Associations between maternal exposure to surgery or pregnancy exposure to fluorinated anesthetics and children's cognitive development and educational outcomes
Associations between maternal exposure to surgery or pregnancy exposure to fluorinated anesthetics and children's cognitive development and educational outcomes
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DOI：
10.1017/s2040174422000472
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发表时间：
2022-08-15
影响因子：
1.7
通讯作者：
Keim, Sarah A.
中科院分区：
文献类型：
--
作者：
Kravets, Melissa E.;Klebanoff, Mark A.;Keim, Sarah A.
麻醉的跨代表观遗传效应，特别是氟化物，已经在大鼠模型中进行了检测，但对人类的翻译尚不清楚。这项研究考察了母亲终生麻醉暴露和妊娠暴露于含氟麻醉剂与儿童认知和教育结果的关系。美国合作围产期项目(1959-1963)的女性报告了终身手术史，产科记录记录了怀孕期间接触麻醉剂的情况。对儿童的全球认知能力和教育结果进行跟踪，直到7岁(n=47,977)。对母婴出生年限、人种和民族、吸烟、教育程度、产次、学习地点进行了Logistic回归和线性回归分析。许多结果与发生在不同生命阶段的产妇手术无关。然而，儿童早期的产妇手术与是否在特殊学校上学(ADJ OR=1.42；95%CI为1.02，1.98)和儿童时期略好的认知能力(例如，WISC智商(ADJβ=0.59；CI 0.13，1.04)(尤其是在男孩中))有关。青春期的产妇手术与7岁时智商略低(ADJ(β=-0.42；CI-0.79，-0.05))和拼写较差有关。出生前接触含氟麻醉药的儿童在7岁时拼写能力略好(ADJβ=1.20；CI 0.02，2.38)，但操作智商较低(仅在男孩中，ADJβ=-1.97；CI-3.88，-0.06)。这项研究表明，母亲接受手术或产前暴露于氟化物对儿童发育和教育结果的影响的证据不一致，适应症和社会经济地位的残留混淆可能解释了观察到的关联。
A transgenerational, epigenetic effect of anesthesia, particularly fluorinated agents, has been examined in rat models, but translation to humans is unclear. This study examined associations of maternal lifetime exposure to anesthesia and pregnancy exposure to fluorinated anesthetics with child cognitive and educational outcomes. Women in the US Collaborative Perinatal Project (1959-1963) reported lifetime history of surgeries, and the obstetric record captured pregnancy exposure to anesthetics. Children were followed to age 7 for global cognitive ability and educational outcomes (n=47,977). Logistic and linear regressions were adjusted for maternal and child birth years, race and ethnicity, smoking, education, parity, study site. Many outcomes were not associated with exposure to maternal surgery that occurred at various life stages. However, maternal surgery in early childhood was associated both with being in a special school or not in school (adj OR=1.42; 95% CI 1.02, 1.98) and with slightly better cognitive ability across childhood (e.g., WISC IQ (adj beta=0.59; CI 0.13, 1.04) (especially among boys)). Maternal surgery in puberty was associated with slightly lower IQ (adj (beta = -0.42; CI -0.79, -0.05) and poorer spelling at age 7. Children's prenatal exposure to fluorinated anesthetics was associated with slightly better spelling ability (adj beta = 1.20; CI 0.02, 2.38) but lower performance IQ at age 7 (only among boys, adj beta = -1.97; CI -3.88, -0.06). This study shows inconsistent evidence of effects of maternal exposure to surgery or prenatal exposure to fluorinated agents on child developmental and educational outcomes Residual confounding by indication and socioeconomic status may explain observed associations.