目的 研究母乳喂养与幼儿神经心理发育的关联,为提升母乳喂养提供依据。方法 纳入2016年8-12月在广东省某两家妇幼保健院常规保健的幼儿,采用自编问卷调查幼儿基本信息和喂养方式,采用年龄与进程问卷(ASQ)评估幼儿神经心理发育水平。运用多重线性回归模型和Logistic回归模型分析喂养方式和各神经发育能区的关联。结果 本研究共纳入245名幼儿,其中母乳喂养102名(41.6%)。所有幼儿中异常率最高的能区为沟通(46.5%),最低为粗大动作(16.3%)。在校正混杂因素后,与母乳喂养幼儿相比,人工喂养幼儿的沟通得分及个人-社会得分较低(β=-11.18,95%CI:-18.13~-4.22,P<0.001;β=-7.61,95%CI:-12.59~-2.64,P<0.001),社交-情绪得分较高(β=17.78,95%CI:4.88~30.69,P=0.01)。此外,人工喂养幼儿在个人-社会、社交-情绪能区发育异常的风险更大(个人-社会:OR=3.24,95%CI:1.19~9.10,P=0.02;社交-情绪:OR=3.39,95%CI:1.34~8.94,P=0.01)。结论 母乳喂养与幼儿个人-社会、社交-情绪能区发育关联密切,是保护因素之一。
Abstract
Objective To investigate the associations between breastfeeding and neurodevelopment in infants,so as to provide evidence for improving breastfeeding rate. Methods Infants who took regular physical examination from two maternal and child health centers in Guangdong from August to December 2016 were enrolled in this study. Children's basic information and feeding patterns were obtained via questionnaire. Ages and Stages Questionnaire(ASQ) was used to evaluate infants' neurodevelopment. Multiple linear regression and Logistic regression were used to analyze the associations between feeding patterns and neurodevelopment of the included infants. Results Totally 245 infants were included,41.6% of whom was breastfed. The abnormal rate of communication domain was the highest(46.5%) and the gross motor domain was the lowest(16.3%) among all neurodevelopmental domains. After adjusted for potential confounding,children with formula feeding scored lower in communication domain and person-social domain(β=-11.18,95%CI:-18.13 to -4.22,P<0.001; β=-7.61,95%CI:-12.59 to -2.64,P<0.001),and scored higher in social-emotional domain(β=17.78,95%CI: 4.88-30.69,P=0.01) when compared with those of breastfeeding. Formula feeding was a risk factor for delayed development of person-social domain(OR=3.24,95%CI:1.19-9.10,P=0.02) and social-emotional domain(OR=3.39,95%CI:1.34-8.94,P=0.01). Conclusion Breastfeeding,one of the protective factors,is important for the development of person-social and social-emotional domains during infancy.
关键词
母乳喂养 /
神经心理发育 /
幼儿
Key words
breastfeeding /
neurodevelopment /
infants
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参考文献
[1] 杜立燕,祁素芬,张英奎,等. 我国母乳喂养保障政策实施现状、存在问题及对策分析[J]. 中国妇幼卫生杂志,2019,10(4):79-81.
[2] Lee MK,Binns C. Breastfeeding and the risk of infant illness in Asia: a review[J]. Int J Environ Res Public Health,2019,17(1):186.
[3] 徐冬梅,冯彩英,杜红梅,等. 母乳喂养与中国0～6岁儿童肥胖发生风险关系的meta分析[J]. 郑州大学学报(医学版),2017,52(1):71-74.
[4] 黄维勇,朱然科,宁静,等. 人工喂养、母乳喂养以及辅食介入时机与婴幼儿过敏性疾病的关系研究[J]. 中国妇幼健康研究,2021,32(5):668-672.
[5] Kim KM,Choi JW. Associations between breastfeeding and cognitive function in children from early childhood to school age: a prospective birth cohort study[J]. Int Breastfeed J,2020,15(1):83.
[6] Victora CG,Bahl R,Barros AJ,et al. Breastfeeding in the 21st century: epidemiology,mechanisms,and lifelong effect[J]. Lancet,2016,387(10017):475-490.
[7] Krol KM,Grossmann T. Psychological effects of breastfeeding on children and mothers[J]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz,2018,61(8):977-985.
[8] Julvez J,Guxens M,Carsin AE,et al. A cohort study on full breastfeeding and child neuropsychological development: the role of maternal social,psychological,and nutritional factors[J]. Dev Med Child Neurol,2014,56(2):148-156.
[9] Amiel CR,Glover V,Ehlert U,et al. Breastfeeding,prenatal depression and children's IQ and behaviour: a test of a moderation model[J]. BMC Pregnancy Childbirth,2021,21(1):62.
[10] 熊冬冬,田策,于睿,等. 孕产妇母乳喂养社会支持的研究现状[J]. 中国妇幼健康研究,2021,32(5):711-715.
[11] 李飞扬. 母乳喂养方式及持续时间对婴儿孤独症样行为影响及其母亲社会地位的效应修饰作用[D]. 合肥:安徽医科大学,2019.
[12] 魏梅,卞晓燕,Squires Jane,等. 年龄与发育进程问卷中国常模及心理测量学特性研究[J]. 中华儿科杂志,2015,53(12):913-918.
[13] 卞晓燕,Squires Jane,卢红梅,等. 年龄与发育进程问卷:社会-情绪(第2版)的中国常模及信度研究[J]. 中国儿童保健杂志,2021,29(1):23-27.
[14] 国家卫生和计划生育委员会. 中国家庭发展报告-2014,2014[M]. 北京:中国人口出版社,2014.
[15] 中华人民共和国国务院.中国儿童发展纲要[M]. 北京:人民出版社,2011.
[16] 祝琴,赵红,马良坤. WHO母乳喂养咨询指南简述及启示[J]. 中国妇幼健康研究,2021,32(5):626-630.
[17] 熊冬冬,田策,于睿,等. 孕产妇母乳喂养社会支持的研究现状[J]. 中国妇幼健康研究,2021,32(5):711-715.
[18] Wakefield MA,Loken B,Hornik RC. Use of mass media campaigns to change health behaviour[J]. Lancet,2010,376(9748):1261-1271.
[19] Yang J,Zhang Y,Li H,et al. The possible effects of breastfeeding on infant development at 3 months: a case-control study[J]. Breastfeed Med,2020,15(10):662-670.
[20] 郑雨芝. 喂养方式对1~6月龄婴儿生长发育的影响[D]. 天津:天津医科大学,2018.
[21] Krol KM,Monakhov M,Lai PS,et al. Genetic variation in CD38 and breastfeeding experience interact to impact infants' attention to social eye cues[J]. Proc Natl Acad Sci U S A,2015,112(39):e5434-e5442.
[22] Choi HJ,Kang SK,Chung MR. The relationship between exclusive breastfeeding and infant development: A 6- and 12-month follow-up study[J]. Early Hum Dev,2018,127:42-47.
[23] Kemp AH,Guastella AJ. The role of oxytocin in human affect: a novel hypothesis[J]. Curr Dir Psychol Sci,2011,20(4):222-231.
[24] 许琪,李瑞莉,金春华,等. 北京市0～3岁儿童神经心理发育现状及影响因素分析[J]. 中国妇幼保健,2015,30(20):3404-3406.
[25] Linde K,Lehnig F,Nagl M,et al. The association between breastfeeding and attachment: a systematic review[J]. Midwifery,2020,81:102592.
[26] 陈平洋. 母乳喂养对早产儿神经系统发育的影响[C]//达能营养中心2020年论文汇编:孕期营养、母乳喂养.北京:中国疾病预防控制中心达能营养中心,2020:7.
基金
广东省重点领域研发计划项目(2019B030335001);国家自然科学基金项目(81872639);广州市残疾人联合会项目(2019)
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