早发型重度子痫前期孕妇分娩早产儿3～4岁时体格发育及行为问题的回顾性研究
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摘要
目的比较早发型重度子痫前期(early on-set severe preeclampsia,ES-PE)孕妇与相应孕周非子痫前期孕妇分娩早产儿3~4岁时体格发育和行为问题的差异。方法选择2011年10月-2012年11月中国医科大学附属盛京医院产科收治的ES-PE孕妇分娩的74例早产儿为观察组;同期住院相应孕周非子痫前期孕妇分娩的80例早产儿为对照组,比较两组早产儿出生时的一般情况。通过电话随访方式,依照Conners父母症状问卷(Parents Symptom Questionnaire,PSQ)对两组早产儿3~4岁时的体格发育和行为问题情况进行评估。结果出生时,观察组早产儿身长及体质量均明显低于对照组(P<0.05);随访时,体格发育方面,仅在出生孕周<32周、出生体质量<1 500 g的亚组中,观察组早产儿的体质指数(BMI)明显低于对照组(P<0.05),其余各亚组比较,差异均无统计学意义(P>0.05)。随访时,孕周<32周、出生体质量≥1 500 g亚组中对照组多动评分明显高于观察组(P<0.05),孕周≥32周、出生体质量≥1 500 g的亚组观察组焦虑评分明显高于对照组(P<0.05),其余各行为学项目评分比较,差异均无统计学意义(均P>0.05)。结论 ES-PE对早产儿的发育有一定影响,但是影响有限。加强围产保健、降低ES-PE发生、延长ES-PE患者孕周对于改善ES-PE胎儿预后有意义。
Objective To compare the differences of physical development and behavioral problems of 3-4-year-old premature infants born by pregnant women with early-onset severe preeclampsia and pregnant women without preeclampsia during the same gestational weeks.Methods Seventy-four premature infants born by pregnant women with early-onset severe preeclampsia treated in the hospital from October2011 to November 2012 were selected as observation group; eighty premature infants born by pregnant women without preeclampsia during the same gestational weeks were selected as control group. The general situations of premature infants at birth were compared. Conners Parents Symptom Questionnaire( PSQ) was used to evaluate physical development and behavioral problems of 3-4-year-old premature infants in the two groups by telephone. Results The birth weight and height of premature infants in observation group were statistically significantly lower than those in control group( P <0. 05). During follow-up,body mass index( BMI) values of premature infants with gestational age < 32 week and birth weight<1 500 g in observation group were statistically significantly lower than those in control group( P<0. 05),there was no statistically significant difference among the other subgroups( P>0. 05). During follow-up,the score of hyperactivity in premature infants with gestational age<32 week and birth weight≥1 500 g in control group were statistically significantly higher than those in observation group( P<0. 05); the score of anxiety in premature infants with gestational age≥32 week and birth weight≥1 500 g in observation group were statistically significantly higher than those in control group( P<0. 05); there was no statistically significant difference in the scores of other behavioral indicators( all P > 0. 05). Conclusion Early-onset severe preeclampsia has a certain impact on development of premature infants,but the effect is limited. Strengthening perinatal health care,reducing the occurrence of early-onset severe preeclampsia,and prolonging gestational week of these patients are of significance in improving fetal prognosis.
Objective To compare the differences of physical development and behavioral problems of 3-4-year-old premature infants born by pregnant women with early-onset severe preeclampsia and pregnant women without preeclampsia during the same gestational weeks.Methods Seventy-four premature infants born by pregnant women with early-onset severe preeclampsia treated in the hospital from October2011 to November 2012 were selected as observation group; eighty premature infants born by pregnant women without preeclampsia during the same gestational weeks were selected as control group. The general situations of premature infants at birth were compared. Conners Parents Symptom Questionnaire( PSQ) was used to evaluate physical development and behavioral problems of 3-4-year-old premature infants in the two groups by telephone. Results The birth weight and height of premature infants in observation group were statistically significantly lower than those in control group( P <0. 05). During follow-up,body mass index( BMI) values of premature infants with gestational age < 32 week and birth weight<1 500 g in observation group were statistically significantly lower than those in control group( P<0. 05),there was no statistically significant difference among the other subgroups( P>0. 05). During follow-up,the score of hyperactivity in premature infants with gestational age<32 week and birth weight≥1 500 g in control group were statistically significantly higher than those in observation group( P<0. 05); the score of anxiety in premature infants with gestational age≥32 week and birth weight≥1 500 g in observation group were statistically significantly higher than those in control group( P<0. 05); there was no statistically significant difference in the scores of other behavioral indicators( all P > 0. 05). Conclusion Early-onset severe preeclampsia has a certain impact on development of premature infants,but the effect is limited. Strengthening perinatal health care,reducing the occurrence of early-onset severe preeclampsia,and prolonging gestational week of these patients are of significance in improving fetal prognosis.
引文
[1]Aarnoudse-Moens CS,Weisglas-Kuperus N,Van-Goudoever JB,et al.Meta-ananlysis of neurobehaioral outcomes in very preterm and/or very low weight children[J].Pediarics,2009,124(2):717-728.
[2]冉霓.秦伟.早产低出生体质量与注意缺陷多动障碍的相关研究进展[J].中国儿童保健杂志,2015,23(5):494-497.
[3]Wilson-Costello D.Is there evidence that long-term outcomes have improved with intensive care?[J].Semin Fetal Neonatal Med,2007,12(5):344-354.
[4]苏林雁.李雪荣.董春香.等.Conners父母症状问卷的中国城市常模[J].中国临床心理学杂志,2001,9(4):241.
[5]宋芳.Conners父母、教师问卷在3-7岁儿童中的临床应用研究[J].中国儿童保健杂志,2004,10(5):376-378.
[6]谢幸.苟文丽.妇产科学[M].第8版,北京:人民卫生出版社.2013:64-71.
[7]邓莹,熊菲,吴蒙蒙,等.61例极低出生体质量早产儿生后第一年生长发育的随访[J].中国当代儿科组织杂志,2016,18(6):482-287.
[8]江雯,邱双燕,蒋雪明,等.不同出生胎龄早产儿生长发育趋势分析[J].中国儿童保健杂志,2016,24(7):742-745.
[9]陈飒英,孙京惠,王云峰,等.不同胎龄早产儿1岁时体格和神经发育差异分析[J].中国新生儿科杂志,2011,26(3):177-180.
[10]Mc Nicholas F,Healy E,White M,et al.Medical,cognitive and academic outcomes of very low birth weight infants at age 10-14years in Ireland[J].Ir J Med Sci,2014,183(4):525-532.
[11]Wan JP,Zhao H,Li T,et al.The common variant rs11646213 is associated with preelcampsia in Han Chinese women[J].PLo S One,2012,47(6):e71202.
[12]Lapillonne A.Intrauterine growth retardation and adult outcome[J].Bull Acad Natl Med,2011,195(3):477-484.
[13]Hack M,Schluchter M,Margevicius S,et al.Trajecrouy and correlates of growth of extremely low birth weight adolescents[J].Pediatr Res,2014,75(2):358-366.
[14]Linnet KM,Wisborg K,Agerbo E,et al.Gestational age,birth weight and the risk of hyperkinetic disorder[J].Arch Dis Child,2006,91(8):655-660.
[15]Hack M,Adult outcomes of preterm children[J].J Dev Behav Pediatr,2009,30(5):460-470.
[16]Kim MS,Yu JH,Lee MY,Et al.Differential expression of extracellular matrix and adhesion molecules in fetal-origin amniotic epithelial cells of preeclamptic pregnancy[J].PLo S One,2016,11(5):e0156038.
[17]Palmer KR,Kaitu'u-Lino TJ,Cannon P,et al.Maternal plasma concentrations of the placental specific s FLT-1 variant,s FLT-1e15a,in fetal growth restriction and preeclampsia[J].J Matern Fetal Neonatal Med,2017,30(6):635-639.
[18]He J,Zhang A,Fang M.et al.Methylation levels at IGF2 and GNAS DMRs in infants born to preeclamptic pregnancies[J].BMC Genomics,2013,14:472-479.
[19]Skjaerven R,Wilcox AJ,Lie RT,et al.The interval between pregnancies and the risk of preeclampsia[J].N Eng J Med,2002,346(1):33-38.
[20]Jasovic-Siveska E,Jasovic V,Stoilova S,et al.Previous pregnancy history,parity,maternal age and risk of pregnancy induced hypertension[J].Bratisl Listy,2011,112(4):188-191.
[21]Rouse DJ,Hirtz DG,Thom E,et al.A randomized,controlled trial of magnesium fate for the prevention of cerebral palsy[J].N Engl J Med,2008,359(9):895-905.
[22]Reeves SA,Gibbs RS,Clack SL.Magnesium for fetal neuroprotection[J].Am J Obstet Gynecol,2011,204(3):202-221.
[23]Doyle LW,Crowther CA,Middleton P,et al.Magnesium sulphate for women at risk of preterm birth for neurprotection of the fetus[J].Cochrane Database Syst Rev,2009,1:CD004661.
[24]Report of the American College of Obstetricians and Gynecologists’Task Force on Hypertension in pregnancy.Hypertension in pregnancy:executive summary[J].Obstet Gynecol,2013,122(5):1122-1131.
[2]冉霓.秦伟.早产低出生体质量与注意缺陷多动障碍的相关研究进展[J].中国儿童保健杂志,2015,23(5):494-497.
[3]Wilson-Costello D.Is there evidence that long-term outcomes have improved with intensive care?[J].Semin Fetal Neonatal Med,2007,12(5):344-354.
[4]苏林雁.李雪荣.董春香.等.Conners父母症状问卷的中国城市常模[J].中国临床心理学杂志,2001,9(4):241.
[5]宋芳.Conners父母、教师问卷在3-7岁儿童中的临床应用研究[J].中国儿童保健杂志,2004,10(5):376-378.
[6]谢幸.苟文丽.妇产科学[M].第8版,北京:人民卫生出版社.2013:64-71.
[7]邓莹,熊菲,吴蒙蒙,等.61例极低出生体质量早产儿生后第一年生长发育的随访[J].中国当代儿科组织杂志,2016,18(6):482-287.
[8]江雯,邱双燕,蒋雪明,等.不同出生胎龄早产儿生长发育趋势分析[J].中国儿童保健杂志,2016,24(7):742-745.
[9]陈飒英,孙京惠,王云峰,等.不同胎龄早产儿1岁时体格和神经发育差异分析[J].中国新生儿科杂志,2011,26(3):177-180.
[10]Mc Nicholas F,Healy E,White M,et al.Medical,cognitive and academic outcomes of very low birth weight infants at age 10-14years in Ireland[J].Ir J Med Sci,2014,183(4):525-532.
[11]Wan JP,Zhao H,Li T,et al.The common variant rs11646213 is associated with preelcampsia in Han Chinese women[J].PLo S One,2012,47(6):e71202.
[12]Lapillonne A.Intrauterine growth retardation and adult outcome[J].Bull Acad Natl Med,2011,195(3):477-484.
[13]Hack M,Schluchter M,Margevicius S,et al.Trajecrouy and correlates of growth of extremely low birth weight adolescents[J].Pediatr Res,2014,75(2):358-366.
[14]Linnet KM,Wisborg K,Agerbo E,et al.Gestational age,birth weight and the risk of hyperkinetic disorder[J].Arch Dis Child,2006,91(8):655-660.
[15]Hack M,Adult outcomes of preterm children[J].J Dev Behav Pediatr,2009,30(5):460-470.
[16]Kim MS,Yu JH,Lee MY,Et al.Differential expression of extracellular matrix and adhesion molecules in fetal-origin amniotic epithelial cells of preeclamptic pregnancy[J].PLo S One,2016,11(5):e0156038.
[17]Palmer KR,Kaitu'u-Lino TJ,Cannon P,et al.Maternal plasma concentrations of the placental specific s FLT-1 variant,s FLT-1e15a,in fetal growth restriction and preeclampsia[J].J Matern Fetal Neonatal Med,2017,30(6):635-639.
[18]He J,Zhang A,Fang M.et al.Methylation levels at IGF2 and GNAS DMRs in infants born to preeclamptic pregnancies[J].BMC Genomics,2013,14:472-479.
[19]Skjaerven R,Wilcox AJ,Lie RT,et al.The interval between pregnancies and the risk of preeclampsia[J].N Eng J Med,2002,346(1):33-38.
[20]Jasovic-Siveska E,Jasovic V,Stoilova S,et al.Previous pregnancy history,parity,maternal age and risk of pregnancy induced hypertension[J].Bratisl Listy,2011,112(4):188-191.
[21]Rouse DJ,Hirtz DG,Thom E,et al.A randomized,controlled trial of magnesium fate for the prevention of cerebral palsy[J].N Engl J Med,2008,359(9):895-905.
[22]Reeves SA,Gibbs RS,Clack SL.Magnesium for fetal neuroprotection[J].Am J Obstet Gynecol,2011,204(3):202-221.
[23]Doyle LW,Crowther CA,Middleton P,et al.Magnesium sulphate for women at risk of preterm birth for neurprotection of the fetus[J].Cochrane Database Syst Rev,2009,1:CD004661.
[24]Report of the American College of Obstetricians and Gynecologists’Task Force on Hypertension in pregnancy.Hypertension in pregnancy:executive summary[J].Obstet Gynecol,2013,122(5):1122-1131.