越南孕产妇孕前血红蛋白浓度、贫血与儿童健康和发育的长期关联。
Long-Term Association Between Maternal Preconception Hemoglobin Concentration, Anemia, and Child Health and Development in Vietnam.
机构信息
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC, United States; Thai Nguyen University of Pharmacy and Medicine, Thai Nguyen, Vietnam.
出版信息
J Nutr. 2023 May;153(5):1597-1606. doi: 10.1016/j.tjnut.2023.03.015. Epub 2023 Mar 15.
BACKGROUND
The long-term association between preconception maternal hemoglobin (Hb) concentrations and child health and development is unclear.
OBJECTIVES
We examined associations between maternal preconception Hb concentrations and anemia with 1) birth outcomes (weight, length, preterm, gestational age, small for gestational age); 2) child Hb at 3 mo, 6 mo, 12 mo, and 24 mo; and 3) motor and mental development at 12 mo and 24 mo (Bayley scales for infant development) and cognitive functioning at 6-7 y (Wechsler Intelligence Scale for Children).
METHODS
We used data from a randomized controlled trial (PRECONCEPT) conducted in Vietnam. Over 5000 women who were intending to conceive were recruited, and offspring were prospectively followed from birth (n = 1599) through 6-7 y (n = 1318). Multivariable linear and logistic regressions were used to assess the association between preconception Hb or anemia (Hb < 12g/dL) on child health and development outcomes, adjusted by supplementation group (tested for interactions) and confounding at maternal, child, and household levels.
RESULTS
At preconception enrollment, 20% of the women were anemic. Maternal preconception Hb was positively associated with child Hb at 3 mo (0.06; 95% CI: 0.01, 0.12), 6 mo (0.08; 95% CI: 0.03, 0.13), 12 mo (0.10; 95% CI: 0.04, 0.15), and 24 mo (0.07; 95% CI: 0.02, 0.12). Likewise, maternal preconception Hb was associated with reduced risk of child anemia at 6 mo (0.89; 95% CI: 0.81, 0.98), 12 mo (0.81; 95% CI: 0.74, 0.89), and 24 mo (0.87; 95% CI: 0.79, 0.95). Maternal preconception anemia was negatively associated with cognition (-1.64; 95% CI: -3.09, -0.19) and language development (-1.61; 95% CI: -3.20, -0.03) at 24 mo. Preconception Hb was not associated with birth outcomes or cognitive outcomes at 6-7 y.
CONCLUSIONS
Maternal preconception Hb was associated with child Hb across the first 1000 d of life. However, preconception Hb was not a significant predictor of birth outcomes or cognitive outcomes at 6-7 y in this cohort from Vietnam.
CLINICAL TRIAL REGISTRATION
PRECONCEPT study (NCT: 01665378).
背景
受孕前母亲血红蛋白（Hb）浓度与儿童健康和发育之间的长期关联尚不清楚。
目的
我们研究了母亲受孕前 Hb 浓度与贫血与以下方面的关联：1）出生结局（体重、身长、早产、胎龄、小于胎龄儿）；2）儿童在 3 个月、6 个月、12 个月和 24 个月时的 Hb；3）儿童在 12 个月和 24 个月时的运动和智力发育（贝利婴幼儿发育量表）以及在 6-7 岁时的认知功能（儿童韦氏智力量表）。
方法
我们使用了越南一项随机对照试验（PRECONCEPT）的数据。超过 5000 名计划怀孕的女性被招募，对她们的后代从出生（n=1599）到 6-7 岁（n=1318）进行了前瞻性随访。采用多变量线性和逻辑回归评估受孕前 Hb 或贫血（Hb<12g/dL）与儿童健康和发育结局之间的关系，同时调整了补充组（检验了交互作用）和母、儿、家庭层面的混杂因素。
结果
在受孕前登记时，20%的女性患有贫血。母亲受孕前 Hb 与儿童在 3 个月时的 Hb 呈正相关（0.06；95%CI：0.01，0.12）、6 个月时（0.08；95%CI：0.03，0.13）、12 个月时（0.10；95%CI：0.04，0.15）和 24 个月时（0.07；95%CI：0.02，0.12）。同样，母亲受孕前 Hb 与儿童在 6 个月时（0.89；95%CI：0.81，0.98）、12 个月时（0.81；95%CI：0.74，0.89）和 24 个月时（0.87；95%CI：0.79，0.95）贫血的风险降低有关。母亲受孕前贫血与儿童在 24 个月时的认知（-1.64；95%CI：-3.09，-0.19）和语言发育（-1.61；95%CI：-3.20，-0.03）呈负相关。受孕前 Hb 与出生结局或 6-7 岁时的认知结局无关。
结论
母亲受孕前 Hb 与儿童生命的前 1000 天的 Hb 有关。然而，在越南的这项队列研究中，受孕前 Hb 并不是出生结局或 6-7 岁时认知结局的显著预测因素。
临床试验注册
PRECONCEPT 研究（NCT:01665378）。
Zotero 插件