Abstract: Objective To investigate emotional and behavioral problems in preschool children in Nantong City, and to analyze the relationship between maternal gestational weight gain (GWG), pre-pregnancy body mass index (BMI), and their combined effects on children′s emotional and behavioral problems, so as to provide evidence for health management during and before pregnancy. Methods A cross-sectional survey was conducted in eight kindergartens in Nantong City from September to December 2023, involving 2 176 preschool children. Maternal GWG and pre-pregnancy BMI were obtained through questionnaires, and children′s emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ). Multivariate Logistic regression models were used for data analysis. Results The abnormal detection rates of preschool children in peer relationship problems, hyperactivity, prosocial behavior, conduct problems, and emotional symptoms were 30.33％(660/2 176)、29.60％(644/2 176)、26.01％(566/2 176)、22.62％(492/2 176), and 18.00％(392/2 176), respectively, with an overall abnormal detection rate of 23.90%(521/2 176). Boys had a higher abnormal detection rate than girls(χ²=94.732, P＜0.01). Maternal pre-pregnancy overweight/obesity and excessive GWG were identified as risk factors for emotional and behavioral problems in preschool children (OR＝1.19, 95%CI: 1.01 - 1.31,P<0.05; OR＝1.12, 95%CI: 1.03 - 1.22,P<0.05). Stratified by pre-pregnancy BMI, excessive GWG was an independent risk factor for emotional and behavioral problems in children across normal-weight, underweight, and overweight/obese groups (OR＝1.09, 95%CI: 1.03 - 1.43,P<0.05; OR＝1.37, 95%CI: 1.02 - 1.89,P<0.05; OR＝1.35, 95%CI: 1.07 - 1.71,P<0.05). The combined effects of insufficient GWG with pre-pregnancy overweight/obesity, excessive GWG with pre-pregnancy underweight, and normal pre-pregnancy BMI significantly increased the risk of emotional and behavioral problems in offspring (OR=1.30,95%CI: 1.15 - 1.56,P<0.05; OR= 1.20, 95%CI: 1.02 - 1.46,P<0.05; OR＝1.10, 95%CI: 1.02 - 1.23,P<0.05). Gender-stratified analysis revealed that insufficient GWG combined with pre-pregnancy overweight/obesity was a risk factor for emotional and behavioral problems in boys. Conclusions Maternal insufficient or excessive GWG and abnormal pre-pregnancy BMI are significantly associated with emotional and behavioral problems in preschool children, especially in boys. The combined effects of insufficient GWG and pre-pregnancy overweight/obesity have a pronounced impact on emotional and behavioral problems.

Key words: gestational weight gain, body mass index, emotional-behavioral problems, preschool children

摘要： 目的 了解南通市学龄前儿童情绪行为问题,并分析母亲孕期增重、孕前BMI以及二者联合作用与儿童情绪行为问题的关系,为孕期和孕前的健康管理提供依据。方法 2023年9—12月在南通市8所幼儿园进行横断面调查,共纳入2 176名学龄前儿童。母亲的孕期增重及孕前BMI通过问卷获得,儿童情绪行为问题通过情绪与行为问题优势与困难问卷(SDQ)评估,采用多因素logistic回归模型分析数据。结果 学龄前儿童在同伴交往问题、多动、亲社会行为、品行问题和情绪症状方面的异常检出率分别为30.33％(660/2 176)、29.60％(644/2 176)、26.01％(566/2 176)、22.62％(492/2 176)和18.00％(392/2 176),总体异常检出率为23.90％(521/2 176),男童情绪行为问题检出率高于女童(χ²=94.732,P<0.01)。母亲孕前超重肥胖和孕期增重过度是学龄前儿童情绪行为问题的危险因素(OR＝1.19,95％CI:1.01～1.31,P<0.05;OR＝1.12,95％CI:1.03～1.22,P<0.05);按孕前BMI分层,孕前BMI正常、消瘦和超重肥胖组中,孕期增重过度均为学龄前儿童情绪行为问题的独立危险因素(OR＝1.09,95％CI:1.03～1.43,P<0.05;OR＝1.37,95％CI:1.02～1.89,P<0.05;OR＝1.35,95％CI:1.07～1.71,P<0.05);孕期增重不足合并孕前超重肥胖、孕期增重过度合并孕前消瘦以及孕前BMI正常的母亲其子代学龄儿童出现情绪行为问题的风险显著增加(OR＝1.30,95％CI:1.15～1.56,P<0.05;OR＝1.20,95％CI:1.02～1.46,P<0.05;OR＝1.10,95％CI:1.02～1.23,P<0.05);性别分层后发现母亲孕期增重不足联合孕前超重肥胖是男童情绪行为问题的危险因素。结论 母亲孕期增重不足或过度以及孕前BMI异常显著与学龄前儿童情绪行为问题相关,尤其在男童中更为明显。孕期增重不足和孕前超重肥胖的联合作用对情绪行为问题影响显著。

关键词: 孕期增重, 体质量指数, 情绪行为问题, 学龄前儿童