摘要目的 明确生命早期不同时期铁缺乏对儿童运动发育的影响.方法 纵向研究,共纳入114名出生于2010年4月至2011年12月的杭州市富阳区儿童(男58名、女56名).基于脐血和9月龄铁营养状况测定,分为出生前铁缺乏组(34名)、出生后铁缺乏组(37名)、铁充足组(43名).对114名儿童在9月龄、18月龄和5周岁时分别采用Peabody运动发育量表和BOT2-简版评估运动能力;利用多层线性模型纵向分析儿童随年龄的运动发育趋势及不同时期铁缺乏对儿童运动发育的影响,并调整相关混杂因素后分析不同时期铁缺乏儿童在不同受教育程度家庭环境下的运动发展差异.结果 9月龄、18月龄、5周岁时参与运动发育评估的儿童分别为107、109和114名;进行多种混杂因素控制后,出生前铁缺乏组儿童的运动评分低于铁充足组儿童,差异有统计学意义(52.04比54.05分,β=-2.01,P=0.007);出生后铁缺乏组儿童的运动评分(53.07分)与铁充足组儿童差异无统计学意义(β=-0.98,P=0.180).无论母亲受教育程度高低,出生前铁缺乏组儿童的运动评分均低于铁充足组儿童(49.86比52.15分,49.58比51.58分,β=-2.29、-2.00,P=0.031、0.049).在铁充足组儿童中,母亲受教育程度较高的儿童运动评分更高(52.45比50.46分,β=1.99,P=0.035).结论 出生前铁缺乏儿童的运动发育不能随年龄增长追赶上铁充足儿童,提示预防母亲孕期缺铁的重要性.

abstractsObjective To clarify the impact of pre-and postnatal iron deficiency on children's motor development.Methods This was a longitudinal follow-up study.A total of 114 infants (58 boys,56 girls) born from April 2010 to December 2011 in Fuyang district of Hangzhou were enrolled.Based on cord blood and 9-month iron status,subjects were divided into prenatal iron deficiency (34 children),postnatal iron deficiency (37 children) and non-iron deficiency group (43 children).Peabody Developmental Motor Scale and BOT2-simplified version were used to evaluate the motor capacity in infants and preschoolers at 9 months,18 months and 5 years,respectively.Hierarchical linear modeling (HLM) was used to investigate the trajectory of motor development with age,the influence of different timing of early iron deficiency on children's motor development,and the differences (adjusted for possible confounding factors) in motor development in children with pre-or postnatal iron deficiency or non-iron deficiency in different family educational environment.Results At the age of 9 months,18 months and 5 years,107,109,and 114 children were evaluated respectively.After controlling for a variety of confounding factors,it was found that children with prenatal iron deficiency had significantly lower scores of motor development compared with non-iron deficiency children (52.04 vs.54.05 scores,β =-2.01,P=0.007),and that children with postnatal iron deficiency had similar scores of motor development compared with non-iron deficiency children,showing no significant difference (53.07 vs.54.05 scores,β=-0.98,P=0.180).Regardless of the maternal education status,prenatal iron deficiency children always had lower motor scores than non-iron deficiency children (49.86 vs.52.15 and 49.58 vs.51.58 scores,β=-2.29,-2.00;P=0.031,0.049).Among the non-iron deficiency children,those whose mothers had a higher education level had higher motor scores compared with those whose mothers had a lower education level (52.45 vs.50.46 scores,β=1.99,P=0.035).Conclusions The motor development of children with prenatal iron deficiency did not catch up with their counterparts without iron deficiency by 5 years of age.The results indicate the importance of preventing iron deficiency in the fetus.