Abstract：
BACKGROUND: Previous research has linked prenatal maternal infections to later childhood developmental outcomes and socioemotional difficulties. However, existing studies have relied on retrospectively self-reported survey data, or data on hospital-recorded infections only, resulting in gaps in data collection.
METHODS: This study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, 2011-2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital-diagnosed prenatal infections and receipt of infection-related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6-8 week or 27-30 month health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross-motor-skills, hearing-communication, vision-social-awareness, personal-social, emotional-behavioural-attention and speech-language-communication) and (b) the trimester(s) in which infections occurred.
RESULTS: After confounder/covariate adjustment, hospital-diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19-1.42). This was broadly consistent across all developmental outcome types and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07-1.67) and 3 (OR: 1.33; 95% CI: 1.21-1.47), that is the trimesters in which foetal brain myelination occurs. Infection-related prescriptions were not associated with any clear increase in odds of having at least one developmental concern after confounder/covariate adjustment (OR: 1.03; 95% CI: 0.98-1.08), but were associated with slightly increased odds of concerns specifically related to personal-social (OR: 1.12; 95% CI: 1.03-1.22) and emotional-behavioural-attention (OR: 1.15; 95% CI: 1.08-1.22) development.
CONCLUSIONS: Prenatal infections, particularly those which are hospital-diagnosed (and likely more severe), are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established.
METHODS: This study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, 2011-2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital-diagnosed prenatal infections and receipt of infection-related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6-8 week or 27-30 month health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross-motor-skills, hearing-communication, vision-social-awareness, personal-social, emotional-behavioural-attention and speech-language-communication) and (b) the trimester(s) in which infections occurred.
RESULTS: After confounder/covariate adjustment, hospital-diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19-1.42). This was broadly consistent across all developmental outcome types and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07-1.67) and 3 (OR: 1.33; 95% CI: 1.21-1.47), that is the trimesters in which foetal brain myelination occurs. Infection-related prescriptions were not associated with any clear increase in odds of having at least one developmental concern after confounder/covariate adjustment (OR: 1.03; 95% CI: 0.98-1.08), but were associated with slightly increased odds of concerns specifically related to personal-social (OR: 1.12; 95% CI: 1.03-1.22) and emotional-behavioural-attention (OR: 1.15; 95% CI: 1.08-1.22) development.
CONCLUSIONS: Prenatal infections, particularly those which are hospital-diagnosed (and likely more severe), are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established.
摘要：
背景：先前的研究已将产前母体感染与以后的儿童发育结果和社会情感困难联系起来。然而,现有研究依赖于回顾性自我报告的调查数据，或仅提供医院记录的感染数据，导致数据收集方面的空白。
方法：这项研究使用了一个大型关联的行政卫生数据集，从出生记录中收集数据，医院记录,在大格拉斯哥和克莱德出生的55,856名儿童的处方和常规儿童健康审查，苏格兰,2011-2015年，以及他们的母亲。Logistic回归模型检查了产前感染，测量为医院诊断的产前感染和怀孕期间接受感染相关处方，和儿童发展的关注（S）由健康访问者在6-8周或27-30个月的健康审查。次要分析检查了结果是否因(a)特定发育结果类型(粗大运动技能，听力通信，视觉-社会意识，个人社会，情绪-行为-注意力和言语-语言-交流）和（b）发生感染的三个月。
结果：经过混杂/协变量调整后，医院诊断的感染与发生至少一种发育问题的几率增加相关(OR:1.30;95%CI:1.19~1.42).这在所有发育结果类型中大致一致，并且似乎与妊娠中期2（OR：1.34;95％CI：1.07-1.67）和3（OR：1.33;95％CI：1.21-1.47）中发生的感染有关，这是胎儿大脑髓鞘形成的三个月。与感染相关的处方与混淆/协变量调整后至少有一个发展问题的几率没有明显增加(OR:1.03;95%CI:0.98-1.08)，但与个人-社会(OR:1.12;95%CI:1.03-1.22)和情绪-行为-注意力(OR:1.15;95%CI:1.08-1.22)发展相关的关注几率略有增加.
结论：产前感染，特别是那些医院诊断的（并且可能更严重），与儿童早期发育结果有关。预防产前感染，监测受影响儿童的支持需求，可以改善儿童的发展，但因果关系仍有待确立。
方法：这项研究使用了一个大型关联的行政卫生数据集，从出生记录中收集数据，医院记录,在大格拉斯哥和克莱德出生的55,856名儿童的处方和常规儿童健康审查，苏格兰,2011-2015年，以及他们的母亲。Logistic回归模型检查了产前感染，测量为医院诊断的产前感染和怀孕期间接受感染相关处方，和儿童发展的关注（S）由健康访问者在6-8周或27-30个月的健康审查。次要分析检查了结果是否因(a)特定发育结果类型(粗大运动技能，听力通信，视觉-社会意识，个人社会，情绪-行为-注意力和言语-语言-交流）和（b）发生感染的三个月。
结果：经过混杂/协变量调整后，医院诊断的感染与发生至少一种发育问题的几率增加相关(OR:1.30;95%CI:1.19~1.42).这在所有发育结果类型中大致一致，并且似乎与妊娠中期2（OR：1.34;95％CI：1.07-1.67）和3（OR：1.33;95％CI：1.21-1.47）中发生的感染有关，这是胎儿大脑髓鞘形成的三个月。与感染相关的处方与混淆/协变量调整后至少有一个发展问题的几率没有明显增加(OR:1.03;95%CI:0.98-1.08)，但与个人-社会(OR:1.12;95%CI:1.03-1.22)和情绪-行为-注意力(OR:1.15;95%CI:1.08-1.22)发展相关的关注几率略有增加.
结论：产前感染，特别是那些医院诊断的（并且可能更严重），与儿童早期发育结果有关。预防产前感染，监测受影响儿童的支持需求，可以改善儿童的发展，但因果关系仍有待确立。
