Tsuchiya Shinobu, Tsuchiya Masahiro, Momma Haruki, Koseki Takeyoshi, Igarashi Kaoru, Nagatomi Ryoichi, Arima Takahiro, Yaegashi Nobuo
Department of Orthodontics and Speech Therapy for Craniofacial Anomalies, Tohoku University Hospital, Sendai, Miyagi, 980-8574, Japan.
Department of Nursing, Tohoku Fukushi University, 6-149-1 Kunimi-ga-oka, Aoba-ku, Sendai, Miyagi, 981-3201, Japan.
BMC Pediatr. 2019 Dec 20;19(1):505. doi: 10.1186/s12887-019-1877-9.
Cleft lip and/or palate is among the most prevalent congenital birth defects, and negatively affects maternal psychological status and may consequently result in higher prevalence of child maltreatment. However, the association of childbirths of infants with cleft lip and/or palate with maternal emotional involvement still remains unclear. We examined the association between childbirths of infants with cleft lip and/or palate and mother-to-infant bonding, using data from the Japan Environment and Children's Study, a nationwide birth cohort study.
A cross-sectional study using the jecs-an-20,180,131 dataset was performed. A total 104,065 fetuses in 15 regional centres in Japan were enrolled after obtaining informed written consent. The Mother-to-Infant Bonding Scale, a self-report scale consisting of 10 items, was used to evaluate maternal bonding at one year after childbirth. Finally, the participants consisted of 79,140 mother-infant pairs, of which 211 mothers of infants with cleft lip and/or palate were included in our analyses. Multivariable logistic regression analysis using multiple imputation for missing data was performed to calculate the odds ratio and 95% confidence interval in the estimation of the association between bonding disorders and childbirths with cleft lip and/or palate.
No increased risk of bonding disorders was observed among all the mothers of infants with cleft lip and/or palate (odds ratio [95% confidence interval]; 0.97 [0.63-1.48], p = 0.880), however, advanced maternal age or multiple parity may adversely affect the associations between bonding disorders and cleft lip and/or palate, respectively. After stratification with a combination of maternal age and parity, a significant association of cleft lip and/or palate with bonding disorders was found only among advanced-age multiparae (odds ratio [95% confidence interval] = 2.51 [1.17-5.37], p = 0.018), but it was weakened after additional adjustment for maternal depression.
Childbirths of infants with cleft lip and/or palate may increase the risk of bonding disorders among advanced-age multiparae, possibly through maternal depression. This finding provides valuable information for the provision of multidisciplinary cleft care.
唇腭裂是最常见的先天性出生缺陷之一，会对母亲的心理状态产生负面影响，进而可能导致儿童受虐待的发生率更高。然而，唇腭裂婴儿的出生与母亲情感投入之间的关联仍不明确。我们利用日本环境与儿童研究（一项全国性的出生队列研究）的数据，研究了唇腭裂婴儿的出生与母婴联结之间的关联。
采用jecs - an - 20,180,131数据集进行横断面研究。在获得书面知情同意后，纳入了日本15个地区中心的总共104,065名胎儿。母婴联结量表是一个由10个项目组成的自我报告量表，用于评估产后一年的母婴联结情况。最终，参与者包括79,140对母婴，其中唇腭裂婴儿的母亲有211名被纳入我们的分析。使用多重填补法对缺失数据进行多变量逻辑回归分析，以计算母婴联结障碍与唇腭裂婴儿出生之间关联的比值比和95%置信区间。
在所有唇腭裂婴儿的母亲中，未观察到母婴联结障碍风险增加（比值比[95%置信区间]；0.97[0.63 - 1.48]，p = 0.880），然而，母亲年龄较大或多胎妊娠可能分别对母婴联结障碍与唇腭裂之间的关联产生不利影响。在按母亲年龄和胎次进行分层后，仅在高龄经产妇中发现唇腭裂与母婴联结障碍之间存在显著关联（比值比[95%置信区间]= 2.51[1.17 - 5.37]，p = 0.018），但在进一步调整母亲抑郁因素后，这种关联减弱。
唇腭裂婴儿的出生可能会增加高龄经产妇出现母婴联结障碍的风险，可能是通过母亲抑郁导致的。这一发现为提供多学科唇腭裂护理提供了有价值的信息。
