【作者】 李明；

【导师】 邵子瑜；

【作者基本信息】 安徽医科大学 ， 公共卫生（儿少卫生与妇幼保健学）， 2021， 硕士

【摘要】 目的描述合肥市孕妇孕早期叶酸水平分布特征、子代6月龄和12月龄生长发育特征,探讨孕妇孕早期叶酸水平以及婴儿血清营养素与婴儿智能发育的关联。方法依据合肥市行政区域经济发展水平和地理位置情况选取四个区,在各区随机抽取1个孕产妇保健手册办理单位,将2019年1月至2019年6月孕早期(12—12+6周)办理《孕产妇保健手册》的孕妇作为目标人群,在确定的时间内,按照随机抽样和自愿参与的原则,选取研究对象。采用自编调查问卷《孕早期血清叶酸水平与婴儿智能发育相关性研究调查表》和《儿童生长发育监测手册》进行基线资料调查和生长发育监测,同时采集孕妇孕早期肘静脉血来检测叶酸水平,采集子代6、12月龄末梢血检测微量元素和维生素含量。采用多因素线性回归分析孕妇血清叶酸水平与婴儿智力发育水平间的关系。结果孕早期叶酸平均浓度为16.75±3.92ng/ml,其中有4.8%的孕妇叶酸水平较低。6月龄婴儿中,沟通、粗大动作、精细动作、解决问题、个人—社会能力发育迟缓率依次分别为4.2%、4.2%、4.2%、7.1%、4.2%;12月龄婴幼儿沟通、粗大动作、精细动作、解决问题、个人—社会能力发育迟缓率依次分别为6.3%、6.3%、6.3%、5.3%、5.3%;小于胎龄儿(small for gestational age infant,SGA)、低出生体重儿(Low birth weight infant,LBWI)的发生率在低叶酸、正常组和高叶酸三组的差异具有统计学意义;控制了相关的混杂性保护因子后我们发现,与低叶酸组相比,正常叶酸组(OR=0.112,95%CI:0.2～0.639)是SGA发生的保护因素,正常叶酸组(OR=0.127,95%CI:0.018～0.888)也是LBWI发生的保护因素。相关性评价分析结果显示,6月龄粗大动作能区得分与铜含量呈正相关(r=0.221,P<0.05),粗大动作能区得分与维生素A含量呈正相关(r=0.226,P<0.05);精细动作能区得分与钙含量呈正相关(r=0.227,P<0.01)。12月龄沟通动作能区得分与维生素A含量呈正相关(r=0.233,P<0.05),12月龄智能(MDI)得分与婴儿体内锌含量呈正相关(r=0.336,P<0.01),与婴儿体内铁含量呈正相关(r=0.264,P<0.01),与婴儿体内维生素D含量也呈正相关(r=0.237,P<0.05)。控制相关混杂因素后发现,铜与6月龄粗大动作能区得分的偏回归系数β为0.708,维生素A与6月龄粗大动作能区得分的偏回归系数β为1.186,钙与6月龄精细动作能区得分的偏回归系数β为1.768。锌与12月龄智能得分的偏回归系数β为0.528,铁与12月龄智能得分的偏回归系数β为0.641,维生素D与12月龄智能得分的偏回归系数β为0.540。结论合肥市孕妇孕早期叶酸水平状况良好,孕早期叶酸水平正常是低出生体重和早产发生的保护因素。6月龄精细动作能区得分与铜和维生素A的含量有关,精细动作能区得分与钙含量有关。12月龄沟通动作能区得分与维生素A含量有关,12月龄智能得分与婴儿体内锌、铁及维生素D均有关。孕早期叶酸水平对婴幼儿智力发育的影响在统计上虽无关联,但低出生体重和早产的保护因素间接对婴幼儿神经系统发育也有保护作用。更多还原

【Abstract】 Objectives To describe the distribution characteristics of folic acid level of pregnant women in early pregnancy and the growth and developmental retardation of infants at the age of 6and 12 months in Hefei,and discuss the relationship between folate level in early pregnancy and infant serum nutrients and infant intelligent development.MethodsFour districts were selected according to the economic development level and geographic location of Hefei’s administrative region,and one unit that handled the Maternal Health Handbook was randomly selected from each district,and pregnant women who had handled the Maternal Health Handbook in the first trimester(12—12+6 weeks)as the target population,within a certain period of time,according to the principle of random sampling and voluntary participation,select the research objects.Self-made questionnaires "Research Questionnaire on the Correlation between Serum Folate Levels in Early Pregnancy and Infant Intelligence Development" and "Children’s Growth and Development Monitoring Manual" were used to conduct baseline data surveys and growth and development monitoring.At the same time,pregnant women’s elbow vein blood was collected in early pregnancy to detect folate level,Collect the peripheral blood of the offspring at the age of 6 and 12 months to detect the content of trace elements and vitamins.Multivariate linear regression was used to analyze the relationship between maternal serum folate level and infant intelligence development level.ResultsThe average concentration of folate in the first trimester was 16.75±3.92ng/ml,and4.8% of pregnant women had low folate levels.Among 6-month-old infants,the rates of communication,gross movements,fine movements,problem solving,and personal-social development delays were 4.2%,4.2%,4.2%,7.1%,and 4.2%respectively,for 12-month-old infants,communication,gross the rates of motor,fine motor,problem-solving,and personal-social capacity development delays were 6.3%,6.3%,6.3%,5.3%,and 5.3% respectively,the incidence of SGA and LBWI were in the low folate,normal and high folate groups.The difference is statistically significant,after controlling for the related confounding protection factors,we found that compared with the low folate group,the normal folate group(OR=0.112,95%CI: 0.2～0.639)is smaller than the gestational age(small for the protective factor for gestational age infant(SGA),the normal folate group(OR=0.127,95%CI: 0.018～0.888)is also the protective factor for low birth weight infant(LBWI).Correlation analysis results showed that the gross motor energy zone score was positively correlated with copper content at 6 months of age(r=0.221,P<0.05),and the gross motor energy zone score was positively correlated with vitamin A content(r=0.226,P<0.05),The fine motor energy zone score was positively correlated with calcium content(r=0.227,P<0.01).The 12-month-old communication performance zone score was positively correlated with vitamin A content(r=0.233,P<0.05),and the 12-month-old intelligence(MDI)score was positively correlated with the infant’s zinc content(r=0.336,P<0.01).The iron content of infants was positively correlated(r=0.264,P<0.01),and it was also positively correlated with the vitamin D content of infants(r=0.237,P<0.05).After controlling for the related confounding factors,it was found that the partial regression coefficient βbetween copper and the gross motor energy zone score at 6 months was 0.708,the partial regression coefficient β between vitamin A and the gross motor energy zone score at 6 months was 1.186,and calcium and 6 months old fine,the partial regression coefficient β of the performance zone score is 1.768.The partial regression coefficient βbetween zinc and 12-month-old intelligence score was 0.528,the partial regression coefficient β between iron and 12-month-old intelligence score was 0.641,and the partial regression coefficient β between vitamin D and 12-month-old intelligence score was 0.540.ConclusionsThe folate level of pregnant women in Hefei is in good condition in the first trimester.Normal folate level in the early trimester is a protective factor for low birth weight and premature delivery.The 6-month-old fine motor energy zone score is related to the content of copper and vitamin A,and the fine motor energy zone score is related to the calcium content.The 12-month-old communicative energy zone score is related to the vitamin A content,and the 12-month-old intelligence score is related to the zinc,iron and vitamin D in the baby.Although the influence of folate levels in early pregnancy on infants’ mental development is not statistically relevant,the protective factors of low birth weight and premature delivery indirectly also have protective effects on infants’ nervous system development.更多还原