摘要目的:探讨产前钼暴露与学龄前儿童内化和外化问题的关联及其潜在的性别特异性。方法:研究对象为马鞍山优生优育队列2 514对母子对，收集孕妇孕早、中和晚期外周血以及新生儿脐带血样本，使用电感耦合等离子体质谱仪检测孕妇外周血和新生儿脐带血血清钼浓度。采用1.5~5.0岁儿童行为量表中文版评估4岁儿童内化和外化问题。血清钼浓度经lg转换，划分为低（< P25）、中（ P25~ P75）和高（≥ P75）水平组，运用二分类logistic回归模型分析钼暴露与儿童内化和外化问题发生风险之间的关联。 结果:调整混杂因素后发现，与血清钼低水平组相比，孕妇整个孕期血清钼中水平组儿童内化问题发生风险增加（ OR=1.32，95% CI：1.02~1.72）；新生儿脐带血血清钼高水平组儿童外化问题发生风险增加（ OR=1.72，95% CI：1.05~2.82）。孕妇孕早期和孕晚期血清钼水平与儿童内化和外化问题发生风险之间无统计学关联（均 P>0.05）。性别分层分析表明，与血清钼低水平组相比，孕妇整个孕期血清钼中水平组（ OR=1.84，95% CI：1.26~2.67）、高水平组（ OR=1.62，95% CI：1.06~2.49）男童内化问题发生风险均增加，但在女童中未发现这种关联。 结论:孕期钼水平与儿童内化问题发生风险呈显著正相关，新生儿脐带血高水平钼会增加儿童外化问题发生风险。性别分层分析显示，孕期血清钼水平与男童内化问题发生风险呈显著正相关。

abstractsObjective:To understand the association of prenatal molybdenum exposure with internalizing and externalizing problems in preschool children and potential sex-specific differences.Methods:A total of 2 514 mother-child pairs were inclided from Ma'anshan Birth Cohort. Maternal peripheral venous blood samples were collected during the first, second, and third trimesters of pregnancy, and neonatal cord blood samples were collected at birth, and serum molybdenum concentrations were measured using inductively coupled plasma-mass spectrometry. The Child Behavior Checklist for age 1.5-5.0 was used to assess children's internalizing and externalizing problems at 4 years old. We converted serum molybdenum concentrations by lg transformation and divided serum molybdenum concentrations into low (< P25), medium ( P25- P75), and high (≥ P75) level groups according to the distribution of serum molybdenum levels. Binary logistic regression models were used to analyze the association between the exposure to molybdenum and the risk for internalizing and externalizing problems in children. Results:After adjusting for confounders, it was found that the risk for internalizing problems increased in children in serum molybdenum moderate-level group ( OR=1.32,95% CI:1.02-1.72) compared with the serum molybdenum low-level group in the whole pregnancy. The serum molybdenum high-level group in neonatal umbilical cord blood ( OR=1.72, 95% CI: 1.05-2.82) was associated with the increased risk for externalizing problems in children. The associations between serum molybdenum levels and the risk for childhood internalizing and externalizing problems were not significant in both the first trimester and third trimester of pregnancy (all P>0.05). Sex-stratified analyses showed an increased risk for internalizing problems in boys in the context of the moderate-level ( OR=1.84,95% CI:1.26-2.67) and high-level ( OR=1.62,95% CI: 1.06-2.49) of serum molybdenum in the whole pregnancy compared with low-level group, but no association was found in girls. Conclusions:Molybdenum level during pregnancy showed significant positive association with the risk for internalizing problems in children, and high level of molybdenum in neonatal umbilical cord blood increased the risk for externalizing problem. Sex-stratified analysis showed that serum molybdenum level during pregnancy showed significant positive association with the risk for internalizing problem in boys.