Garrison Amanda, Boivin Michael, Khoshnood Babak, Courtin David, Alao Jules, Mireku Michael, Ibikounle Moudachirou, Massougbodji Achille, Cot Michel, Bodeau-Livinec Florence
Département Méthodes Quantitatives en Santé Publique (METIS), Ecole des Hautes Etudes en Santé Publique, Rennes, France.
Université de Paris, Center of Research in Epidemiology and Statistics/CRESS, INSERM, INRA, Paris, France.
PLoS Negl Trop Dis. 2021 Mar 19;15(3):e0009260. doi: 10.1371/journal.pntd.0009260. eCollection 2021 Mar.
An estimated 30% of women in Sub-Saharan Africa suffer from soil-transmitted helminth infection during pregnancy (SHIP), which has been shown to increase risk of pre-term birth, low birth weight, and maternal anemia. A previous study in Benin found that SHIP was associated with impaired cognitive and gross motor development scores in 635 one-year-old children. The objective of the present study was to follow children prospectively to investigate whether the association between SHIP and child neurocognitive and behavioral development persisted at age six.
Our prospective child cohort included 487 live-born singletons of pregnant women enrolled in the Malaria in Pregnancy Preventive Alternative Drugs clinical trial in Allada, Benin. SHIP was assessed at three antenatal visits (ANVs) through collection and testing of stool samples. Neurocognitive and behavioral development was assessed in six-year-old children by trained investigators using the Kaufman Assessment Battery for Children 2nd edition and the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression models generated coefficients and 95% confidence intervals and potential mediating factors were tested. Prevalence of SHIP was 13% at the 1st ANV, 9% at the 2nd ANV, and 1% at delivery. SHIP was not associated with low neurocognitive scores in children at six years. Higher SDQ internalizing scores, indicating increased emotional impairments in children, were associated with helminth infection at the 2nd ANV/delivery 1.07 (95% CI 0.15, 2.00) and at least once during pregnancy 0.79 (95% CI 0.12, 1.46) in adjusted models. Mediation analysis did not reveal significant indirect effects of several mediators on this association.
Our study shows that while SHIP is not associated with impaired long-term neurocognitive development, infections may have significant negative impacts on emotional development in six-year-old children. SHIP remains a critical public health issue, and adequate prevention and treatment protocols should be enforced in low- and middle-income countries.
据估计，撒哈拉以南非洲地区30%的女性在孕期感染土源性蠕虫（SHIP），研究表明这会增加早产、低出生体重和孕产妇贫血的风险。此前在贝宁进行的一项研究发现，SHIP与635名一岁儿童的认知和粗大运动发育评分受损有关。本研究的目的是对儿童进行前瞻性跟踪调查，以研究SHIP与儿童神经认知和行为发育之间的关联在6岁时是否依然存在。
我们的前瞻性儿童队列包括在贝宁阿拉达进行的孕期疟疾预防性替代药物临床试验中登记的487名单胎活产孕妇的子女。通过收集和检测粪便样本，在三次产前检查（ANV）时对SHIP进行评估。由经过培训的研究人员使用考夫曼儿童评估量表第二版和家长报告的优势与困难问卷（SDQ）对6岁儿童的神经认知和行为发育进行评估。多元线性回归模型生成系数和95%置信区间，并对潜在中介因素进行检验。第一次产前检查时SHIP的患病率为13%，第二次产前检查时为9%，分娩时为1%。SHIP与6岁儿童的低神经认知评分无关。较高的SDQ内化得分表明儿童情绪障碍增加，在调整模型中，第二次产前检查/分娩时蠕虫感染与之相关，系数为1.07（95%置信区间0.15，2.00），孕期至少感染一次与之相关，系数为0.79（95%置信区间0.12，1.46）。中介分析未揭示几种中介因素对这种关联有显著间接影响。
我们的研究表明，虽然SHIP与长期神经认知发育受损无关，但感染可能对6岁儿童的情绪发育有显著负面影响。SHIP仍然是一个关键的公共卫生问题，低收入和中等收入国家应实施适当的预防和治疗方案。
