A Birth Cohort Study On Association Of Early Life Factors With Cognitive Development Of Preschool Children

Objective: To investigate the cognitive development of preschool children in Kaifu District,explore the influence of early life factors on suspected cognitive delay,and provide more scientific guidance for promoting cognitive development in preschool children.Methods: Newborn delivered in 2015 from three strees in Kaifu District of Changsha were selected as the research objects.Questionnaires were used to follow up children and collect health-related information.Early life factors were collected aged 1-24 months,cognitive development of children was evaluated by ASQ-3 aged 36-60 months.Mixed effects model was used to analyze the influence of early life factors on children’s scores of cognitive development.Generalized estimating equation was applied to explore the influence of early life factors on children’s cognitive suspected development delay(SDD).Results: A total of 735 children were included in the study.The rate of SDD respectively was 21.79%,7.17%,13.45%,17.64% and 31.88% at36,42,48,54,60 months.The rate of SDD in the problem-solving area was lower than that in other areas at each month.The mean scores of ASQ-3 were 276.30,283.74,283.15,284.98 and 276.79,respectively.At 36～54month,the mean score of children in fine motor area was lower than that in other areas.The results of mixed effect model showed that maternal education level(b=-1.697),paternal BMI(b=-2.775),maternal pregnancy anemia(b=-0.370),pregnancy nutritional supplement(b=1.587)and child gender(b=-0.694)were the influencing factors of communication area.Maternal pregnancy anemia(b=-0.965),feeding pattern at 8 months(b=-0.747)and child gender(b=-0.688)were the influencing factors of gross motor.Maternal age at delivery(b=-5.759),education level(b=-3.779),gestational weight gain(b=-1.667),gestational age(b=-2.665),child gender(b=-3.548)and feeding pattern at 8 months(b=-3.109)were the influencing factors of fine motor area.Maternal education level(b=-1.449)and child gender(b=-0.720)were the influencing factors of problem solving area.Paternal education level(b=-2.359),birth order(b=-1.549),child gender(b=-2.465)and feeding pattern at 6 months(b=-1.605)were the influencing factors of personal social area.The results of the generalized estimating equation showed that the influencing factors for SDD in communication area were maternal gestation age(RR=1.041,95%CI: 1.006～1.078),maternal education level(RR=1.054,95%CI:1.012～1.098),pregnancy anemia(RR=0.963,95%CI:0.937～0.991),maternal passive smoking(RR=0.981,95%CI: 0.968～0.995)and child gender(RR=1.018,95%CI: 1.004～1.032).Maternal education level(RR=1.042,95%CI: 1.003～1.087),child gender(RR=1.021,95%CI:1.005～1.038)and feeding pattern at 8 months(RR=1.021,95%CI:1.002～1.041)were the influencing factors of SDD in gross motor area.Maternal education level(RR=1.059,95%CI: 1.004～1.118),maternal BMI(RR=1.029,95%CI: 1.002～1.056),child gender(RR=1.040,95%CI:1.022～1.058)and gestational age(RR=1.028,95%CI: 1.003～1.053)were the influencing factors of SDD in fine motor area.Maternal education level(RR=1.043,95%CI: 1.012～1.076)and child gender(RR=1.014,95%CI:1.003～1.025)were the influencing factors of SDD in problem solving area.Maternal postpartum depression(RR=0.946,95%CI: 0.910～0.984),child gender(RR=1.036,95%CI: 1.017～1.055)and feeding pattern at 8 months(RR=1.031,95%CI: 1.002～1.062)were the influencing factors of SDD in personal social area.Conclusions: The scores of ASQ-3 in preschool children in Kaifu District are similar to those of urban children in China.The rate of SDD in five areas was different in each month.The early life influencing factors of different cognitive areas are different.Strengthening perinatal health care can promote the cognitive development of preschool children.