Valentini Nadia Cristina, Chiquetti Eloá Maria, Hass Júlia Vicente, Nobre Glauber Carvalho
School of Physical Education, Physiotherapy and Dance, Federal University of Rio Grande Do Sul, R. Felizardo, Rio Grande Do Sul, 750 - Jardim Botânico, Porto Alegre, 90690-200, Brazil.
Department of Physiotherapy, Federal University of Pampa, Uruguaiana, Rio Grande Do Sul, Brazil.
Eur J Pediatr. 2025 Aug 27;184(9):579. doi: 10.1007/s00431-025-06393-1.
Different risk factors are related to motor development in the first months of life; however, prenatal, birth, and contextual risks are usually investigated separately, restraining the ability to understand the weight of each factor on development. This study examined the relationships among prenatal and birth risks and contextual factors on infant motor development (outcome) in the first 4 months of life. This cross-sectional and associative study assessed 662 infants (corrected ages from 34 weeks of post-conceptional age to 17 weeks of post-term). Infants' motor development was assessed using the Test of Infant Motor Performance, hospital records provided biomedical information, and parents completed a demographic questionnaire. The GLM was used; a significant regression model was obtained ( (647) = 57.615, p < .001, AIC = 5965.8, BIC = 6037.8). Breastfeeding length (p < .001) and home opportunities (p = 0.045) positively explained motor development. Further, drug taking (p = 0.018), other(s) children living at home (p = 0.015), and prematurity levels: 32-37 weeks (p < 0.001), 28-32 weeks (p < 0.001), and below 28 weeks (p = 0.008) compared to a term birth negatively explained motor development. The deviance-based R2 indicates that 51% of the variance in the outcome variable is explained by the model predictors. Motor development in the first 4 months of life is influenced by multiple factors; some are more robust than others and require early prevention strategies such as educating mothers about the risks of drug consumption and promoting longer time for breastfeeding.
This study highlights that, beyond prenatal substance addiction as a risk factor, extended breastfeeding and enriched home motor environments serve as key protective factors supporting infant motor development.
• Prematurity and prenatal substance exposure are major risk factors for delayed infant motor development. • Breastfeeding and enrich home environment can protect against developmental delays.
• This study provides robust evidence that cumulative biological and environment risks act synergistically to significantly impair motor development, highlighting the importance of assessing multiple risks factors simultaneously rather than in isolation. • The protective effect of breastfeeding duration remains significant even when accounting for cumulative risks, while enhanced home opportunities for motor stimulation serve as a key modifiable factor mitigating these risks, this is the first study to show how gestational age, prenatal drug exposure, breastfeeding, and home stimulation colectivelly influence infant motor development in a middle-income setting.
不同的风险因素与生命最初几个月的运动发育相关；然而，产前、出生及环境风险通常是分开研究的，这限制了我们理解每个因素对发育影响程度的能力。本研究考察了产前和出生风险以及环境因素与出生后前4个月婴儿运动发育（结果）之间的关系。这项横断面关联研究评估了662名婴儿（矫正年龄从孕龄34周至过期妊娠17周）。使用婴儿运动表现测试评估婴儿的运动发育，医院记录提供生物医学信息，父母完成一份人口统计学调查问卷。使用了广义线性模型；得到了一个显著的回归模型（F(647)=57.615，p<.001，AIC=5965.8，BIC=6037.8）。母乳喂养时长（p<.001）和家庭机会（p=0.045）对运动发育有正向解释作用。此外，与足月儿相比，吸毒（p=0.018）、家中有其他孩子（p=0.015）以及早产水平：32 - 37周（p<.001）、28 - 32周（p<.001）和28周以下（p=0.008）对运动发育有负向解释作用。基于偏差的R²表明，模型预测变量解释了结果变量中51%的方差。出生后前4个月的运动发育受多种因素影响；有些因素比其他因素影响更大，需要早期预防策略，如教育母亲关于吸毒的风险以及提倡更长时间的母乳喂养。
本研究强调，除了产前物质成瘾作为一个风险因素外，延长母乳喂养和丰富家庭运动环境是支持婴儿运动发育的关键保护因素。
• 早产和产前物质暴露是婴儿运动发育延迟的主要风险因素。• 母乳喂养和丰富家庭环境可预防发育延迟。
• 本研究提供了有力证据，表明累积的生物和环境风险协同作用，显著损害运动发育，凸显了同时评估多种风险因素而非单独评估的重要性。• 即使考虑累积风险，母乳喂养时长的保护作用仍然显著，而增加家庭运动刺激机会是减轻这些风险的关键可改变因素，这是第一项展示在中等收入环境中胎龄、产前药物暴露、母乳喂养和家庭刺激如何共同影响婴儿运动发育的研究。
