营养、社会经济和分娩特征与坦桑尼亚儿童的神经发育有关。

Nutritional, Socioeconomic, and Delivery Characteristics Are Associated with Neurodevelopment in Tanzanian Children.

机构信息

Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA.

Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA; Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA.

出版信息

J Pediatr. 2019 Apr;207:71-79.e8. doi: 10.1016/j.jpeds.2018.10.066. Epub 2018 Dec 14.

DOI:10.1016/j.jpeds.2018.10.066

PMID:30559023

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6440850/

Abstract

OBJECTIVES

To evaluate the hypothesis that various maternal, socioeconomic, delivery, and infant nutritional characteristics are associated with early childhood development in young Tanzanian children.

STUDY DESIGN

We performed a prospective cohort study among 206 HIV-exposed, uninfected and 247 HIV-unexposed Tanzanian infants who had been enrolled in 2 separate micronutrient trials (NCT00197730 and NCT00421668). Trained nurses administered culturally modified Bayley Scales of Infant and Toddler Development, 3rd edition (BSID-III), to evaluate cognitive, motor, and language development at 15 months of age. This analysis explored predictors of BSID-III z-scores using multivariable linear regression.

RESULTS

Among maternal determinants, we found that low maternal height predicted all BSID-III domains in HIV-unexposed children; low maternal education predicted lower cognitive (standardized mean difference, -0.41; 95% CI, -0.74 to -0.08) and lower gross motor scores (standardized mean difference, -0.32; 95% CI, -0.61 to -0.04) in HIV-exposed children. Among delivery characteristics, facility delivery predicted higher cognitive scores (standardized mean difference, 1.36; 95% CI, 0.26-2.46); and oxytocin administration predicted lower fine motor scores (standardized mean difference, -0.48; 95% CI, -0.87 to -0.09) in HIV-exposed children. Higher length-for-age z-scores at 6 weeks of age predicted better cognitive (standardized mean difference, 0.15; 95% CI, 0.01-0.29) and expressive language scores (standardized mean difference, 0.16; 95% CI, 0.02-0.29) at 15 months in HIV-exposed infants.

CONCLUSIONS

This hypothesis-generating study found significant associations between nutritional status and health of the mother and child, and maternal educational attainment, with direct measures of early childhood development at 15 months of age. In addition, several aspects of delivery (facility birth and oxytocin administration) were associated with early childhood development. Future intervention trials should focus on modifiable maternal, infant, and obstetric factors to strengthen the evidence base concerning early childhood development.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT00197730 and NCT00421668.

摘要

目的

评估以下假设，即各种产妇、社会经济、分娩和婴儿营养特征与坦桑尼亚幼儿的早期儿童发展有关。

研究设计

我们对 206 名 HIV 暴露但未感染和 247 名 HIV 未暴露的坦桑尼亚婴儿进行了前瞻性队列研究，这些婴儿曾参加过两项单独的微量营养素试验（NCT00197730 和 NCT00421668）。经过培训的护士使用文化修改后的贝利婴幼儿发育量表第三版（BSID-III）评估了 15 个月时的认知、运动和语言发育。该分析使用多变量线性回归探讨了 BSID-III z 评分的预测因素。

结果

在产妇决定因素方面，我们发现，母亲身高较低预测了 HIV 未暴露儿童的所有 BSID-III 领域；母亲教育程度较低预测了 HIV 暴露儿童的认知（标准化均数差，-0.41；95%置信区间，-0.74 至-0.08）和粗大运动评分较低（标准化均数差，-0.32；95%置信区间，-0.61 至-0.04）。在分娩特征方面，分娩地点为医疗机构预测了更高的认知评分（标准化均数差，1.36；95%置信区间，0.26-2.46）；催产素给药预测了 HIV 暴露儿童的精细运动评分较低（标准化均数差，-0.48；95%置信区间，-0.87 至-0.09）。6 周时的身高与年龄比值 z 评分较高预测了 HIV 暴露婴儿 15 个月时认知（标准化均数差，0.15；95%置信区间，0.01-0.29）和表达性语言评分（标准化均数差，0.16；95%置信区间，0.02-0.29）较高。