剖宫产与学龄前儿童感觉统合失调的前瞻性队列研究

Association between cesarean section and sensory integration dysfunction in preschool children: a prospective cohort study

摘要:

目的 采用前瞻性队列研究，评价剖宫产与学龄前儿童感觉统合失调的关联。 方法 依托上海交通大学医学院附属新华医院和附属国际和平妇幼保健院2012年建立的多中心母婴队列，于2017年采用儿童感觉统合能力发展评定量表，从前庭平衡、触觉防御和本体觉3个维度评价392名学龄前儿童感觉统合功能。剖宫产出生为暴露因素，阴道分娩者作为对照组。采用多因素logistic回归分析评估剖宫产与感觉统合各维度失调的关联。 结果 学龄前儿童感觉统合失调率为21.9%（86/392），前庭平衡、触觉防御和本体觉失调率分别为5.9%（23/392）、5.4%（21/392）和15.1%（59/392）。调整母亲分娩年龄、母亲受教育程度及儿童出生情况等混杂因素后，剖宫产儿童发生本体觉失调的风险性显著增加（RR=4.16，95%CI：1.41~12.30，P<0.05）。按性别分层分析发现，剖宫产男童本体觉失调的发生风险高于阴道分娩男童（RR=5.75，95%CI：1.26~26.40，P<0.05）。 结论 剖宫产能显著增加学龄前儿童本体觉失调的发生风险，尤其是对男童的影响更为明显。

Abstract:

Objective To study the association between cesarean section and sensory integration dysfunction (SID) in preschool children through a prospective cohort study. Methods Based on the multicenter mother-infant cohort established by the Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the International Peace Maternity and Child Health Hospital Affiliated to Shanghai Jiao Tong University School of Medicine in 2012, the sensory integration functions (three dimensions: vestibular balance, tactile defensiveness, and proprioception) of 392 preschool children were evaluated by the Chinese Children Sensory Integration Capacity Development Rating Scale in 2017. Births by cesarean section were the exposure factors, and the children born by vaginal delivery were enrolled as controls. A multivariable logistic regression analysis was used to evaluate the association of cesarean section with each dimension of SID. Results The prevalence rate of SID was 21.9% (86/392) among the preschool children, and the prevalence rates of vestibular balance disorder, tactile over-responsivity, and proprioceptive disorder were 5.9% (23/392), 5.4% (21/392), and 15.1% (59/392) respectively. After adjustment for the confounding factors including maternal age at delivery and maternal educational level and child birth situation, the cesarean section group had a significant increase in the risk of proprioceptive disorder (RR=4.16, 95%CI: 1.41-12.30, P<0.05). The stratified analysis based on sex showed that the boys born by cesarean section had a significantly higher risk of proprioceptive disorder than those born by vaginal delivery (RR=5.75, 95%CI: 1.26-26.40, P<0.05). Conclusions Cesarean section can significantly increase the risk of proprioceptive disorder in preschool children, especially in boys.