Soil-transmitted helminth infection in pregnancy and long-term child neurocognitive and behavioral development: A prospective mother-child cohort in Benin.
Soil-transmitted helminth infection in pregnancy and long-term child neurocognitive and behavioral development: A prospective mother-child cohort in Benin.
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DOI：
10.1371/journal.pntd.0009260
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发表时间：
2021-03
影响因子：
3.8
通讯作者：
Bodeau-Livinec F
中科院分区：
文献类型：
--
作者：
Garrison A;Boivin M;Khoshnood B;Courtin D;Alao J;Mireku M;Ibikounle M;Massougbodji A;Cot M;Bodeau-Livinec F
据估计，撒哈拉以南非洲30%的妇女在怀孕期间患有土壤传播蠕虫感染（SHIP），这已被证明会增加早产，低出生体重和孕产妇贫血的风险。贝宁先前的一项研究发现，SHIP与635名一岁儿童的认知和大运动发育评分受损有关。本研究的目的是前瞻性地跟踪儿童，以调查SHIP与儿童神经认知和行为发育之间的关联是否在6岁时持续存在。我们的前瞻性儿童队列包括487名参加在贝宁阿拉达进行的妊娠期疟疾预防替代药物临床试验的活产单胎孕妇。通过收集和检测粪便样本，在三次产前访视（ANV）时评估SHIP。由经过培训的研究人员使用儿童考夫曼评估成套测验第2版和父母报告的优势和困难问卷（SDQ）评估6岁儿童的神经认知和行为发育。多元线性回归模型生成的系数和95%置信区间和潜在的中介因素进行了测试。SHIP的患病率在第一次ANV时为13%，在第二次ANV时为9%，在分娩时为1%。SHIP与6岁儿童的低神经认知评分无关。较高的SDQ内化评分，表明儿童的情绪障碍增加，与蠕虫感染在第二次ANV/交付1.07（95% CI 0.15，2.00）和至少一次在怀孕期间0.79（95% CI 0.12，1.46）在调整后的模型。调解分析没有发现显着的间接影响，几个调解员对这种关联。我们的研究表明，虽然SHIP与长期神经认知发育受损无关，但感染可能对6岁儿童的情感发育产生重大负面影响。SHIP仍然是一个关键的公共卫生问题，应在低收入和中等收入国家执行适当的预防和治疗方案。土壤传播的蠕虫感染每年影响15亿人，主要是在低收入和中等收入国家，并导致儿童营养不良，贫血和神经认知发育受损。然而，妊娠期的这些感染及其对后代的影响研究较少。先前的一项研究发现，怀孕期间土壤传播的蠕虫感染与出生后一年的后代认知功能受损之间存在关联。目前的研究旨在前瞻性地跟踪这些儿童，直到六年，以确认这些关联是否持续存在。妊娠期感染不再与儿童的认知或运动功能相关;然而，感染与行为发育受损相关。基于动物的模型假设母体炎症和不良的出生结局是这种关系背后的机制;然而，我们的研究结果并不支持这些机制。这是在撒哈拉以南非洲进行的为数不多的前瞻性队列研究之一，以调查这些关联，需要更多的研究来证实结果。局限性包括功效有限以及结果可能是由于多个统计检验的偶然性。应向低收入和中等收入国家感染风险高的人口提供适当和可获得的孕期和儿童期预防和治疗服务。
An estimated 30% of women in Sub-Saharan Africa suffer from soil-transmitted helminth infection during pregnancy (SHIP), which has been shown to increase risk of pre-term birth, low birth weight, and maternal anemia. A previous study in Benin found that SHIP was associated with impaired cognitive and gross motor development scores in 635 one-year-old children. The objective of the present study was to follow children prospectively to investigate whether the association between SHIP and child neurocognitive and behavioral development persisted at age six. Our prospective child cohort included 487 live-born singletons of pregnant women enrolled in the Malaria in Pregnancy Preventive Alternative Drugs clinical trial in Allada, Benin. SHIP was assessed at three antenatal visits (ANVs) through collection and testing of stool samples. Neurocognitive and behavioral development was assessed in six-year-old children by trained investigators using the Kaufman Assessment Battery for Children 2nd edition and the parent-reported Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression models generated coefficients and 95% confidence intervals and potential mediating factors were tested. Prevalence of SHIP was 13% at the 1st ANV, 9% at the 2nd ANV, and 1% at delivery. SHIP was not associated with low neurocognitive scores in children at six years. Higher SDQ internalizing scores, indicating increased emotional impairments in children, were associated with helminth infection at the 2nd ANV/delivery 1.07 (95% CI 0.15, 2.00) and at least once during pregnancy 0.79 (95% CI 0.12, 1.46) in adjusted models. Mediation analysis did not reveal significant indirect effects of several mediators on this association. Our study shows that while SHIP is not associated with impaired long-term neurocognitive development, infections may have significant negative impacts on emotional development in six-year-old children. SHIP remains a critical public health issue, and adequate prevention and treatment protocols should be enforced in low- and middle-income countries. Soil-transmitted helminth infections impact 1.5 billion individuals, primarily in low- and middle- income countries, each year and contribute to malnutrition, anemia, and impaired neurocognitive development in children. However, these infections in pregnancy and their impact on offspring have been less studied. One previous study found associations between soil-transmitted helminth infection during pregnancy and impaired cognitive functioning in offspring one year after birth. The current study aimed to follow these children prospectively until six years in order to confirm whether these associations persisted or not. Infections during pregnancy were no longer associated with cognitive or motor functioning in children; however, infections were associated with impaired behavioral development. Animal-based models have hypothesized maternal inflammation and poor birth outcomes to be the mechanisms behind this relationship; however, our findings did not support these mechanisms. This is one of very few prospective cohort studies in Sub-Saharan Africa to investigate these associations, and more research is needed to corroborate results. Limitations include limited power and the possibility that results are due to chance from multiple statistical tests. Adequate and accessible prevention and treatment efforts in pregnancy and childhood should be provided to populations in low- and middle- income countries at high risk of infection.
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