妊娠相关焦虑对学龄前儿童执行功能的影响及性别差异

谢晶晶; 王晓旭; 严双琴; 徐叶清; 朱鹏; 郝加虎; 陶芳标; 黄锟

doi:10.16835/j.cnki.1000-9817.2021.09.020

妊娠相关焦虑对学龄前儿童执行功能的影响及性别差异

doi: 10.16835/j.cnki.1000-9817.2021.09.020

谢晶晶^{1, 2},
王晓旭^{1, 2},
严双琴³,
徐叶清³,
朱鹏^{1, 2},
郝加虎^{1, 2},
陶芳标^{1, 2},
黄锟^{1, 2, 4, ,}

1.
安徽医科大学公共卫生学院儿少卫生与妇幼保健学系/出生人口健康教育部重点实验室/人口健康与优生安徽省重点实验室，合肥 230032
2.
国家卫生健康委配子及生殖道异常研究重点实验室
3.
马鞍山市妇幼保健院
4.
安徽医科大学公共卫生学院预防医学科研实验中心

基金项目:

国家重点研发计划 2016YFC1000204-2

国家自然科学基金 81872630

科技部科技基础资源调查专项 2017FY101107

详细信息

作者简介:
谢晶晶(1995-)，女，安徽阜阳人，在读硕士，主要研究方向为环境优生

通讯作者:
黄锟，E-mail: ahmuhaungk@163.com

中图分类号: G 444 B 844.1
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- 被引次数: 0
出版历程
- 收稿日期: 2020-12-29
- 修回日期: 2021-01-28
- 网络出版日期: 2021-09-24
- 刊出日期: 2021-09-24

Effect of pregnancy-related anxiety on executive function of preschool children and gender difference

XIE Jingjing^{1, 2},
WANG Xiaoxu^{1, 2},
YAN Shuangqin³,
XU Yeqing³,
ZHU Peng^{1, 2},
HAO Jiahu^{1, 2},
TAO Fangbiao^{1, 2},
HUANG Kun^{1, 2, 4
, ,}

1.
Departmetn of Maternal Child and Adolescent Health School of Public Health/Key Laboratory of Population Health Across Life Cycle/Anhui Provincial Key Laboratory of Population Health and Aristogenics, Anhui Medical University, Hefei(230032), China

摘要

摘要: 目的探讨母体妊娠相关焦虑对子代学龄前执行功能(EFs)的影响及性别差异，以期针对性优化子代生命早期发育环境。方法选取中国安徽出生队列2008年10月—2010年10月在安徽省马鞍山市妇幼保健院孕早期建卡的孕妇，收集孕妇一般情况和妊娠相关焦虑情况。对队列内的3 556名3~5岁儿童进行随访，收集儿童相关特征，采用《学龄前儿童执行功能评定量表》(父母版)评价其执行功能。结果与对照组相比，仅孕早期存在妊娠相关焦虑与学龄前男童工作记忆、计划/组织功能和总执行功能(GEC)异常风险有关[OR 值(95%CI)分别为 1.40(1.06~1.85)，1.64(1.06~2.54)，1.89(1.27~2.82)]；孕早、晚期同时存在妊娠相关焦虑与学龄前男童抑制、工作记忆、计划/组织功能和 GEC 异常风险有关[ OR值(95%CI)分别为 2.60(1.45~4.67)，2.45(1.69~3.57)，2.23(1.28~3.88)，3.27(2.03~5.28)]。仅孕早期存在妊娠相关焦虑与学龄前女童抑制和工作记忆异常有关[OR 值(95%CI)分别为 1.79(1.13~2.83)，1.45(1.07~1.98)]；仅孕晚期存在妊娠相关焦虑与学龄前女童抑制功能异常有关[OR 值(95%CI)= 2.26(1.17~4.38)]；孕早、晚期同时存在妊娠相关焦虑与学龄前女童抑制和工作记忆功能异常风险有关[OR 值(95%CI)分别为 2.45(1.40~4.28)，2.02(1.35~3.01)]。结论妊娠相关焦虑显著影响子代学龄前儿童执行功能，并存在剂量反应关系。妊娠相关焦虑在男童中主要影响工作记忆、计划/组织功能和总执行功能，在女童主要影响其工作记忆和抑制功能。
- 妊娠 /
- 焦虑 /
- 精神卫生 /
- 回归分析 /
- 儿童，学龄前
Abstract: Objective To understand the effect of pregnancy-related anxiety on preschool children's executive functions(EFs) and gender difference in order to optimize the early development environment of offspring life. Methods This study was based on the China-Anhui Birth Cohort Study. Pregnant women from Maternal and Child Health Care Hospital in Ma'anshan, Anhui province between October 2008 and October 2010 were recruited. The general information of pregnant women and the pregnancy-related anxiety were collected prospectively in the first trimester of pregnancy. A cohort of 3 556 children aged 3-5 were followed up and their basic characteristics were collected. Executive function of preschool children was assessed by Behavior Rating Inventory of Executive Function-Preschool Version(BRIEF) (parent version). Results In boys compared with the control group pregnancy￣related anxiety in the first trimester of pregnancy was associated with the risk of abnormality in working memory planning/organization and GEC[OR(95%CI) = 1.40(1.06-1.85), 1.64(1.06-2.54), 1.89(1.27-2.82)]. Anxiety in the both trimesters of pregnancy was as-sociated with the risk of abnormality in inhibition working memory planning/organization and GEC[OR(95%CI) = 2.60(1.45-4.67), 2.45(1.69-3.57), 2.23(1.28-3.88), 3.27(2.03-5.28)] . In girls pregnancy-related anxiety in the first trimester of pregnancy was associated with the risk of abnormality in inhibition and working memory [OR(95%CI) = 1.79(1.13-2.83), 1.45(1.07-1.98)] . Anxiety in the third trimester of pregnancy was associated with the risk of abnormality in inhibition [OR(95%CI) = 2.26(1.17-4.38)] . Anxiety in both trimesters of pregnancy was associated with the risk of abnormality in inhibition and working memory [OR(95%CI) = 2.45(1.40-4.28), 2.02(1.35-3.01)] . Conclusion Pregnancy-related anxiety significantly affected the executive function of preschool children, and there was a significant dose-response relationship. Pregnancy-related anxiety primarily affects working memory, planning/organization and GEC function in boys, and the working memory, inhibition function in girls.
- Pregnancy /
- Anxiety /
- Mental health /
- Regression analysis /
- Child, preschool

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表 1 母亲和儿童基本情况男女童分布特征

Table 1. Distribution of mothers and children

变量	选项	男童(n=1 915)	女童(n=1 641)
家庭人均月收入/元^a	< 2 000	1 071(55.9)	981(59.8)
	2 000~3 999	696(36.3)	541(33.0)
	≥4 000	142(7.4)	118(7.2)
母亲孕早期居住地^a	农村	235(12.3)	200(12.2)
	城市	1 675(87.5)	1 440(87.8)
不良孕产史^a	有	930(48.6)	777(47.3)
	无	984(51.4)	864(52.7)
妊娠合并症^a	有	278(14.5)	233(14.2)
	无	1 619(84.5)	1 396(85.1)
分娩方式	自然分娩	629(32.8)	559(34.1)
	剖宫产	1 286(67.2)	1 082(65.9)
产次^a	初产妇	1 806(94.3)	1 569(95.6)
	经产妇	108(5.6)	71(4.3)
孕周/周^a	< 37	63(3.3)	57(3.5)
	37~38	493(25.7)	369(22.5)
	39~40	1 166(60.9)	1 011(61.6)
	≥41	179(9.3)	195(11.9)
4个月内喂养方式^a	纯母乳	680(35.5)	624(38.0)
	非纯母乳	1 194(62.3)	981(59.8)
3岁前父母带养	高比例	831(43.4)	747(45.5)
	非高比例	1 084(56.6)	894(54.5)
近半年儿童主要居住地	市区	1 708(89.2)	1 456(88.7)
	非市区	207(10.8)	185(11.3)
注：()内数字为构成比；a表示有缺失值。

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表 2 不同性别儿童母亲不同妊娠相关焦虑下执行功能异常检出率比较

Table 2. Comparison of relevance ratio of abnormal executive function in different pregnancy-related anxiety among mothers of different sex children

儿童性别	母亲焦虑分组	人数	统计值	抑制	转换	情绪控制	工作记忆	计划/组织	总执行功能
男	孕早期	322		24(7.5)	8(2.5)	14(4.3)	93(28.9)	34(10.6)	42(13.0)
	孕晚期	121		8(6.6)	3(2.5)	5(4.1)	29(24.0)	11(9.1)	13(10.7)
	孕早期和孕晚期	136		16(11.8)	5(3.7)	8(5.9)	58(42.6)	18(13.2)	29(21.3)
	对照组	1 336		67(5.0)	22(1.6)	46(3.4)	288(21.6)	81(6.1)	96(7.2)
			χ²值	11.59	3.35	2.37	33.88	15.17	35.67
			P值	< 0.01	0.34	0.50	< 0.01	0.00	< 0.01
女	孕早期	304		34(11.2)	18(5.9)	4(1.3)	83(27.3)	18(5.9)	30(9.9)
	孕晚期	103		12(11.7)	5(4.9)	1(1.0)	25(24.3)	5(4.9)	9(8.7)
	孕早期和孕晚期	137		19(13.9)	8(5.8)	3(2.2)	43(31.4)	5(3.6)	13(9.5)
	对照组	1 097		67(6.1)	49(4.5)	11(1.0)	204(18.6)	36(3.3)	72(6.6)
			χ²值	29.53	4.14	2.66	41.40	8.59	11.07
			P值	< 0.01	0.25	0.45	< 0.01	0.04	0.01
注：()内数字为检出率/%

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表 3 母亲妊娠相关焦虑与学龄前男童执行功能关联的Logistic回归分析[n = 1 915, OR 值(OR 值 95%CI)]

Table 3. Logistic regression analysis between mother's pregnancy-related anxiety and executive function in preschool boys[n = 1 915, OR(OR 95%CI)]

母亲焦虑组别	模型	抑制	转换	情绪控制	工作记忆	计划/组织	总执行功能
孕早期	模型1	1.53(0.94~2.47)	1.52(0.67~3.45)	1.28(0.69~2.35)	1.47(1.12~1.94)^*	1.83(1.20~2.79)^*	1.94(1.32~2.85)^*
	模型2	1.51(0.92~2.48)	1.13(0.45~2.87)	1.25(0.66~2.34)	1.40(1.06~1.85)^*	1.64(1.06~2.54)^*	1.89(1.27~2.82)^*
孕晚期	模型1	1.34(0.63~2.86)	1.52(0.45~5.15)	1.21(0.47~3.10)	1.15(0.74~1.78)	1.55(0.80~3.00)	1.56(0.84~2.87)
	模型2	1.48(0.69~3.17)	1.52(0.45~5.16)	1.25(0.49~3.22)	1.15(0.74~1.79)	1.52(0.78~2.97)	1.67(0.90~3.10)
孕早期和孕晚期	模型1	2.53(1.42~4.50)^*	2.28(0.85~6.12)	1.75(0.81~3.80)	2.71(1.88~3.89)^*	2.36(1.37~4.07)^*	3.50(2.21~5.55)^*
	模型2	2.60(1.45~4.67)^*	1.96(0.66~5.78)	1.86(0.86~4.03)	2.45(1.69~3.57)^*	2.23(1.28~3.88)^*	3.27(2.03~5.28)^*
注：*P < 0.05。

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表 4 母亲妊娠相关焦虑与学龄前女童的执行功能关联的Logistic回归分析[n = 1 641, OR 值(OR 值 95%CI)]

Table 4. Logistic regression analysis between mother's pregnancy-related anxiety and executive function in preschool girls[n = 1 641, OR(OR 95%CI)]

母亲焦虑组别	模型	抑制	转换	情绪控制	工作记忆	计划/组织	总执行功能
孕早期	模型1	1.94(1.25~2.99)^*	1.35(0.77~2.35)	1.32(0.42~4.16)	1.65(1.22~2.21)^*	1.86(1.04~3.32)^*	1.56(0.99~2.44)
	模型2	1.79(1.13~2.83)^*	1.21(0.68~2.16)	1.35(0.43~4.27)	1.45(1.07~1.98)^*	1.44(0.77~2.71)	1.42(0.89~2.27)
孕晚期	模型1	2.03(1.06~3.89)^*	1.09(0.43~2.80)	0.97(0.12~7.57)	1.40(0.87~2.26)	1.50(0.58~3.92)	1.36(0.66~2.81)
	模型2	2.26(1.17~4.38)^*	1.14(0.44~2.97)	0.98(0.13~7.65)	1.35(0.82~2.21)	1.74(0.66~4.63)	1.46(0.70~3.06)
孕早期和孕晚期	模型1	2.48(1.44~4.26)^*	1.33(0.61~2.86)	2.21(0.61~8.02)	2.00(1.35~2.96)^*	1.12(0.43~2.90)	1.49(0.80~2.77)
	模型2	2.45(1.40~4.28)^*	1.41(0.65~3.10)	2.18(0.60~7.91)	2.02(1.35~3.01)^*	1.01(0.38~2.67)	1.52(0.81~2.88)
注：*P < 0.05。

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