Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio; and.
Pediatrics. 2018 Apr;141(4). doi: 10.1542/peds.2017-2826.
The study objective was to determine if maternal and paternal exposure to adverse childhood experiences (ACEs) have a significant association with negative offspring development at 24 months of age in a suburban pediatric primary care population.
A retrospective cohort study was conducted of 311 mother-child and 122 father-child dyads who attended a large pediatric primary care practice. Children were born from October 2012 to June 2014, and data were collected at the 2-, 4-, and 24-month well-child visits. Multivariable Poisson regression with robust error variance was used to model the relationship between self-reported parental ACEs and the outcomes of suspected developmental delay at 24 months and eligibility for early intervention services.
For each additional maternal ACE, there was an 18% increase in the risk for a suspected developmental delay (relative risk: 1.18, 95% confidence interval: 1.08-1.29). A similar trend was observed for paternal ACEs (relative risk: 1.34, 95% confidence interval: 1.07-1.67). Three or more maternal ACEs (versus <3 ACEs) was associated with a significantly increased risk for a suspected developmental delay that affected multiple domains. Similar effects were observed for early intervention services.
Parental ACE exposures can negatively impact child development in multiple domains, including problem solving, communication, personal-social, and motor skills. Research is needed to elucidate the psychosocial and biological mechanisms of intergenerational risk. This research has implications for the value of parental ACE screening in the context of pediatric primary care.
本研究旨在确定在一个郊区儿科初级保健人群中,父母经历不良童年经历(ACEs)是否与 24 个月龄子女的负面发育结果显著相关。
对在一家大型儿科初级保健机构就诊的 311 对母婴和 122 对父子进行了回顾性队列研究。这些儿童于 2012 年 10 月至 2014 年 6 月期间出生,在 2、4 和 24 个月的儿童健康访视时收集数据。使用具有稳健误差方差的多变量泊松回归来模拟父母 ACEs 与 24 个月时疑似发育迟缓的结果以及是否有资格获得早期干预服务之间的关系。
对于每增加一个母亲 ACE,疑似发育迟缓的风险增加 18%(相对风险:1.18,95%置信区间:1.08-1.29)。对于父亲 ACE 也观察到类似的趋势(相对风险:1.34,95%置信区间:1.07-1.67)。与<3 个 ACEs 相比,母亲 ACEs 超过 3 个与多个领域的疑似发育迟缓风险显著增加相关。对于早期干预服务也观察到类似的效果。
父母 ACE 暴露可能会对多个领域的儿童发育产生负面影响,包括解决问题、沟通、个人-社会和运动技能。需要研究来阐明代际风险的心理社会和生物学机制。这项研究对儿科初级保健中父母 ACE 筛查的价值具有重要意义。