欧盟儿童队列网络中儿童和青少年的早期成长和情感、行为和认知结果：超过109,000人的个体参与者数据荟萃分析

IF 13.6 Q1 HEALTH CARE SCIENCES & SERVICES

Lancet Regional Health-Europe Pub Date : 2025-02-26 DOI:10.1016/j.lanepe.2025.101247

Romy Gonçalves , Sophia Blaauwendraad , Demetris Avraam , Andrea Beneíto , Marie-Aline Charles , Ahmed Elhakeem , Joaquin Escribano , Louise Etienne , Gonzalo García-Baquero Moneo , Ana Gonçalves Soares , Jasmin de Groot , Veit Grote , Dariusz Gruszfeld , Kathrin Guerlich , Monica Guxens , Barbara Heude , Berthold Koletzko , Aitana Lertxundi , Manuel Lozano , Hanan El Marroun , Vincent W.V. Jaddoe

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引用次数: 0

摘要

胎儿和婴儿的发育可能对以后生活中的认知结果和精神病理至关重要。我们评估了从童年到青春期的出生特征和早期生活成长与行为和认知结果的关系。方法采用来自欧洲8个出生队列的109481名儿童的统一数据。以出生体重、胎龄和2岁时体重指数（BMI）为暴露变量。结果包括儿童期（4-10岁）、青春期早期（11-16岁）和青春期晚期（17-20岁）的内化和外化问题、注意缺陷多动障碍（ADHD）、自闭症谱系障碍（ASD）和非言语智商（non-verbal IQ）。我们使用广义线性模型对1阶段个体参与者数据进行meta分析。结果：孕周越大，内化问题（差值为- 0.48 (95% CI: - 0.59, - 0.37)）、外化问题（差值为- 0.34 (95% CI: - 0.44, - 0.23)）和ADHD症状（差值为- 0.38 (95% CI: - 0.49, - 0.27)）得分越低，非言语智商得分越高（差值为0.65 (95% CI: 0.41, 0.89)）。与早产相比，早产与较高的内化问题（差异3.43 (95% CI: 2.52, 4.33)）和外化问题（差异2.31 (95% CI: 1.16, 3.46)）、ADHD症状（差异4.15 (95% CI: 3.15, 5.16)）、ASD症状（差异3.23 (95% CI: 0.37, 6.08)）和较低的非语言智商（差异5.44 (95% CI: - 7.44, - 3.44)）相关。与适当胎龄（AGA）相比，出生时胎龄小（SGA）与较高的ADHD症状（差异4.88 (95% CI: 3.87, 5.90)）和较低的非语言智商（差异- 7.02 (95% CI: - 8.84, - 5.21)）相关。出生时胎龄大与ADHD症状较低（差异为- 1.09 (95% CI: - 1.73, 0.45)）和较高的非语言智商（差异为2.47 (95% CI: 0.77, 4.18)）相关。探索性分析显示，与出生时胎龄合适且2岁时BMI正常的儿童相比，出生时体型较小的SGA儿童的非言语智商得分最低（差异为- 8.14百分位数（95% CI: - 11.89, - 4.39））。胎儿和儿童早期的成长都与整个童年和青春期的情感、行为和认知结果有关。代偿性婴儿生长可能在一定程度上减弱次优胎儿生长的不利影响。未来的研究需要确定通过改善生命早期生长来优化新一代心理健康结果的潜力。本项目获得欧盟地平线2020研究与创新计划(LIFECYCLE，资助协议No . 733206, 2016；EUCAN-Connect资助协议编号824989；ATHLETE，授权协议号874583)。

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Early-life growth and emotional, behavior and cognitive outcomes in childhood and adolescence in the EU child cohort network: individual participant data meta-analysis of over 109,000 individuals

Background

Fetal and infant development might be critical for cognitive outcomes and psychopathology later in life. We assessed the associations of birth characteristics and early life growth with behavior and cognitive outcomes from childhood to adolescence.

Methods

We used harmonized data of 109,481 children from 8 European birth cohorts. Birth weight, gestational age, and body mass index (BMI) tertiles at the age of 2 years were used as the exposure variables. Outcomes included internalizing and externalizing problems and attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and non-verbal intelligence quotient (Non-verbal IQ) in childhood (4–10 years), early adolescence (11–16 years), and late adolescence (17–20 years). We used 1-stage individual participant data meta-analyses using generalized linear models.

Findings

A one-week older gestational age was associated with lower scores for internalizing problems (difference −0·48 (95% CI: −0·59, −0·37)), externalizing problems (difference −0·34 (95% CI: −0·44, −0·23)), and ADHD symptoms (difference −0·38 (95% CI: −0·49, −0·27)), and with higher scores for non-verbal IQ (difference 0·65 (95% CI: 0·41, 0·89)). As compared to term birth, preterm birth was associated with higher internalizing problems (difference 3·43 (95% CI: 2·52, 4·33)) and externalizing problems (difference 2·31 (95% CI: 1·16, 3·46)), ADHD symptoms (difference 4·15 (95% CI: 3·15, 5·16)), ASD symptoms (difference 3·23 (95% CI: 0·37, 6·08)), and lower non-verbal IQ (difference −5·44 (95% CI: −7·44, −3·44)). Small size for gestational age at birth (SGA) in comparison with appropriate size for gestational age (AGA) was associated with higher ADHD symptoms (difference 4·88 (95% CI: 3·87, 5·90)) and lower Non-verbal IQ (difference −7·02 (95% CI: −8·84, −5·21)). Large size for gestational age at birth was associated with lower ADHD symptoms (difference −1·09 (95% CI: −1·73, 0·45)) and higher non-verbal IQ (difference 2·47 (95% CI: 0·77, 4·18)). Explorative analyses showed that as compared to children with an appropriate size for gestational age at birth and a normal BMI at the age of 2 years, children born SGA who remained small at 2 years had the lowest non-verbal IQ score (difference −8·14 percentiles (95% CI: −11·89, −4·39)).

Interpretation

Both fetal and early childhood growth are associated with emotional, behavioral and cognitive outcomes throughout childhood and adolescence. Compensatory infant growth might partly attenuate the adverse effects of suboptimal fetal growth. Future studies are needed to identify the potential for optimizing mental health outcomes in new generations by improving early-life growth.

Funding

This project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement No 733206, 2016; EUCAN-Connect grant agreement No 824989; ATHLETE, grant agreement No 874583).

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来源期刊

Lancet Regional Health-Europe Multiple-

CiteScore

19.90

自引率

1.40%

发文量

260

审稿时长

9 weeks

期刊介绍： The Lancet Regional Health – Europe, a gold open access journal, is part of The Lancet's global effort to promote healthcare quality and accessibility worldwide. It focuses on advancing clinical practice and health policy in the European region to enhance health outcomes. The journal publishes high-quality original research advocating changes in clinical practice and health policy. It also includes reviews, commentaries, and opinion pieces on regional health topics, such as infection and disease prevention, healthy aging, and reducing health disparities.