父母孕产期及环境危险因素与儿童孤独症发生关系的Meta分析

doi:10.11852/zgetbjzz2023-1172

摘要/Abstract

摘要： 目的通过Meta评价儿童孤独症的父母孕产期及环境高危因素,为儿童孤独症的预防及早期发现提供科学循证依据。方法分别检索万方、维普、CNKI 及 PubMed 数据库中的中英文病例对照研究,评价文献质量,搜集风险条目,运用Review manager 5.3 软件统计分析数据,计算OR值及其 95%CI。结果最终纳入15篇文献,累计观察组病例 1 758例,对照组健康儿童7 848例,涉及6个国家。资料分析显示,父亲年龄>35岁(OR=2.60,95%CI:1.58~4.61)、母孕期情绪不良史(焦虑、抑郁、压力大)(OR=3.06,95%CI:2.23~4.20)、母孕期主被动吸烟史(OR=3.57,95%CI:2.68~4.75)、父亲性格内向(OR=2.55,95%CI:1.35~4.78)、母亲人工流产史(OR=3.76,95%CI:2.54~5.57)、母亲职业毒物暴露史(OR=2.24,95%CI:1.35~3.70)、孕期疾病史(妊娠期高血压、糖尿病、甲减等)(OR=2.47,95%CI:1.22~4.98)、母亲怀孕6月内接触电离辐射(经常使用电脑)(OR=2.35,95%CI:1.39~3.98)、家族中有精神疾病病史(OR=8.26,95%CI:2.90~23.50)、母孕期用药史(抗感染药、激素类)(OR=5.24,95%CI:2.50~10.96)10项因素与儿童孤独症的发生风险相关(P<0.05)。结论父母孕产期及环境不良因素与儿童孤独症的发病密切相关,在母亲孕期应积极监测高危风险因素的暴露,减少、减低患病诱因,对高危群体应早期监测其发育行为发展轨迹,早发现、早干预。

关键词: 儿童孤独症, 环境因素, 孕产期因素, Meta分析

Abstract: Objective To assess the association of maternal and environmental factors with the risk of autism in children, thereby informing strategies for prevention and early intervention. Methods A comprehensive search was conducted for case-control studies in both Chinese and English, utilizing databases including Wanfang, VIP, CNKI, and PubMed.The quality of the retrieved literature was rigorously assessed, and relevant risk factors were extracted for analysis.Statistical evaluation was performed using Review Manager 5.3, focusing on odds ratios (OR) and 95% confidence intervals (CI) as primary measures. Results Fifteen articles, encompassing a total of 1 758 cases in the observation group and 7 848 healthy children in the control group from six countries, were included in the final analysis.The Results indicated significant associations between autism and several factors, including paternal age over 35 years old (OR=2.60, 95%CI:1.58 - 4.61), maternal emotional disorders during pregnancy (anxiety, depression, stress) (OR=3.06, 95%CI:2.23 - 4.20), maternal smoking (active and passive) during pregnancy (OR=3.57, 95%CI:2.68 - 4.75), paternal introversion (OR=2.55, 95%CI:1.35 - 4.78), history of maternal induced abortion (OR=3.76, 95% CI:2.54 - 5.57), and maternal occupational exposure to toxins (OR=2.24, 95%CI:1.35 - 3.70).Additional significant associations were observed with maternal pregnancy-related diseases (hypertension, diabetes, hypothyroidism, etc.) (OR=2.47, 95%CI:1.22 - 4.98), maternal exposure to ionizing radiation (including frequent computer use) during the first six months of pregnancy (OR=2.35, 95%CI:1.39 - 3.98), family history of mental illness (OR=8.26, 95%CI:2.90 - 23.50), and maternal use of certain medications (anti-infective drugs, hormones) (OR=5.24, 95%CI:2.50 - 10.96). Conclusions The findings suggest a complex interplay of genetic, environmental and maternal health factors in the etiology of childhood autism.Early identification and mitigation of these risk factors, alongside vigilant monitoring during pregnancy, are imperative for reducing the incidence of autism and improving child health outcomes.

Key words: childhood autism, environmental factors, maternal factors, Meta-analysis

中图分类号:

R749.94

黎帅, 黄启军, 夏宇, 刘振寰. 父母孕产期及环境危险因素与儿童孤独症发生关系的Meta分析[J]. 中国儿童保健杂志, 2024, 32(10): 1122-1127.

LI Shuai, HUANG Qijun, XIA Yu, LIU Zhenhuan. Meta-analysis of the correlation of prenatal, perinatal and environmental risk factors with childhood autism[J]. Chinese Journal of Child Health Care, 2024, 32(10): 1122-1127.

参考文献

[1] Association AP.Diagnostic and statistical manual of mental disorders 5thed[M].Arlington:American psychiatric publishing.2013.
[2] Zhou H, Xu X, Yan W, et al.Prevalence of autism spectrum disorder in China:A nationwide multi-center population-based study among children aged 6 to 12 years[J].Neurosci Bull, 2020,36(9):961-971.
[3] Maenner MJ, Warren Z, Williams AR,et al.Prevalence and characteristics of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 Sites,United States, 2020[J].MMWR Surveill Summ, 2023,72(2):1-14.
[4] Leigh JP, Du J.Briefreport:forecasting the economic burden of autism in 2015 and 2025 in the United States[J].J Autism Dev Disord, 2015,45(12):4135-4139.
[5] 静进.孤独症谱系障碍的治疗干预现状与建议[J].中国儿童保健杂志,2023,31(9):939-944.
Jing J.Status quo and suggestions on treatment and intervention of autism spectrum disorder[J].Chin J Child Health Care, 2019,31(9):939-944.(in Chinese)
[6] 柯晓燕.孤独症谱系障碍早期识别与早期诊断的现状与挑战[J].中国儿童保健杂志,2023,31(3):238-240.
Ke XY.Status and challenges of early recognition and diagnosis of autism spectrum disorders[J].Chin J Child Health Care,2019,31(3):238-240.(in Chinese)
[7] Salgado-Cacho JM, Moreno-Jiménez MDP, de Diego-Otero Y.Detection of early warning signs in autism spectrum disorders:A systematic review[J].Children (Basel), 2021,8(2):253-276.
[8] Luchini C, Stubbs B, Solmi M, et al.Assessing the quality of studies in meta-analyses:Advantages and limitations of the newcastle ottawa scale[J].World J Meta-Anal, 2017,5(4):80-84.
[9] 冼丹霞,金宇,谢笑英,等.儿童孤独症发病危险因素的病例对照研究[J].中国儿童保健杂志, 2014, 22(1):24-27.
Xian DX, Jin Y, Xie XY, et al.A case-control study of risk factors for autism in children[J].Chin J Child Health Care, 2014, 22(1):24-27.(in Chinese)
[10] 董静怡,杜文冉,崔立华等.儿童孤独症谱系障碍行为的孕前和孕期危险因素研究[J].中国妇幼健康研究,2023,34(1):5-9.
Dong JY, Du W, Cui LH et al.Preconception and prenatal risk factors for autism spectrum disorder behavior in children[J].Chin Jwoman.and Child Health Res, 2019,34(1):5-9.(in Chinese)
[11] 郑艳,沈妙文.儿童孤独症与母亲怀孕前后相关影响因素的调查研究[J].中国妇幼保健,2014,29(28):4609-4610.
Zheng Y, Shen MW.Investigation on the related influencing factors of autism in children and mothers before and after pregnancy[J].Matern Child Health Care China,2014,29(28):4609-4610.(in Chinese)
[12] 郑冬梅,吕莹,孙彩虹,等.母孕产期环境因素与孤独症谱系障碍的关联研究[J].哈尔滨医科大学学报, 2015, 49(6):524-527.
Zheng DM, Lyu Y, Sun CH, et al.Association between maternal environmental factors and autism spectrum disorders[J].J Harbin Med Univ, 2015, 49(6):524-527.(in Chinese)
[13] 袁嫣,宋虎杰,赵宁侠,等.孤独症谱系障碍危险因素的临床调查研究[J].河北中医,2018,40(1):18-22.
Yuan Y, Song H J, Zhao N X, et al.Clinical investigation on risk factors of autism spectrum disorder[J].Hebeii J Tradit Chin Med,2018,40(1):18-22.(in Chinese)
[14] 毛燕燕,胡宏,陈东燕,等.父母亲生育年龄等围孕期因素与儿童孤独症谱系障碍的关联性[J].中华生殖与避孕杂志, 2022, 42(4):372-378.
Mao YY, Hu H, Chen DY, et al.The association between perinatal factors such as parental reproductive age and autism spectrum disorders in children[J].Chin J Reprod Contracept, 2022, 42 (4):372-378.(in Chinese)
[15] 李辉,潘黎明,戚锋锋,等.湖州市婴幼儿孤独症谱系障碍患病率及危险因素调查分析[J].中国妇幼保健, 2023,38(11):2049-2053.
Li H, Pan LM, Qi FF, et al.Investigation and analysis of the prevalence and risk factors of autism spectrum disorder in infants and young children in Huzhou city[J].Matern Child Health Care China, 2023,38 (11):2049-2053.(in Chinese)
[16] 钟丽霞,熊喜悦.儿童孤独症谱系障碍人口统计学特征及相关危险因素分析[J].中国儿童保健杂志,2019,27(1):94-97.
Zhong LX, Xiong XY.Demographic characteristics and related risk factors analysis of autism spectrum disorder in children[J].Chin J Child Health Care, 2019,27(1):94-97.(in Chinese)
[17] 黄小玲,张玉琼,唐玉文,等.学龄前孤独症谱系障碍儿童相关危险因素的调查分析[J].神经损伤与功能重建, 2021, 16(4):213-215.
Huang XL, Zhang YQ, Tang YW, et al.Investigation and analysis of risk factors related to autism spectrum disorder in preschool children[J].Neural Injury and Functional Reconstruction, 2021, 16 (4):213-215.(in Chinese)
[18] Qutranji L, Alkayyali T, Alkhateeb W,et al.Evaluation of the relationship between environmental factors, nutrition, and metabolic changes in children diagnosed with autism in north cyprus:A case-control study.[J].Cureus, 2021, 13(8):e17016.
[19] Gerges P, Bitar T, Hawat M,et al.Risk and protective factors in autism spectrum disorders:A case control study in the Lebanese population[J].Int J Environ Res Public Health, 2020, 17(17):6323.
[20] Hadjkacem I, Ayadi H, Turki M,et al.Prenatal, perinatal and postnatal factors associated with autism spectrum disorder[J].J Pediatr (Rio J), 2016,92(6):595-601.
[21] Duan G, Yao M, Ma Y, et al.Perinatal and background risk factors for childhood autism in central China[J].Psychiatry Res, 2014, 220(1-2):410-417.
[22] Yong Z, Dou Y,Gao Y, et al.Prenatal, perinatal, and postnatal factors associated with autism spectrum disorder cases in Xuzhou, China[J].Transl Pediatr,2021, 10(3):635-646.
[23] Saroukhani S, Samms-Vaughan M, Lee M J, et al.Perinatal factors associated with autism spectrum disorder in Jamaican children[J].J Autism Dev Disord, 2020, 50(9):3341-3357.
[24] Zavaleta-Ramírez P, Rosetti M F, Albores-Gallo L, et al.Pathways to a diagnosis of autism spectrum disorder[J].Psychiatr Serv, 2020, 71(11):1120-1126.
[25] Höfer J, Hoffmann F, Kamp-Becker I, et al.Pathways to a diagnosis of autism spectrum disorder in Germany:A survey of parents[J].Child Adolesc Psychiatry Ment Health, 2019, 13(1):1-10.
[26] Al-Mamari W, Idris AB, Aala′A AZ, et al.Parental age and the risk of autism spectrum disorder in Oman:A case-control study[J].Sultan Qaboos Univ Med J, 2021, 21(3):465-471.
[27] Çöl N, Kömürcü-Karuserci Ö, Demirel C.The possible effects of maternal electronic media device usage during pregnancy on children′s sleep patterns[J].Turk Arch Pediatr, 2021, 56(3):254-260.
[28] Adamjee Burhani H, Hussain S, Lakshmanan J, et al.Perinatal risk factors in children diagnosed with autism spectrum disorder in Dubai:A case-control study[J].Dubai Med J, 2023, 6(3):155-162.
[29] Bai D, Yip BHK, Windham GC, et al.Association of genetic and environmental factors with autism in a 5-country cohort[J].JAMA Psychiatry, 2019, 76(10):1035-1043.
[30] Nutor C, Dunlop A, Sadler O, et al.Prenatal cannabis use and offspring autism-related behaviors:Examining maternal stress as a moderator in a black American cohort[J].J Autism Dev Disord, 2023,4(25):1-13.
[31] 殷道根,何珍,段学燕,等.中国人群儿童孤独症危险因素的Meta分析[J].中国妇幼保健, 2018, 33(12):2877-2879.
Yin DG, He Z, Duan XY, et al.Meta analysis of risk factors for autism in Chinese children[J].Matern Child Health Care China, 2018, 33 (12):2877-2879.(in Chinese)
[32] 钱晟,李佳钰,李静,等.儿童孤独症的妊娠期和围产期危险因素Meta分析[J].中国妇幼健康研究, 2021, 32(3):430-435.
Qian S, Li JY, Li J, et al.Meta analysis of pregnancy and perinatal risk factors for autism in children[J].Chin J Woman Child Health Res, 2021, 32 (3):430-435.(in Chinese)