Leverett Shelby D, Brady Rebecca G, Tooley Ursula A, Lean Rachel E, Tillman Rebecca, Wilson Jillian, Ruscitti Michayla, Triplett Regina L, Alexopoulos Dimitrios, Gerstein Emily D, Smyser Tara A, Warner Barbara, Luby Joan L, Smyser Christopher D, Rogers Cynthia E, Barch Deanna M
Division of Biology & Biomedical Sciences, Neurosciences Program, Washington University in Saint Louis, St Louis, MO; Department of Psychiatry, Washington University in Saint Louis, St Louis, MO.
Division of Biology & Biomedical Sciences, Neurosciences Program, Washington University in Saint Louis, St Louis, MO.
J Pediatr. 2025 Jan;276:114289. doi: 10.1016/j.jpeds.2024.114289. Epub 2024 Sep 2.
To investigate whether parenting or neonatal brain volumes mediate associations between prenatal social disadvantage (PSD) and cognitive/language abilities and whether these mechanisms vary by level of disadvantage.
Pregnant women were recruited prospectively from obstetric clinics in St Louis, Missouri. PSD encompassed access to social (eg, education) and material (eg, income to needs, health insurance, area deprivation, and nutrition) resources during pregnancy. Neonates underwent brain magnetic resonance imaging. Mother-child dyads (n = 202) returned at age 1 year for parenting observations and at age 2 years for cognition/language assessments (Bayley Scales of Infant and Toddler Development, Third Edition). Generalized additive and mediation models tested hypotheses.
Greater PSD associated nonlinearly with poorer cognitive/language scores. Associations between parenting and cognition/language were moderated by disadvantage, such that supportive and nonsupportive parenting behaviors related only to cognition/language in children with lesser PSD. Parenting mediation effects differed by level of disadvantage: both supportive and nonsupportive parenting mediated PSD-cognition/language associations in children with lesser disadvantage, but not in children with greater disadvantage. PSD-associated reductions in neonatal subcortical grey matter (β = 0.19; q = 0.03), white matter (β = 0.23; q = 0.02), and total brain volume (β = 0.18; q = 0.03) were associated with lower cognition, but did not mediate the associations between PSD and cognition.
Parenting moderates and mediates associations between PSD and early cognition and language, but only in families with less social disadvantage. These findings, although correlational, suggest that there may be a critical threshold of disadvantage, below which mediating or moderating factors become less effective, highlighting the importance of reducing disadvantage as primary prevention.
探讨养育方式或新生儿脑容量是否介导产前社会劣势（PSD）与认知/语言能力之间的关联，以及这些机制是否因劣势程度而异。
前瞻性地从密苏里州圣路易斯的产科诊所招募孕妇。PSD包括孕期获得社会（如教育）和物质（如收入需求比、医疗保险、地区贫困和营养）资源的情况。新生儿接受脑磁共振成像检查。母婴二元组（n = 202）在1岁时返回进行养育观察，在2岁时返回进行认知/语言评估（贝利婴幼儿发展量表第三版）。采用广义相加模型和中介模型检验假设。
PSD程度越高，与较差的认知/语言得分呈非线性相关。养育方式与认知/语言之间的关联受到劣势程度的调节，即支持性和非支持性养育行为仅与PSD程度较低儿童的认知/语言相关。养育方式的中介效应因劣势程度而异：支持性和非支持性养育方式在劣势程度较低的儿童中均介导了PSD与认知/语言之间的关联，但在劣势程度较高的儿童中则不然。PSD相关的新生儿皮质下灰质（β = 0.19；q = 0.03）、白质（β = 0.23；q = 0.02）和全脑体积减少（β = 0.18；q = 0.03）与较低的认知水平相关，但未介导PSD与认知之间的关联。
养育方式调节并介导了PSD与早期认知和语言之间的关联，但仅在社会劣势较小的家庭中如此。这些发现虽然是相关性的，但表明可能存在一个关键的劣势阈值，低于该阈值，中介或调节因素的效果会减弱，突出了减少劣势作为一级预防的重要性。
