JAMA:晚产儿也许更加聪明,但有风险
2016/06/10
6月6日,发表于《JAMA Pediatrics》杂志上的研究表明,与39周或40周足月儿相比,41周晚生儿认知水平可能更高,但身体机能水平更低。


6月6日,发表于《JAMA Pediatrics》杂志上的研究表明,与39周或40周足月儿相比,41周晚生儿认知水平可能更高,但身体机能水平更低。

曾有研究表明,足月儿长大及成年后将有更健康的机体和认知功能,晚生儿可能有较高的健康并发症风险,但很少有研究揭示晚生儿长期认知和身体机能的相关信息。在该研究中,美国西北大学的研究人员对佛罗里达州的140多万名儿童进行了统计,这些儿童均属于独生子女,出生于1994年至2002年之间,出生时间在妊娠37周至41周之间,其中有80%长大后参加了公立学校。

测量认知和身体机能

研究人员通过三种认知水平分析方法和两种身体机能测量方法评估了这些儿童的认知水平和身体机能,采集了2013年4月至2016年1月之间的相关数据。

认知水平测量包括三个指标:8-15岁之间数学与阅读的平均佛罗里达州综合评估分数、“天才”——被定义为卓越的智力发展及高性能的智力、认知水平低下——被定义为得分在第五百分位的考生或由于残疾免除佛罗里达州综合考评的考生。

身体机能测试主要考察的参数包括,正常新生儿的身体状况及学校记录的相关残疾情况,包括特殊学生教育场所,例如因为说话能力、外形、感觉障碍或由于机体情况长期需要待在医院或家里。

晚生儿表现出更高的认知功能

研究人员比较了妊娠41周晚生儿与妊娠39周或40周足月儿的认知水平和身体机能。三种认知水平检测方法均表明,晚生儿比足月儿认知水平分数更高。结果发现,妊娠41周出生的儿童在小学和中学的平均成绩更高,被归为“天才”的概率比足月儿高2.8%,认知水平低下的概率比足月儿低3.1%。然而,晚生儿在上学年龄身体缺陷的概率比足月儿高2.1%,此外,晚生儿在出生时存在缺陷的概率更大。

研究人员认为,晚生儿在认知和身体机能上可能存在一个“权衡”,晚生儿出生时发生缺陷的风险更大,在儿童期面临的机体挑战更大,但他们具有高水平认知的概率更大,“虽然这篇文章不能作为临床医生的行动指导,但能提供有用的长期信息帮助医生和父母在分娩时做适合的决定。”然而,这项研究存在许多局限性,包括策略术语的不同,语言表达习惯的不同等。

相关链接:

Children born late seem to score better on cognitive tests

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  • Long-term Cognitive and Health Outcomes of School-Aged Children Who Were Born Late-Term vs Full-Term

    Importance Late-term gestation (defined as the 41st week of pregnancy) is associated with increased risk of perinatal health complications. It is not known to what extent late-term gestation is associated with long-term cognitive and physical outcomes. Information about long-term outcomes may influence physician and patient decisions regarding optimal pregnancy length. Objective To compare the cognitive and physical outcomes of school-aged children who were born full term or late term. Design, Setting, and Participants We analyzed Florida birth certificates from 1994 to 2002 linked to Florida public school records from 1998 to 2013 and found 1 442 590 singleton births with 37 to 41 weeks’ gestation in the Florida Bureau of Vital Statistics. Of these, 1 153 716 children (80.0%) were subsequently located in Florida public schools. Linear and logistic regression models were used to assess the association of gestational age with cognitive and physical outcomes at school age. Data analysis took place between April 2013 and January 2016. Exposures Late-term (born at 41 weeks) vs full-term (born at 39 or 40 weeks) gestation. Main Outcomes and Measures There were a number of measures used, including the average Florida Comprehensive Assessment Test mathematics and reading scores at ages 8 through 15 years; whether a child was classified as gifted, defined as a student with superior intellectual development and capable of high performance; poor cognitive outcome, defined as a child scoring in the fifth percentile of test takers or having a disability that exempted him or her from taking the Florida Comprehensive Assessment Test; and Exceptional Student Education placement owing to orthopedic, speech, or sensory impairment or being hospitalbound or homebound. Results Of 1 536 482 children born in Florida from singleton births from 1994 to 2002 with complete demographic information, 787 105 (51.2%) were male; 338 894 (22.1%) of mothers were black and 999 684 (65.1%) were married at time of birth, and the mean (SD) age for mothers at time of birth was 27.2 (6.2) years. Late-term infants had 0.7% of an SD (95% CI, 0.001-0.013; P = .02) higher average test scores in elementary and middle school, 2.8% (95% CI, 0.4-5.2; P = .02) higher probability of being gifted, and 3.1% (95% CI, 0.0-6.1; P = .05) reduced probability of poor cognitive outcomes compared with full-term infants. These cognitive benefits appeared strongest for children with disadvantaged family background characteristics. Late-term infants were also 2.1% (95% CI, −0.3 to 4.5; P = .08) more likely to be physically impaired. Conclusions and Relevance There appears to be a tradeoff between cognitive and physical outcomes associated with late-term gestation. Children born late-term performed better on 3 measures of school-based cognitive functioning but worse on 1 measure of physical functioning relative to children born full term. Our findings provide longer-run information for expectant parents and physicians who are considering delivery at full term vs late term. These findings are most relevant to uncomplicated, low-risk pregnancies.

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