摘要目的 探讨选择性剖宫产(ECS)对婴儿发育行为的影响.方法 将2013年5月至2014年9月于安徽省马鞍山市妇幼保健院进行产检并在马鞍山市居住>6个月的3474名孕妇纳入研究,排除妊娠终止者162名、双胎者39名、助产者14名、紧急剖宫产者76名及未知分娩方式者141名,共有3042对母婴进入最终分析.采用自制《孕产期母婴健康记录表》获取孕产妇人口学特征、孕产史、孕期生活方式及相关疾病等情况;从产科记录中获得婴儿基本情况及分娩方式信息.分别在婴儿6和18月龄时应用《年龄与发育进程问卷(第3版)》(ASQ-3)进行沟通、粗大动作、精细动作、解决问题和个人-社会5个能区的发育评估.采用多因素非条件logistic回归模型分析选择性剖宫产与婴儿发育行为的关系.结果 ECS率为47.5%(1443/3042),其中无指征和有指征ECS率分别为27.2%(826/3042)和20.3%(617/3042).调整孕妇人口学特征、孕期暴露情况及婴儿基本情况后,与自然分娩相比,无指征ECS和有指征ECS会增加6月龄婴儿粗大动作发育迟缓的风险[RR(95%CI)分别为1.72(1.08~2.77)和1.87(1.11~3.15)],无指征ECS会降低6月龄婴儿精细动作发育迟缓的风险[RR(95%CI)为0.48(0.28~0.82)];无指征和有指征ECS对18月龄婴儿沟通、粗大动作、精细动作、问题解决和个人-社会的发育行为的影响均无统计学意义,无指征ECS组RR(95%CI)值分别为0.86(0.43~1.74)、1.55(0.86~2.78)、0.74(0.49~1.15)、1.10(0.68~1.78)和1.17(0.66~2.08),有指征ECS组RR(95%CI)值分别为0.33(0.12~1.02)、1.10(0.55~2.21)、0.79(0.48~1.29)、0.58(0.29~1.13)和1.48(0.78~2.81).结论 ECS影响6月龄婴儿的运动发育,未发现对18月龄婴儿发育行为有影响.

abstractsObjective To investigate the effect of elective cesarean section (ECS) on infants' developmental behaviors. Methods A total of 3 474 pregnant women living in Ma'anshan more than 6 months and accepting obstetric examination in Ma'anshan Maternal and Child Care Center were recruited from May 2013 to September 2014.Excluding participants with pregnancy termination(162),twin pregnancy (39),assisted delivery(14),emergency cesarean section(76)and unclear delivery mode(141),3 042 pair of mother and infant entered the final analysis. Information of maternal basic demographic characteristics, pregnancy histories, pregnancy life style and pregnancy-related diseases were collected by using self-complied Maternal and Child Health Questionnaire. Information of infants' general condition and delivery modes were acquired from obstetric record.The Ages and Stages Questionnaires-third edition was used to assess infants'communication,gross motor,fine motor,problem solving and person-social function, which was completed at age of 6 months old and 18 months old, respectively. And multi-factor non-conditional logistic regression model was used to analyze the association between ECS and infants' developmental behaviors. Results The prevalence of ECS was 47.5% (1 443/3 042), among which ECS without medical indication and ECS with medical indication were 27.2% (826/3 042) and 20.3% (617/3 042), respectively. After maternal demographic characteristics, pregnant exposure and infants' basic information adjusted, compared to women with vaginal delivery, both ECS with medical indication and without medical indication increased the risk of a delay in gross motor on infants at 6 months old (RR (95% CI:1.72(1.08-2.77)and 1.87(1.11-3.15),respectively.)ECS without indication decreased the risk of a delay in fine motor on infants at 6 months old(RR(95% CI):0.48(0.28-0.82)),both ECS without medical indication and with medical indication had no statistically significant effect on 18 months infants' communication, gross motor, fine motor, problem solving and person-social function, the RR (95% CI) for ECS without medical indication were 0.86(0.43-1.74),1.55(0.86-2.78),0.74(0.49-1.15),1.10(0.68-1.78) and 1.17(0.66-2.08),respectively;and the RR(95% CI)for ECS with medical indication were 0.33(0.12-1.02), 1.10 (0.55- 2.21), 0.79 (0.48- 1.29), 0.58 (0.29- 1.13) and 1.48 (0.78- 2.81), respectively. Conclusion ECS affected motor development in infants at the age of 6 months old,and no influence was found in infants at the age of 18 months old.