Qiu Han, Zhou Chun-Yan, Hu Shou-Xun, Li Luan-Luan, Wang Xi-Rui, Zhang Jun, Tian Ying, Wang Bin, Yu Xiao-Dan
Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Shanghai, 200127, China.
Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
World J Pediatr. 2025 Sep 19. doi: 10.1007/s12519-025-00969-5.
The first five years of life are sensitive periods for neurodevelopment. Poor maternal metrics of cardiovascular health may influence offspring neurodevelopment. Previous studies focused only on one or two metrics, or different time window. This study is aimed to investigate the effects of combined cardiovascular health metric exposure during pregnancy on the neurodevelopment of offspring during crucial periods.
A total of 1007 mother‒child pairs recruited from 2013 to 2016 from the Shanghai Birth Cohort were included. Five maternal cardiovascular health metrics at 28 weeks of gestation were collected. Offspring neurodevelopment at 2-3 years and 4-5 years was evaluated with the Bayley-III and Wechsler preschool and primary scale of intelligence, fourth edition (WPPSI-IV), respectively.
After adjusting for confounders, the scores for cognition and language at 2-3 years significantly increased by 1.63 [95% confidence interval (CI) 0.42-2.83, P = 0.008] and 0.84 (95% CI 0.005-1.67, P = 0.049) per one-point higher maternal cardiovascular health score, respectively. After false discovery rate adjustment, the associations were preserved in the cognitive domain. Similarly, each one-point higher maternal cardiovascular health score was associated with an increase of 0.92 (95% CI 0.16-1.68, P = 0.018) and 0.71 (95% CI 0.01-1.40, P = 0.047) in the visual space index and working memory index scores at 4-5 years, respectively, but with an false discovery rate-adjusted P > 0.05; in the sex-stratified analysis, the visual space index scores significantly increased (β = 1.47, 95% CI 0.38-2.56, P = 0.009), regardless of false discovery rate correction. In addition, each one-point higher maternal cardiovascular health score reduced the relative risk of suboptimal development in the visual space index domain by 0.83 (95% CI 0.70-0.99; P = 0.041) in female offspring despite the non-significant after false discovery rate adjustment.
Our study provides novel evidence that maternal cardiovascular health during pregnancy is associated with offspring neurodevelopment within the first five years of life and that female offspring appear to derive greater benefit from higher maternal cardiovascular health scores. The potential role of maternal cardiovascular health in identifying risk of neurodevelopmental delay in clinical practice needs to be further explored.
生命的头五年是神经发育的敏感期。母亲心血管健康指标不佳可能会影响后代的神经发育。以往的研究仅关注一两个指标，或不同的时间窗口。本研究旨在调查孕期综合心血管健康指标暴露对关键时期后代神经发育的影响。
纳入2013年至2016年从上海出生队列招募的1007对母婴。收集妊娠28周时的五项母亲心血管健康指标。分别使用贝利婴幼儿发展量表第三版（Bayley-III）和韦氏学前及初小儿童智力量表第四版（WPPSI-IV）评估2至3岁和4至5岁后代的神经发育情况。
在调整混杂因素后，母亲心血管健康评分每升高1分，2至3岁时的认知和语言得分分别显著提高1.63 [95%置信区间（CI）0.42 - 2.83，P = 0.008]和0.84（95% CI 0.005 - 1.67，P = 0.049）。经过错误发现率调整后，这些关联在认知领域依然存在。同样，母亲心血管健康评分每升高1分，4至5岁时的视觉空间指数和工作记忆指数得分分别增加0.92（95% CI 0.16 - 1.68，P = 0.018）和0.71（95% CI 0.01 - 1.40，P = 0.047），但经错误发现率调整后的P>0.05；在按性别分层分析中，无论是否进行错误发现率校正，视觉空间指数得分均显著增加（β = 1.47，95% CI 0.38 - 2.56，P = 0.009）。此外，母亲心血管健康评分每升高1分，尽管经错误发现率调整后不显著，但可使雌性后代视觉空间指数领域发育欠佳的相对风险降低0.83（95% CI 0.70 - 0.99；P = 0.041）。
我们的研究提供了新的证据，表明孕期母亲心血管健康与后代生命头五年的神经发育相关，且雌性后代似乎从母亲较高的心血管健康评分中获益更大。母亲心血管健康在临床实践中识别神经发育延迟风险的潜在作用有待进一步探索。
