Clinical Evaluation Of Gesell Scale In The Early Neurodevelopment Among Offspring Of Mothers With Systemic Lupus Erythematosus

Objective: To investigate the neurodevelopmental level in early offspring of systemic lupus erythematosus（SLE）patients with pregnancy by Gesell scale and analyze the related factors.Methods: From May 2020 to January 2022,47 12-month-old offspring of SLE patients with pregnancy in the Second Hospital of Lanzhou University were collected as SLE group,and 35 healthy mothers with similar birth and gestational age were collected as control group.（1）To analyze the differences of birth weight,gestational age,premature delivery rate,low birth weight rate,delivery mode,feeding mode,parental education,active or passive smoking history during pregnancy between SLE group and control group.（2）To analyze the neurodevelopmental level of SLE group and control group at12 months of age: Gesell development scale was used to evaluate the development level of children in five energy areas: large exercise,fine exercise,adaptability,language and personal-social.The developmental level is expressed by developmental quotient（DQ）,DQ=developmental age/actual age×100.DQ≥85 is defined as normal development,85>DQ≥75 is defined as the critical state,DQ<75 is defined as developmental abnormality.According to the results of Gesell development scale,SLE was divided into two subgroups: group A（dysplasia group）15 cases,group B（normal or critical state group）32 cases.Developmental abnormalities: defined as at least one of the five energy regions DQ<75,normal or critical developmental status:defined as DQ≥75 in all energy regions.（3）The neurodevelopmental characteristics of group A and group B in SLE subgroup were analyzed.（4）To analyze the differences of birth weight,gestational age,premature delivery rate,delivery mode,feeding mode,maternal history of adverse pregnancy,pregnancy complications,prenatal disease activity,autoantibodies and pregnancy medication between group A and group B in SLE subgroup.（5）Multiple linear regression was used to analyze the influencing factors of language development at 12 months of age in SLE group.Results:（1）The birth weight,gestational age and exclusive breastfeeding rate of SLE group were lower than those of the control group（P<0.05）,and the premature delivery rate,cesarean section rate and formula milk feeding rate were significantly higher than those of the control group,the difference was statistically significant（P>0.05）.（2）The developmental quotient of language area in SLE group was lower than normal level（DQ=83.21±17.79,DQ<85）.The proportions of fine motor,large motor,personal-social,language and adaptive developmental abnormalities in SLE group were 17.02%,12.77%,23.40%,19.15% and 19.15%,respectively（DQ<75）.The developmental quotient of 68.08% of children in SLE group in all energy regions was assessed as normal or critical state（DQ≥75）.In the control group,the proportion of fine exercise,large exercise,personal-social,language and adaptive developmental abnormalities were 5.71%,11.43%,11.43%,11.43% and 8.57%,respectively（DQ<75）.In the control group,88.57% of children in all energy areas were assessed as normal or critical state（DQ≥75）.（3）In SLE subgroup,the developmental quotient of the large motor energy region in group A was the highest（DQ=74.71±19.79）,and that of the language energy region was the lowest（DQ=66.57±18.78）.The DQ scores of five energy regions in group A were lower than those in group B（P<0.05）.（4）In SLE subgroup,the gestational age of group A was less than that of group B,the premature delivery rate was higher than that of group B（P<0.05）.and the proportion of maternal prenatal disease activity in group A was higher than that in group B（P>0.05）.（5）Pure breastfeeding ≥6 months,gestational age at birth ≥37 weeks,and maternal low disease activity before delivery were conducive to the development of language ability in the 12-month-old offspring of SLE patients with pregnancy（P<0.05）.Conclusion:（1）The early neurodevelopmental level of the offspring of SLE patients with pregnancy may fall behind the offspring of healthy mothers,and the language energy area is more prominent.Feeding pattern,gestational age at birth and maternal prenatal disease activity may be the factors affecting the language development level of offspring.（2）Gesell development scale was used to evaluate the early neurodevelopmental level of offspring in SLE patients with pregnancy.Early detection of neurodevelopmental disorders in offspring of SLE patients with pregnancy is helpful to early clinical intervention and improve the quality of life of offspring.