剖宫产对儿童自闭症样行为的影响：纯母乳喂养的中介作用。
Impact of caesarean delivery on children's autism-like behaviours: the mediation of exclusive breastfeeding.
机构信息
Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, 230032, China.
Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, 230032, China.
出版信息
Int Breastfeed J. 2022 Jul 15;17(1):53. doi: 10.1186/s13006-022-00493-6.
BACKGROUND
The rate of autism spectrum disorder (ASD) has been rising worldwide, and therefore it is important to identify potential causes of ASD to facilitate early prevention. This study examined the role of breastfeeding and the association between caesarean delivery (CD) and children's autism spectrum disorder.
METHODS
The data were from the Ma'anshan birth cohort (MABC) in China, that was set up between May 2013 and September 2014. Women within 14 gestational weeks were recruited. The delivery mode was extracted from medical notes and infant feeding was obtained from questionnaire surveys. Autism-like behaviour was assessed using the Checklist for Autism in Toddlers (CHAT-23) when children were 18 months old, and 3 years of age. At 5 years of age, autism-like behaviour was assessed using the Clancy Autism Behavior Scale behavior. Structural equation models tested the mediation effects of breastfeeding between CD and children's autism spectrum disorder.
RESULTS
In all, 1520 (48.89%) women gave birth via CD, and 406 (13.86%) children were identified with autism-like behaviours at 18 months. Compared with women giving birth via vaginal delivery, those giving birth via CD were more likely to experience a higher proportion of delayed initiation of breastfeeding (p < 0.01), and delayed onset of lactogenesis (p < 0.01). CD was associated with a lower proportion of exclusive breastfeeding at 4 months after delivery (p = 0.02). Autism-like behaviour was less likely amongst infants with exclusively breastfeeding at 4 months than amongst those not exclusively breastfeeding at 4 months (p < 0.01). SEM indicated that women who gave birth by CD were more likely to stop exclusive breastfeeding in the first 4 months (standard estimations = - 0.04, p = 0.02), and those children who were not exclusively breastfed at 4 months were more likely to have autism-like behaviours (standard estimations = - 0.05, p < 0.01). The associations persisted at 3 years, but not at 5 years.
CONCLUSIONS
Exclusive breastfeeding at 4 months of age mediated the association between caesarean delivery and children's autism-like behaviours.
背景
自闭症谱系障碍（ASD）的发病率在全球范围内呈上升趋势，因此，确定 ASD 的潜在原因对于促进早期预防至关重要。本研究探讨了母乳喂养的作用以及剖宫产（CD）与儿童自闭症谱系障碍之间的关系。
方法
数据来自中国马鞍山出生队列（MABC），该队列于 2013 年 5 月至 2014 年 9 月建立。招募了 14 孕周内的女性。分娩方式从病历中提取，婴儿喂养方式从问卷调查中获取。当孩子 18 个月大时，使用幼儿自闭症检查表（CHAT-23）评估自闭症样行为，3 岁时再次评估。在 5 岁时，使用克兰西自闭症行为量表行为评估自闭症样行为。结构方程模型测试了母乳喂养在 CD 和儿童自闭症谱系障碍之间的中介作用。
结果
共有 1520 名（48.89%）女性通过 CD 分娩，406 名（13.86%）儿童在 18 个月时被诊断为自闭症样行为。与阴道分娩的女性相比，通过 CD 分娩的女性更有可能延迟开始母乳喂养（p<0.01）和延迟泌乳（p<0.01）。CD 与产后 4 个月的纯母乳喂养比例较低有关（p=0.02）。与 4 个月内不进行纯母乳喂养的婴儿相比，4 个月内进行纯母乳喂养的婴儿自闭症样行为的可能性较小（p<0.01）。SEM 表明，通过 CD 分娩的女性更有可能在头 4 个月内停止纯母乳喂养（标准估计值=-0.04，p=0.02），而 4 个月内不进行纯母乳喂养的儿童更有可能出现自闭症样行为（标准估计值=-0.05，p<0.01）。这些关联在 3 岁时仍然存在，但在 5 岁时没有。
结论
4 个月时的纯母乳喂养中介了 CD 分娩与儿童自闭症样行为之间的关联。
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