杂因素后，这种关联不再显著。在6岁时，无论在粗分析还是调整分析中，孕周与行为之间均无关联。11岁时，孕周为34 - 36周出生的儿童患任何精神疾病的比值比比足月儿童高60%（1.6；1.1 - 2.1），但在调整分析中这种关联消失了。
在这个大型队列中，从中童年到青春期早期的行为问题更多地与家庭社会经济特征和其他儿童围产期状况有关，而不是与出生时的孕周有关。
