Effect of pregnancy planning and fertility treatment on cognitive outcomes in children at ages 3 and 5: longitudinal cohort study.
Effect of pregnancy planning and fertility treatment on cognitive outcomes in children at ages 3 and 5: longitudinal cohort study.
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DOI：
10.1136/bmj.d4473
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发表时间：
2011-07-26
期刊：
影响因子：
--
通讯作者：
Quigley MA
中科院分区：
文献类型：
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作者：
Carson C;Kelly Y;Kurinczuk JJ;Sacker A;Redshaw M;Quigley MA
目的 调查怀孕计划、受孕时间和不孕不育治疗如何影响 3 岁和 5 岁的认知发展。设计基于人群的前瞻性队列研究。在英国开展千年队列研究。参与者 18 818 名儿童在 9 个月时招募，并在 3 和 5 岁时进行随访。 11~790 名具有妊娠、认知结果和混杂因素可用数据的单身人士被纳入 3 岁时的分析和 12~136 名 5 岁时的分析中。 暴露措施 母亲报告是否计划怀孕，以及第一次怀孕时的感受；计划怀孕的人提供了受孕时间以及任何辅助生殖技术的详细信息。人群被分为“无计划”（无计划且不快乐）、“不合时宜”（无计划但快乐）、“计划”（计划，受孕时间<12个月）、“生育力低下”（计划，受孕时间≥12个月）、“诱导排卵”（接受克罗米芬柠檬酸盐）和“辅助生殖”（体外受精或胞浆内单精子注射）。 “计划”组是所有分析中的对照组。结果衡量英国能力量表 (BAS II) 的三个组成部分。命名词汇评估 3 岁时的言语能力；这项测试在 5 岁时重复进行，使用图片相似性和模式构建子量表来衡量非语言和空间能力。结果 在未经调整的分析中，计划外怀孕的儿童在所有量表上的得分均显着低于计划怀孕的儿童，例如，3岁时平均语言能力得分的差异为-4.8（95%置信区间-6.0至-3.7；P<0.05），相当于平均延迟四个月。在对社会人口因素进行调整后，这些差异有所减弱：-0.3（-1.3至0.7），相当于没有延迟。辅助生殖后出生的孩子在语言能力测试中始终表现得更好（3岁时为3.8（-0.2至7.9），5岁时为3.5（0.2至6.8）），这表明这些孩子平均领先三到四个月；随着混杂因素的调整，这种差异并没有完全消失。不孕症治疗后出生的儿童在非语言测试（辅助生殖后为-1.2（-4.1至1.6），诱导排卵后为-1.5（-3.5至0.4））和空间能力测试（辅助生殖后为-2.7（-6.9至1.6））的平均得分较低，但差异并不显着。结论 计划怀孕、生育力低下或辅助生殖不会对 3 岁或 5 岁儿童的认知发展产生不利影响。未经调整的分析中观察到的差异几乎完全可以用各组之间社会经济环境的明显不平等来解释。
Objective To investigate how pregnancy planning, time to conception, and infertility treatment influence cognitive development at ages 3 and 5. Design Prospective population based cohort study. Setting Millennium Cohort Study in the United Kingdom. Participants 18 818 children recruited at 9 months and followed up at 3 and 5 years. 11 790 singletons with available data on pregnancy, cognitive outcomes, and confounders were included in analyses at age 3 and 12 136 at age 5. Exposure measures Mothers reported whether the pregnancy was planned, and their feelings when first pregnant; those in whom the pregnancy was planned provided time to conception, and details of any assisted reproductive technologies. The population was divided into “unplanned” (unplanned and unhappy), “mistimed” (unplanned but happy), “planned” (planned, time to conception <12 months), “subfertile” (planned, time to conception ≥12 months), “induced ovulation” (received clomiphene citrate), and “assisted reproduction” (in vitro fertilisation or intracytoplasmic sperm injection). The “planned” group was the comparison group in all analyses. Outcome measures Three components of the British Ability Scales (BAS II). Naming vocabulary assessed verbal ability at age 3; this test was repeated at age 5 with the picture similarities and pattern construction subscales, which measure non-verbal and spatial abilities. Results In unadjusted analyses, the scores on all scales in children from unplanned pregnancies were significantly lower than in those from planned pregnancies—for example, the difference in mean verbal ability score at age 3 was −4.8 (95% confidence interval −6.0 to −3.7; P<0.05), equivalent to an average delay of four months. After adjustment for sociodemographic factors these differences were attenuated: −0.3 (−1.3 to 0.7), equivalent to no delay. Children born after assisted reproduction performed consistently better in verbal ability tests (3.8 (−0.2 to 7.9) at age 3 and 3.5 (0.2 to 6.8) at age 5), which suggests that on average these children are three to four months ahead; this difference did not completely disappear with adjustment for confounders. Children born after infertility treatment had lower mean scores in non-verbal tests (−1.2 (−4.1 to 1.6) after assisted reproduction and −1.5 (−3.5 to 0.4) after induced ovulation) and in spatial ability tests (−2.7 (−6.9 to 1.6) after assisted reproduction), though the differences were not significant. Conclusions Pregnancy planning, subfertility, or assisted reproduction do not adversely affect children’s cognitive development at age 3 or 5. The differences observed in the unadjusted analyses are almost entirely explained by marked inequalities in socioeconomic circumstances between the groups.
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