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孕期母亲心理压力的各种产前暴露与儿童出生后24个月内神经发育之间的前瞻性关联。

Prospective associations between various prenatal exposures to maternal psychological stress and neurodevelopment in children within 24 months after birth.

作者信息

Wei Qian, Zou Jiaojiao, Ma Xuemei, Xiao Xirong, Zhang Yunhui, Shi Huijing

机构信息

Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China.

Obstetrics & Gynecology Hospital, Fudan University, Shanghai 200011, China.

出版信息

J Affect Disord. 2023 Apr 14;327:101-110. doi: 10.1016/j.jad.2023.01.103. Epub 2023 Feb 3.

Abstract

BACKGROUND

There is increasing evidence that prenatal exposure to maternal psychological distress may be a factor influencing offspring neurodevelopment, but stress type-dependent effects of maternal psychological distress on offspring neurodevelopment in early childhood have yet to be fully elucidated. Additionally, although positive maternal mental health exerts potential effects in protecting against adverse health outcomes, few investigators have considered the effects of positive maternal mental health on offspring neurodevelopment in early childhood.

AIMS

To determine the associations between various prenatal exposures to maternal psychological distress and positive life-event experiences and offspring neurodevelopment within 24 months of age.

METHODS

A total of 4412 mother-child dyads were recruited from the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC). Maternal perceived stress, negative life-event stress, positive life-event experiences around the time of conception (i.e., three months prior to and after conception) were assessed at 12-16 gestational weeks, and maternal anxiety and depressive symptoms were assessed at 32-36 gestational weeks. We measured children's neurodevelopment using the Ages and Stages Questionnaire, Third Edition (ASQ-3) at two, six, 12, and 24 months postnatally. We then exploited generalized linear models to estimate the associations between prenatal maternal psychological distress and positive life-event experiences and children's neurodevelopment at the above periods, and generalized linear mixed models were applied to assess the associations between maternal psychological distress and positive life-event experiences and suspected developmental delay (SDD) in children within 24 months after birth based on a longitudinal design.

RESULTS

Maternal perceived stress and negative life-event stress around the time of conception, and anxiety and depressive symptoms during late pregnancy were negatively associated with scores of children's neurodevelopment at two, six, 12, and 24 months of age; while maternal life-event experiences were positively associated with scores of children's neurodevelopment. Longitudinal analysis revealed that higher levels of maternal negative life-event stress and depressive symptoms augmented the risk of SDD in personal-social (OR = 1.435, 1.681). Mothers who experienced higher levels of positive life-event experiences exhibited a reduced risk of SDD in gross motor and personal-social domains (OR = 0.373, 0.350).

CONCLUSIONS

Prenatal exposure to maternal psychological distress is negatively associated with children's neurodevelopment in early childhood depending upon the type of distress. Maternal positive life-event experiences around the time of conception appeared to present potential benefits for child neurodevelopment.

摘要

背景

越来越多的证据表明,孕期暴露于母亲的心理困扰可能是影响后代神经发育的一个因素,但母亲心理困扰对幼儿期后代神经发育的应激类型依赖性影响尚未完全阐明。此外,尽管母亲的积极心理健康对预防不良健康结果具有潜在作用,但很少有研究者考虑母亲的积极心理健康对幼儿期后代神经发育的影响。

目的

确定孕期暴露于母亲的各种心理困扰和积极生活事件经历与24个月龄内后代神经发育之间的关联。

方法

从上海母婴队列(Shanghai MCPC)中招募了4412对母婴。在孕12 - 16周时评估母亲在受孕前后(即受孕前三个月和受孕后三个月)的感知压力、负面生活事件压力和积极生活事件经历,在孕32 - 36周时评估母亲的焦虑和抑郁症状。在产后2个月、6个月、12个月和24个月时,使用《年龄与发育阶段问卷》第三版(ASQ - 3)测量儿童的神经发育情况。然后利用广义线性模型估计孕期母亲心理困扰和积极生活事件经历与上述时期儿童神经发育之间的关联,并应用广义线性混合模型基于纵向设计评估母亲心理困扰和积极生活事件经历与出生后24个月内儿童疑似发育迟缓(SDD)之间的关联。

结果

受孕前后母亲的感知压力和负面生活事件压力,以及孕晚期的焦虑和抑郁症状与儿童在2个月、6个月、12个月和24个月龄时的神经发育得分呈负相关;而母亲的生活事件经历与儿童的神经发育得分呈正相关。纵向分析显示,母亲较高水平的负面生活事件压力和抑郁症状增加了个人社交方面SDD的风险(比值比分别为1.435、1.681)。经历较高水平积极生活事件的母亲在大运动和个人社交领域出现SDD的风险降低(比值比分别为0.373、0.350)。

结论

孕期暴露于母亲的心理困扰与幼儿期儿童神经发育呈负相关,具体取决于困扰的类型。受孕前后母亲的积极生活事件经历似乎对儿童神经发育具有潜在益处。

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