目的 探究孕母产前抑郁 (AD) 对子代早期脑发育及1岁时神经行为发育的影响,为促进母婴健康提供科学依据。方法 前瞻性选取2022年1—12月在广州中医药大学第一附属医院产科门诊进行早孕建册 (孕周＜13周) 的821例孕母,于孕晚期 (≥28周)诊断为AD的孕母子代124例 (15.1%) 进行出院后追踪随访,排除23例(18.5%)失访或未定期完成相关评估者,最终纳入101例AD孕母子代作为AD组,并随机选取同期健康产检孕母子代101例作为对照组,观察并比较两组新生儿生后24～48h脑结构超声测量值及随访1岁时神经行为发育状况。结果 AD组胼胝体长度、小脑蚓部高度和小脑蚓部前后径测量值低于对照组,差异有统计学意义(t=6.901、7.548、2.320,P＜0.05)。AD组1岁时适应性、语言和个人社交发育落后于对照组,差异有统计学意义(t=2.147、1.016、4.246,P＜0.05)。在校正混杂因素后发现,孕母存在AD的子代语言(OR=2.124,95%CI:1.624~7.264)和个人社交(OR=2.016,95%CI:2.014~6.998)发育异常的风险增高 (P＜0.05)。结论 孕母患AD与子代大脑早期微观结构改变有关,并可导致子代1岁时神经行为发育异常风险增高,临床需加强孕母心理健康评估,并重视其子代出院后随访管理,促进母婴健康。
Abstract
Objective To investigate the impact of antenatal depression (AD) in pregnant women on early brain development in offspring and neurobehavioral development at 1 year of age, in order to provide scientific basis for promoting maternal and child health. Methods A prospective study was conducted on 821 pregnant women who registered for early pregnancy care (gestational age <13 weeks) at the Obstetrics Clinic of the First Affiliated Hospital of Guangzhou University of Chinese Medicine between January and December 2022.Among them,124 (15.1%) were diagnosed with AD in late pregnancy (≥28 weeks).After excluding 23 cases (18.5%) due to loss to follow-up or incomplete assessments,101 offspring of AD mothers were included in the AD group.Additionally,101 offspring of healthy pregnant women from the same period were randomly selected as the control group.Brain structure ultrasound measurements were taken within 24 - 48 hours after birth,and neurobehavioral development was assessed at 1 year of age. Results The AD group showed significantly lower measurements in corpus callosum length,cerebellar vermis height,and anteroposterior diameter of the cerebellar vermis compared to the control group (t=6.901,7.548,2.320,P<0.05).At 1 year of age,the AD group exhibited delays in adaptive behavior,language,and personal-social development compared to the control group (t=2.147,1.016,4.246,P<0.05).After adjusting for confounding factors,offspring of mothers with AD had an increased risk of language (OR=2.124,95%CI:1.624 - 7.264) and personal-social (OR=2.016,95%CI:2.014 - 6.998) developmental abnormalities (P<0.05). Conclusions Maternal AD is associated with early microstructural changes in offspring brain development and increases the risk of neurobehavioral abnormalities at 1 year of age.Clinically,it is essential to strengthen mental health assessments in pregnant women and enhance postnatal follow-up management to promote maternal and child health.
关键词
产前抑郁 /
脑结构 /
神经行为发育 /
子代
Key words
prenatal depression /
brain structure /
neurobehavioral development /
offspring
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