LONGITUDINAL ANALYSES OF PRENATAL AND POSTNATAL LEAD-EXPOSURE AND EARLY COGNITIVE-DEVELOPMENT
LONGITUDINAL ANALYSES OF PRENATAL AND POSTNATAL LEAD-EXPOSURE AND EARLY COGNITIVE-DEVELOPMENT
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DOI：
10.1056/nejm198704233161701
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发表时间：
1987-04-23
影响因子：
158.5
通讯作者：
RABINOWITZ, M
中科院分区：
文献类型：
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作者：
BELLINGER, D;LEVITON, A;RABINOWITZ, M
在对249名从出生到2岁的儿童进行的前瞻性队列研究中，我们评估了产前和产后铅暴露与早期认知发育之间的关系。根据脐带血中的铅水平，将儿童分为三个产前暴露组之一：低（< 3 μ g/dl）、中（6 - 7 μ g/dl）或高（≥ 3 μ g/dl）。10 μ g/分升）。从六个月大开始，每半年评估一次发育，使用贝利婴儿发育量表的智力发育指数（平均值± 0.标准差，100 ±。16）。在同一时间获得的毛细血管血液样本提供了出生后铅暴露的措施。纵向数据的回归方法被用来评估婴儿的铅水平和他们的发展分数调整后的潜在混杂因素之间的关联。在所有年龄段，高产前暴露组的婴儿得分低于其他两组。低暴露组和高暴露组的总体表现之间的估计差异为4.8分（95%置信区间，2.3至7.3）。在中等和高暴露组之间，估计差异为3.8点（95%置信区间，1.3至6.3）。得分与婴儿出生后血铅水平无关。似乎胎儿在血铅浓度远低于25 μ g/分升时可能受到不利影响，该水平目前由疾病控制中心定义为幼儿可接受的最高水平。
In a prospective cohort study of 249 children from birth to two years of age, we assessed the relation between prenatal and postnatal lead exposure and early cognitive development. On the basis of lead levels in umbilical-cord blood, children were assigned to one of three prenatal-exposure groups: low (< 3 .mu.g per deciliter), medium (6 to 7 .mu.g per deciliter), or high (.gtoreq. 10 .mu.g per deciliter). Development was assessed semiannually, beginning at the age of six months, with use of the Mental Development Index of the Bayley Scales of Infant Development (mean .+-. SD, 100 .+-. 16). Capillary-blood samples obtained at the same times provided measures of postnatal lead exposure. Regression methods for longitudinal data were used to evaluate the association between infants'' lead levels and their development scores after adjustment for potential confounders. At all ages, infants in the high-prenatal-exposure group scored lower than infants in the other two groups. The estimated difference between the overall performance of the low-exposure and high-exposure groups was 4.8 points (95 percent confidence interval, 2.3 to 7.3). Between the medium- and high-exposure groups, the estimated difference was 3.8 points (95 percent confidence interval, 1.3 to 6.3). Scores were not related to infants'' postnatal blood lead levels. It appears that the fetus may be adversely affected at blood lead concentrations well below 25 .mu.g per deciliter, the level currently defined by the Centers for Disease Control as the highest acceptable level for young children.