孕期血压与2岁儿童神经发育关联的前瞻性出生队列研究  

A prospective birth cohort study on the association between gestational blood pressure and neurodevelopment in 2-year-old children

作　　者：肖显赫 陈磊 李延龙 熊兆英 周远忠 夏玮[1] 李媛媛[1] 徐顺清[1] 曾怀才 刘洪秀 Xiao Xianhe;Chen Lei;Li Yanlong;Xiong Zhaoying;Zhou Yuanzhong;Xia Wei;Li Yuanyuan;Xu Shunqing;Zeng Huaicai;Liu Hongxiu(The Institute of Environmental Medicine,School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430056,China;Key Laboratory of Maternal&Child Health and Exposure Science of Guizhou Higher Education Institutes,School of Public Health,Zunyi Medical University,Zunyi 563000,China;School of Public Health,Guilin Medical University,Guilin 541100,China)

机构地区：[1]华中科技大学同济医学院公共卫生学院环境医学研究所,武汉430030 [2]华中科技大学同济医学院附属武汉儿童医院,武汉430056 [3]遵义医科大学公共卫生学院,贵州省高等学校孕妇儿童健康与暴露科学重点实验室,遵义563000 [4]桂林医学院公共卫生学院,桂林541100

出　　处：《中华预防医学杂志》2024年第9期1302-1310,共9页Chinese Journal of Preventive Medicine

基　　金：国家自然科学基金(22006046);贵州省科技计划项目[QKHPTRC-CXTD(2022)014];贵州省教育厅科学研究项目[QJJ(2023)019];桂林医科大学广西环境暴露组学与全生命周期健康重点实验室开放项目(2023-GKLEH-02)。

摘　　要：目的研究孕期血压与2岁儿童神经发育之间的关联。方法基于“武汉健康宝贝出生队列”,选取3754对母婴为研究对象。基于孕期多次血压测量数据,计算全孕期和各孕期的血压均值、累积血压、血压变异。血压变异采用标准差(SD)、变异系数(CV)、独立于均值的变异率(VIM)评估。随访测试婴幼儿2岁时的神经发育,获得智力发育指数(MDI)和运动发育指数(PDI)。采用多重线性回归和广义估计方程分析孕期血压数据与神经发育指数之间的关联。结果3754名孕妇的年龄为(29.1±3.6)岁,孕前BMI为(20.9±2.7)kg/m^(2),分娩孕周为(39.3±1.2)周。3754名儿童出生体重为(3330.9±397.7)g,出生身长为(50.3±1.6)cm。多重线性回归模型分析结果显示,在调整了相关混杂因素后,全孕期收缩压、舒张压、脉压的平均血压、累积血压、血压标准差、血压变异系数、独立于均值的血压变异率,均与2岁儿童MDI和PDI得分呈负向关联。广义估计方程分析结果显示,调整了相关混杂因素后,孕早、中、晚期平均收缩压均与MDI、PDI具有负向关联;累积血压与MDI、PDI的负向关联仅在孕早期被发现;孕期血压变异与MDI、PDI的负向关联则主要集中在孕中、晚期。结论孕期血压与2岁儿童神经发育指数呈负向关联。Objective To investigate the association between gestational blood pressure and neurodevelopment in 2-year-old children.Methods Based on the"Wuhan Healthy Baby Birth Cohort",3754 mother-infant pairs were enrolled in this study.Based on multiple blood pressure measurements during pregnancy,the mean,cumulative,and variability of blood pressure throughout the entire pregnancy and each trimester were calculated.Blood pressure variability was evaluated using standard deviation(SD),coefficient of variability(CV),and variability independent of mean(VIM).Follow-up testing of neurodevelopment in infants and young children at the age of two was conducted to obtain the Mental Development Index(MDI)and the Psychomotor Development Index(PDI).The multivariate linear regression and generalized estimation equation were used to analyze the association between gestational blood pressure data and neurodevelopmental index.Results The age of 3754 pregnant women was(29.1±3.6)years,with a pre-pregnancy BMI of(20.9±2.7)kg/m^(2)and a gestational age of(39.3±1.2)weeks.The birth weight of 3754 children was(3330.9±397.7)grams,and the birth length was(50.3±1.6)centimeters.The results of the multivariate linear regression analysis showed that after adjusting for relevant confounding factors,the mean blood pressure,cumulative blood pressure,standard deviation of blood pressure,coefficient of variation of blood pressure,independent blood pressure variability of systolic blood pressure,diastolic blood pressure,and pulse pressure throughout pregnancy were negatively associated with the MDI and PDI scores of 2-year-old children.The analysis results of the generalized estimation equation showed that after adjusting for relevant confounding factors,the average systolic blood pressure in the first,second,and third trimesters was negatively associated with MDI/PDI.The negative association between cumulative blood pressure and MDI/PDI was only found in the first trimester.The negative association between blood pressure variation during pregnancy a

关 键 词：血压 妊娠 神经发育 儿童 队列研究 血压变异 

分 类 号：R172[医药卫生—妇幼卫生保健]