Chetty-Mhlanga Shala, Viglietti Paola, Röösli Martin, Dalvie Mohamed Aqiel
Centre for Environment and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, South Africa; Swiss Tropical Public Health Institute, Basel, Switzerland; University of Basel, Switzerland.
Centre for Environment and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, South Africa.
Neurotoxicology. 2022 Jan;88:36-43. doi: 10.1016/j.neuro.2021.10.010. Epub 2021 Oct 27.
Maternal substance use and its long-term effect on the neurocognitive functions of children is a global public health issue. Despite an increase in substance use in rural areas of low to middle-income countries, research is limited in these populations.
We have therefore explored the effect of maternal drinking and smoking behaviors on the neurocognitive functioning of rural school children.
A cross-sectional analysis on the determinants of current, past and gestational maternal alcohol use and gestational smoking on child neurocognitive functions was conducted on school-children (N = 482), embedded within the child health agricultural cohort (CapSA) study across seven schools in rural Western Cape, South Africa. Standardised neurocognitive assessment tools included the Cambridge Automated Neuropsychological Battery (CANTAB) and the KIDSCREEN-10 to measure health-related quality of life via a child questionnaire. Maternal smoking and drinking behaviour were captured using a parent/guardian questionnaire.
Of the 482 parents/guardians who completed the survey, 29 % reported current drinking 27 % reported past drinking and 10 % reported maternal gestational drinking, while 31 % reported gestational smoking. Significant associations were observed between past and current maternal drinking and child's reduced rapid visual processing accuracy in attention [β:-0.03; 95 % confidence interval (CI): -0.05;-0.004] and between maternal drinking during pregnancy and reduced child's spatial working memory (β: -0.59; CI: -1.02; -0.15). Heavy (>5 cigarettes per day) gestational smoking was associated with lowered child's learning in memory (β:-1.69; 95 % CI: -3.05; -0.33) and lower health-related quality of life (β: -3.41; CI: -6.64; -0.17). The odds of a child repeating a grade were 1.69 (CI: 2.81-1.02) for those exposed to maternal gestational smoking and 1.68 (CI: 3.31-0.85) for those exposed to maternal gestational drinking compared to those who were not exposed.
The consistent negative associations across all four maternal substance use proxies, six neurocognitive health outcomes and one health symptom is suggestive of adverse health effects, warranting longitudinal follow-up. Health policies to eliminate gestational substance use are recommended.
母亲使用物质及其对儿童神经认知功能的长期影响是一个全球公共卫生问题。尽管低收入和中等收入国家农村地区物质使用有所增加，但针对这些人群的研究有限。
因此，我们探讨了母亲饮酒和吸烟行为对农村学童神经认知功能的影响。
对南非西开普农村地区七所学校儿童健康农业队列（CapSA）研究中的482名学童进行横断面分析，研究当前、过去和孕期母亲饮酒及孕期吸烟对儿童神经认知功能的影响因素。标准化神经认知评估工具包括剑桥自动神经心理测试组（CANTAB）和儿童生活质量量表（KIDSCREEN-10），通过儿童问卷测量与健康相关的生活质量。母亲吸烟和饮酒行为通过家长/监护人问卷获取。
在完成调查的482名家长/监护人中，29%报告当前饮酒，27%报告过去饮酒，10%报告孕期母亲饮酒，31%报告孕期吸烟。过去和当前母亲饮酒与儿童注意力方面快速视觉处理准确性降低之间存在显著关联[β：-0.03；95%置信区间（CI）：-0.05；-0.004]，孕期母亲饮酒与儿童空间工作记忆降低之间也存在显著关联（β：-0.59；CI：-1.02；-0.15）。重度（每天>5支香烟）孕期吸烟与儿童记忆学习能力降低（β：-1.69；95%CI：-3.05；-0.33）和与健康相关的生活质量降低（β：-3.41；CI：-6.64；-0.17）相关。与未暴露的儿童相比，暴露于孕期母亲吸烟的儿童留级几率为1.69（CI：2.81 - 1.02），暴露于孕期母亲饮酒的儿童留级几率为1.68（CI：3.31 - 0.85）。
在所有四种母亲物质使用指标、六种神经认知健康结果和一种健康症状中均存在一致的负相关，提示存在不良健康影响，需要进行纵向随访。建议制定消除孕期物质使用的卫生政策。
