儿童孤独症的妊娠期和围产期危险因素Meta分析

目的采用Meta分析的方法评价儿童孤独症的妊娠期和围产期危险因素,为儿童孤独症的预防提供科学、客观的参考依据。方法检索PubMed、Embase、Web of Science、中国知网(CNKI)、万方(Wanfang)等数据库,纳入有关病例对照研究,使用Stata14.0软件进行Meta分析。结果母亲年龄>35岁(OR=1.518,95%CI:1.248~1.787)、父亲年龄>35岁(OR=1.180,95%CI:1.083~1.286)、有精神病家族史(OR=3.539,95%CI:2.145~4.934)、妊娠期高血压(OR=1.492,95%CI:1.040~1.910)、妊娠期被动吸烟史(OR=3.035,95%CI:2.040~4.515)、先兆流产(OR=2.201,95%CI:1.355~3.578)、妊娠期并发症(OR=2.673,95%CI:1.620~3.726)、剖宫产(OR=1.290,95%CI:1.118~1.402)、出生时体重<2500g(OR=1.554,95%CI:1.276~1.832)、早产(OR=1.582,95%CI:1.349~1.855)、脐带绕颈(OR=4.876,95%CI:1.058~8.693)、5分钟Apgar评分<7分(OR=1.927,95%CI:1.135~2.719)、新生儿病理性黄疸(OR=4.298,95%CI:2.977~6.162)、儿童性别为男性(OR=3.834,95%CI:2.861~4.808)、先天畸形(OR=1.908,95%CI:1.417~2.569)和未采取母乳喂养(OR=1.713,95%CI:1.250~2.347)是儿童孤独症的危险因素,使用产钳分娩(OR=0.777,95%CI:0.563~0.991)可能是儿童孤独症的保护因素。结论应当做好全孕期的预防保健,尽可能减少妊娠期和围产期高危因素的出现。如果儿童和家庭暴露于危险因素,要密切关注儿童的神经心理发育轨迹。

A meta-analysis:prenatal and perinatal risk factors of autism

Objective To investigate prenatal and perinatal risk factors of autism by means of meta-analysis so as to provide a scientific and objective basis for prevention of autism.Methods The English databases such as PubMed,EMBASE,Web of Science and Chinese databases CNKI and Wanfang were looked over in key searching terms of"autism","autism spectrum disorder","risk factors","children","prenatal","perinatal and neonatal risk factors".The related case-control studies were included and Stata version 14.0 was used to conduct mata-analyses.Results Maternal age>35 years(OR=1.518,95%CI:1.248~1.787),paternal age>35 years(OR=1.180,95%CI:1.083~1.286),family history of psychosis(OR=3.539,95%CI:2.145~4.934),gestational hypertension(OR=1.492,95%CI:1.040~1.910),passive smoking during pregnancy(OR=3.035,95%CI:2.040~4.515),threatened abortion(OR=2.201,95%CI:1.355~3.578),pregnancy complications(OR=2.673,95%CI:1.620~3.726),cesarean section(OR=1.290,95%CI:1.118~1.402),low birth weight(<2500 g)(OR=1.554,95%CI:1.276~1.832),premature labor(OR=1.582,95%CI:1.349~1.855),umbilical cord around neck(OR=4.876,95%CI:1.058~8.693),5 minutes Apgar score<7(OR=1.927,95%CI:1.135~2.719),neonatal pathologic jaundice(OR=4.298,95%CI:2.977~6.162),male gender(OR=3.834,95%CI:2.861~4.808),congenital malformation(OR=1.908,95%CI:1.417~2.569),no breastfeeding(OR=1.713,95%CI:1.250~2.347)were all risk factors of autism.Forceps/vacuum extraction(OR=0.777,95%CI:0.563~0.991)was a protective factor of autism.Conclusion Preventive health care throughout pregnancy should be done better to minimize occurrence of high-risk factors in prenatal and perinatal period.If children and families are exposed to those risk factors mentioned above,more close attention should be paid to neuro-psychological development trace of these children.