孕中晚期妊娠相关焦虑与幼儿18月龄孤独症样行为的队列研究

摘要

Objective To investigate the relationship of pregnancy-related anxiety of pregnant women in second/third trimesters and autism-like behaviors in their offspring at 18 months of age.Methods Based on a prospective cohort study design,we evaluated the situation of pregnancy-related anxiety of women during second and third trimesters through a Pregnancy-Related Anxiety Questionnaire.Subjects under study were classified into three groups,1) those with pregnancy-related anxiety during both trimesters,2) those with pregnancy-related anxiety at one trimester and 3) those without pregnancy-related anxiety in either trimester.When their children were 18 months,autism-like behaviors (ALB) were evaluated,using the part A of Checklist for Autism in Toddlers-23,and then classified into three groups as non-ALB group,minor ALB group and major ALB group.Multi-nominal logistic Regression was used to analyze the relationship of pregnancy-related anxiety with autism-like behaviors.Results Compared with non-ALB group,children whose mother with pregnancy-related anxiety during both trimesters presented significant higher risk on ALB than children whose mother without pregnancy-related anxiety in these two periods (relative risk,RR=2.43,95％ CI:1.21-4.86,P=0.012),major factors as pregnant women's IQ and gestational diabetes mellitus,premature delivery and education levels of fosterers on these pregnant women were under control.Our results from the stratified analysis showed:when in the subgroup that mother was the main fosterer of the child,there was an significant increase of risk in children whose mothers with pregnancy-related anxiety during both trimesters (RR=4.22,95％ CI:1.73-10.32,P=0.002).Conclusion The association between pregnancy-related anxiety and autism-like behavior was not strong but influenced by the fosterer of the child.%目的 探讨孕中晚期妊娠相关焦虑与其子女18月龄时孤独症样行为的关系.方法 应用前瞻性队列研究设计,分别在孕中期、孕晚期采用《妊娠相关焦虑量表》评定孕妇妊娠相关焦虑症状,在儿童1 8月龄时运用《婴幼儿孤独症筛查表-23》A部分评定幼儿孤独症样行为.使用多项logistic回归法分析孕期妊娠相关焦虑对幼儿孤独症样行为的影响.结果 控制协变量后,与无孤独症样行为组相比,孕中晚期均有妊娠相关焦虑者子女比2个孕期均无妊娠相关焦虑者子女更容易发生较多孤独症样行为(RR=2.43,95％CI:1.21 ～ 4.86).但按主要带养人是否为幼儿母亲进行分层后发现,仅在主要带养人为母亲情况下,孕中晚期均有妊娠相关焦虑组子女18月龄时发生较多孤独症样行为的风险,显著高于孕中晚期均无妊娠相关焦虑组(RR=4.22,95％CI:1.73 ～10.32),在主要带养人不是母亲情况下并不显著.结论 孕中晚期妊娠相关焦虑与幼儿孤独症样行为的关系并不强劲,受儿童带养人情况的影响.