巴基斯坦一项产前焦虑随机对照试验干预对婴儿发育的影响。
Effects of a Prenatal Anxiety Randomized Controlled Trial Intervention on Infant Development in Pakistan.
作者信息
Surkan Pamela J, Park Soim, Sheng Ziyue, Zaidi Ahmed, Atif Najia, Osborne Lauren M, Rahman Atif, Malik Abid
机构信息
Department of International Health (PJ Surkan, S Park, and Z Sheng), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of International Health (PJ Surkan, S Park, and Z Sheng), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
出版信息
Acad Pediatr. 2025 Jan-Feb;25(1):102551. doi: 10.1016/j.acap.2024.07.018. Epub 2024 Aug 2.
OBJECTIVE
Given that infant development is influenced by caregiver mental health, we tested whether an intervention to reduce antenatal anxiety could affect infant development. A secondary aim was to test depressive symptoms, maternal responsiveness, and maternal infant bonding as mediators of this relationship.
METHODS
Between 2020 and 2022, pregnant women participated in a randomized controlled trial of the Happy Mother-Healthy Baby (HMHB) program based on cognitive behavioral therapy. We collected data on child development from 202 intervention and 198 control participants in a public hospital in Pakistan. Child development was measured using the Ages and Stages Questionnaires-Version 3 at six weeks postpartum. Using intent-to-treat analyses, we examined whether the intervention was associated with performance on the five ASQ-3 domains. Causal mediation analysis was used to assess depressive symptoms, bonding, and maternal-infant responsiveness as mediators.
RESULTS
Socio-demographic characteristics were evenly distributed between study arms. Intervention arm infants showed a 2.1-point increase (95% CI: 0.12, 4.17) in communication scores compared to controls. Though not achieving statistical significance, intervention infants also showed a 2.0-point increase (95% CI: -0.06, 4.09) in gross motor development performance. Bonding, depression, and responsiveness were mediators between the intervention and infant communication (B=1.94 (95% CI: 0.86, 3.25) depression; B= 0.57 (95% CI: 0.09, 1.16) bonding; B= 0.53 (95% CI: 0.01, 1.21) and responsiveness (B= 1.94 (95% CI: 0.86, 3.25)). Bonding, responsiveness, and depression mediated 25%, 23%, and 87% of the total association, respectively.
CONCLUSIONS
HMHB positively affected infant communication at six-week follow-up. Larger studies with longer follow-up are needed to confirm and extend these findings.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032.
目的
鉴于婴儿发育受照料者心理健康的影响，我们测试了一项减轻产前焦虑的干预措施是否会影响婴儿发育。第二个目标是测试抑郁症状、母亲反应性和母婴联结作为这种关系的中介因素。
方法
在2020年至2022年期间，孕妇参与了一项基于认知行为疗法的“快乐母亲-健康宝宝”（HMHB）项目的随机对照试验。我们从巴基斯坦一家公立医院的202名干预组参与者和198名对照组参与者中收集了儿童发育数据。在产后六周使用《年龄与阶段问卷》第三版来测量儿童发育情况。采用意向性分析，我们研究了该干预措施是否与五个ASQ-3领域的表现相关。使用因果中介分析来评估抑郁症状、联结和母婴反应性作为中介因素。
结果
社会人口学特征在研究组间分布均匀。与对照组相比，干预组婴儿的沟通得分提高了2.1分（95%置信区间：0.12，4.17）。尽管未达到统计学显著性，但干预组婴儿的大运动发育表现也提高了2.0分（95%置信区间：-0.06，4.09）。联结、抑郁和反应性是干预与婴儿沟通之间的中介因素（抑郁：B=1.94（95%置信区间：0.86，3.25）；联结：B=0.57（95%置信区间：0.09，1.16）；反应性：B=0.53（95%置信区间：0.01，1.21））。联结、反应性和抑郁分别介导了总关联的25%、23%和87%。
结论
在六周随访时，HMHB对婴儿沟通有积极影响。需要进行更大规模、更长随访期的研究来证实和扩展这些发现。
试验注册
ClinicalTrials.gov NCT03880032；https://clinicaltrials.gov/ct2/show/NCT03880032 。
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