摘要
目的分析学龄前儿童情绪与行为问题的生命早期影响因素，探讨母亲孕期情绪症状与学龄前儿童情绪和行为问题之间的关联。方法基线资料来源于中国安徽出生队列（C-ABCS）中的马鞍山市出生队列。该队列于2008年10月至2010年10月在马鞍山市4家市级医疗卫生机构接受孕期保健的孕妇中招募研究对象，共计5084名孕妇及4669名单胎活产儿进入队列；分别采用《焦虑自评量表》和《流行病调查中心抑郁自评量表》评价孕期焦虑和抑郁症状。于2014年4月至2015年4月对队列进行随访，采用家长填写的长处与困难量表（SDQ）了解儿童情绪与行为问题发生情况，共随访有SDQ评定结果的3～6学龄前儿童3653名。采用多因素logistic回归模型分析孕期焦虑、抑郁症状与学龄前儿童情绪和行为问题之间的关联。结果学龄前儿童情绪症状、品行问题、多动、同伴交往异常率分别为6．3％（229／3653）、7．5％（274／3653）、7．6％（278／3653）、2．8％（103／3653）；困难总分异常率为7．6％（277／3653）；亲社会行为异常率为10．9％（398／3653）；影响因子异常率为27．4％（981／3577）。母亲孕早期焦虑、抑郁的检出率分别为2．7％（100／3653）、4．7％（171／3653）；母亲孕中期焦虑、抑郁的检出率分别为2．0％（66／3375）、3．6％（122／3375）。多因素logistic回归模型分析结果显示，控制孕龄、户口、家庭收入、母亲文化程度、父亲文化程度等混杂因素，与母亲孕早、中期均无焦虑症状症状儿童的相比，母亲孕早、中期均有焦虑症状儿童情绪症状异常的风险较高，0R（95％CI）值为5．90（2．00～17．48）；与母亲孕早、中期均无抑郁症状症状儿童的相比，母亲孕早、中期均有抑郁症状儿童情绪症状异常的风险较高，0R（95％CI）值为3．07（1．30一7．28）；与母亲孕中期无焦虑症状的儿童相比，母亲孕中期有焦虑症状儿童困难总分异常的风险较高，0R（95％c，）值为2．27（1．10—4．71）；与母亲孕中期无抑郁症状的儿童相比，母亲孕中期有抑郁症状儿童困难总分异常的风险较高，0R（95％CI）值为2．20（1．24～3．93）；母亲孕期情绪症状与子代品行问题、多动、同伴交往和亲社会行为关联均无统计学意义（P〉0．05）。结论母亲孕期焦虑和抑郁症状对学龄前儿童情绪和行为问题有着负面的影响，积极开展孕前和孕期教育，使母亲保持健康积极的孕期情绪可能会减少或预防儿童情绪和行为问题的发生。
Objective To investigate the related influencing factors of preschool children＇s emotional and behavioral problems in early life and explore the associations between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children. Methods Based on the Ma＇anshan Birth Cohort Study of the China-Anhui Birth Cohort Study （C-ABCS）,women were recruited at their first clinical visit between October 2008 and October 2010 in four municipal medical and health institutions of Ma＇anshan City, a total of 5 084 pregnant women and 4 669 singletons live births were included in the birth cohort. Women completed measures of depressive （Self-Rating Anxiety scale） and anxious （Center for Epidemiologic Studies Depression） symptoms in pregnancy. By the age of 3-6 follow-up, 3 653 children were followed with completed information between April 2014 and April 2015, strengths and difficulties questionnaires were used to assessed offspring emotional and behavioral problems. Logistics regression was used to investigate the relationship between the symptoms of depression or anxiety during pregnancy and emotional and behavioral problems in preschool children. Results The detected rates of emotional symptoms, conduct problems, hyperactivity and peer problems in preschool children were 6.3%（229/3 653）, 7.5%（274/3 653）, 7.6%（278/3 653） and 2.8%（103/3 653）, while 7.6%（277/3 653）for total difficulties, 10.9%（398/3 653） for prosocial behavior and 27.4%（981/3 557） for impact respectively. Prevalence of anxiety and depression in the first trimester was 2.7%（100/3 653） and 4.7%（171/3 653） respectively, and in the second trimester was 2.0%（66/3 375） and 3.6%（122/3 375） respectively. After we controlled the confoundings of gestation age, place of residence, family income, maternal education, paternal education, premature birth and folic acid supplement before pregnancy, multinomial logistic regression analysis showed that the risk of children＇s emotional symptoms in maternal anxiety in both first-trimester and second-trimester group was higher than the group of no depression and anxiety symptoms, and OR（95%CI） was 5.90（2.00- 17.48）. Compared with whose mother no depression in both first-trimester and second-trimester, the risk of children＇s emotional symptoms in maternal depression in both first-trimester and second-trimester group was higher, and 0R（95%CI） was 3.07 （1.30-7.28）. And the risk of children＇s total difficulties of maternal anxiety in second-trimester was 2.27 （95%CI： 1.10-4.71） times of no anxiety in second-trimester. While the risk of children＇s total difficulties of maternal depression in second-trimester was 2.20 （95%CI： 1.24-3.93） times of no depression in second-trimester. Maternal emotional symptoms were not significant associations with conduct problems, hyperactivity, peer problems and prosocial behaviors （P〉 0.05）. Conclusion There was a negative impact of maternal anxiety and depression symptoms during pregnancy on emotional and behavioral problems in preschool children. These findings highlight the need for additional clinical and research attention to both maternal depression and anxiety in pregnancy, which may be helpful to reduce the incidence of children＇s emotional and behavioral problems and act as an important measure in prevention.
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2016年第2期129-135,共7页
Chinese Journal of Preventive Medicine
基金
国家自然科学基金（81373012、81330068）
关键词
儿童
学龄前
情绪
怀孕期间
行为
队列研究
Child,preschool
Emotions
Peripartum period
Behavior
Cohort studies
