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择期剖宫产与婴儿发育行为之间的关联:一项队列研究

[Association between elective cesarean section and infants' developmental behaviors: a cohort study].

作者信息

Sun Y F, Huang K, Hu Y B, Gao H, Niu Y, Tao X Y, Tao R W, Zhu P, Tao F B

机构信息

School of Public Health, Anhui Medical University, Hefei 230032, China.

出版信息

Zhonghua Yu Fang Yi Xue Za Zhi. 2017 Dec 6;51(12):1069-1073. doi: 10.3760/cma.j.issn.0253-9624.2017.12.004.

Abstract

To investigate the effect of elective cesarean section (ECS) on infants' developmental behaviors. A total of 3 474 pregnant women living in Ma'anshan more than 6 months and accepting obstetric examination in Ma'anshan Maternal and Child Care Center were recruited from May 2013 to September 2014. Excluding participants with pregnancy termination (162), twin pregnancy (39), assisted delivery (14), emergency cesarean section (76) and unclear delivery mode (141), 3 042 pair of mother and infant entered the final analysis. Information of maternal basic demographic characteristics, pregnancy histories, pregnancy life style and pregnancy-related diseases were collected by using self-complied . Information of infants' general condition and delivery modes were acquired from obstetric record. The Ages and Stages Questionnaires-third edition was used to assess infants' communication, gross motor, fine motor, problem solving and person-social function, which was completed at age of 6 months old and 18 months old, respectively. And multi-factor non-conditional logistic regression model was used to analyze the association between ECS and infants' developmental behaviors. The prevalence of ECS was 47.5% (1 443/3 042), among which ECS without medical indication and ECS with medical indication were 27.2% (826/3 042) and 20.3% (617/3 042), respectively. After maternal demographic characteristics, pregnant exposure and infants' basic information adjusted, compared to women with vaginal delivery, both ECS with medical indication and without medical indication increased the risk of a delay in gross motor on infants at 6 months old ( (95 1.72 (1.08-2.77) and 1.87 (1.11-3.15), respectively.) ECS without indication decreased the risk of a delay in fine motor on infants at 6 months old ( (95):0.48 (0.28-0.82)), both ECS without medical indication and with medical indication had no statistically significant effect on 18 months infants' communication, gross motor, fine motor, problem solving and person-social function, the (95) for ECS without medical indication were 0.86 (0.43-1.74), 1.55 (0.86-2.78), 0.74 (0.49-1.15), 1.10 (0.68-1.78) and 1.17 (0.66-2.08), respectively; and the (95) for ECS with medical indication were 0.33 (0.12-1.02), 1.10 (0.55-2.21), 0.79 (0.48-1.29), 0.58 (0.29-1.13) and 1.48 (0.78-2.81), respectively. ECS affected motor development in infants at the age of 6 months old, and no influence was found in infants at the age of 18 months old.

摘要

探讨择期剖宫产(ECS)对婴儿发育行为的影响。2013年5月至2014年9月,招募了3474名在马鞍山居住超过6个月且在马鞍山市妇幼保健院接受产科检查的孕妇。排除终止妊娠者(162例)、双胎妊娠者(39例)、助产者(14例)、急诊剖宫产者(76例)及分娩方式不明者(141例)后,3042对母婴进入最终分析。通过自行编制的问卷收集产妇基本人口学特征、妊娠史、孕期生活方式及妊娠相关疾病等信息。从产科记录中获取婴儿一般情况及分娩方式信息。采用《年龄与阶段问卷》第三版分别在婴儿6月龄和18月龄时评估其沟通、大运动、精细运动、问题解决及个人-社会功能。并采用多因素非条件logistic回归模型分析ECS与婴儿发育行为之间的关联。ECS的发生率为47.5%(1443/3042),其中无医学指征的ECS和有医学指征的ECS分别为27.2%(826/3042)和20.3%(617/3042)。在调整产妇人口学特征、孕期暴露及婴儿基本信息后,与阴道分娩的产妇相比,有医学指征和无医学指征的ECS均增加了婴儿6月龄时大运动发育迟缓的风险(比值比(OR)(95%可信区间(CI))分别为1.72(1.08 - 2.77)和1.87(1.11 - 3.15))。无指征的ECS降低了婴儿6月龄时精细运动发育迟缓的风险(OR(95%CI):0.48(0.28 - 0.82)),无医学指征和有医学指征的ECS对18月龄婴儿的沟通、大运动、精细运动、问题解决及个人-社会功能均无统计学意义上的显著影响,无医学指征的ECS的OR(95%CI)分别为0.86(0.43 - 1.74)、1.55(0.86 - 2.78)、0.74(0.49 - 1.15)、1.10(0.68 - 1.78)和1.17(0.66 - 2.08);有医学指征的ECS的OR(95%CI)分别为0.33(0.12 - 1.02)、1.10(0.55 - 2.21)、0.79(0.48 - 1.29)、0.58(0.29 - 1.13)和1.48(0.78 - 2.81)。ECS影响6月龄婴儿的运动发育,对18月龄婴儿未发现影响。

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