目的 探讨母血和脐带血胆碱暴露水平对婴儿早期神经行为发育的潜在影响,为促进婴儿神经行为发育提供科学依据。方法 采用前瞻性队列研究,方便抽样选取2023年12月—2024年10月在南通大学附属妇幼保健院单胎足月分娩的产妇及其婴儿。调查产妇孕晚期膳食胆碱摄入情况,采集并检测母血、脐血血清胆碱水平,于婴儿1、3、6月龄采用贝利婴幼儿发展量表-中国城市修订版(BSID-CR)进行神经行为发育评估。采用Spearman等级相关分析膳食胆碱摄入量与母血、脐血胆碱水平的相关性。通过广义估计方程分析母血、脐血胆碱水平与婴儿神经行为发育的关系。结果 共纳入159对母婴进行分析。能量调整后的膳食胆碱摄入量与母血胆碱水平呈正相关(rs=0.300,P＜0.001)。实验检测母血胆碱水平为2.84(2.21,3.98)mmol/L,按中位数分组后,较高母血胆碱组婴儿在3月龄时智力粗分(Waldχ2=4.571)、智力发展指数(Waldχ2=4.622)高于较低组(P＜0.05)。实验检测脐血胆碱水平为1.35(1.01,1.96)mmol/L,按中位数分组后,较高脐血胆碱组婴儿1月龄时智力粗分高于较低组(Waldχ2=3.979,P＝0.046)。结论 母血胆碱水平影响3月龄婴儿智力发展,而脐血胆碱水平与1月龄婴儿智力发展密切相关。应重视孕产妇膳食胆碱摄入情况和婴儿神经行为发育状况,以促进母婴健康。
Abstract
Objective To investigate the potential effect of internal choline exposure on early neurobehavioral development in infants, so as to provide a scientific basis for promoting infants neurobehavioral development. Methods In this prospective cohort study, singleton full-term pregnant women who delivered at the Affiliated Maternity and Child Health Care Hospital of Nantong University between December 2023 and October 2024 and their infants were recruited by convenience sampling. Dietary choline intake in late pregnancy was assessed, and choline levels in maternal blood and cord blood were measured. Infant neurobehavioral development was evaluated at 1, 3, and 6 months of age using the Bayley Scales of Infant Development Revised in Chinese Cities (BSID-CR). Spearman's rank correlation was used to analyze the correlations between dietary choline intake and choline levels in maternal and cord blood. Generalized estimating equations were used to examine the associations between maternal/cord blood choline levels and infant neurobehavioral development. Results A total of 159 mother-infant pairs were included. Energy-adjusted dietary choline intake was positively correlated with maternal blood choline levels (rs=0.300, P<0.001). The choline content in maternal blood was 2.84 (2.21, 3.98) mmol/L. After dichotomization by the median, infants in the higher maternal blood choline group had higher mental raw scores and mental development index at 3 months of age than those in the lower group (Wald χ2=4.571, 4.622, P<0.05). The choline content in cord blood was assayed at 1.35 (1.01, 1.96) mmol/L. After dichotomization by the median, infants in the higher cord blood choline group had higher mental raw scores at 1 month of age than those in the lower group (Wald χ2=3.979, P=0.046). Conclusions Higher maternal blood choline levels are associated with cognitive development in infants at 3 months of age, whereas cord blood choline levels are associated with cognitive development in infants at 1 month of age. Attention should be paid to dietary choline intake during pregnancy and to infant neurobehavioral development, so as to promote maternal and child health.
关键词
胆碱 /
母血 /
脐带血 /
神经行为发育 /
高效液相色谱串联质谱法
Key words
choline /
maternal blood /
cord blood /
neurobehavioral development /
liquid chromatography-tandem mass spectrometry
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基金
南通大学临床医学专项科研基金项目(2023HY003);江苏省妇幼保健协会科研课题(FYX202353);南通市卫健委科研课题(MS2023080)
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