本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.23727

摘要内容如下：

重要性

孕期和幼儿期的多领域干预改善了儿童的神经发育，但对额外的孕前干预的影响知之甚少。

目的

评价包括健康在内的多层面办法的效果；营养；水、环境卫生和个人卫生（讲卫生运动）；在孕前和（或）孕期和幼儿期对儿童神经发育采取心理社会支助干预措施。

设计、设置和参与者

在这项涉及印度德里中低收入社区的随机试验中，13500名参与者被分配接受孕前干预或常规护理，以观察早产和儿童生长的主要结果。怀孕的参与者被随机分配到怀孕和早期儿童干预或常规护理。神经发育评估是本文报告的试验的次要结果，在24个月大的儿童子样本中进行，包括509名孕前、妊娠和儿童早期干预；仅孕前干预的473例；仅怀孕和儿童早期干预就有380人；350名接受常规护理。本研究于2000年11月1日至2022年2月25日进行。

干预措施

健康、营养、心理社会护理和支持，以及孕前、孕期和幼儿期的饮水、环境卫生和个人卫生干预措施。

主要成果和措施

24个月时的认知、运动、语言和社会情绪表现，使用贝利婴幼儿发展量表3工具进行评估。

结果

参与者的平均年龄为23.8岁（标准差为3.0岁）。在24个月大时，与对照组相比，孕前干预组儿童的认知得分较高（平均差异[MD]，1.16；98.3%CI，0.18-2.13），但语言、运动和社会情绪评分与对照组相似。那些接受怀孕和早期儿童干预的人有更高的认知能力（MD，1.48；98.3%CI，0.49-2.46），语言（MD，2.29；98.3%CI，1.07-3.50），运动（MD，1.53；98.3%CI，0.65-2.42）和社会情绪评分（MD，4.15；98.3%CI，2.18-6.13）高于对照组。妊娠和幼儿组中度至重度认知功能障碍的发生率也较低（发生率RR，0.62；98.3%CI，0.40-0.96），语言（发病率RR，0.73；98.3%CI，0.57-0.93）和社会情绪（发生率RR，0.49；98.3%CI，0.24-0.97）优于对照组。孕前、孕期和儿童早期干预组的儿童具有较高的认知能力（MD，2.60；98.3%CI，1.08-4.12），语言（MD，3.46；98.3%CI，1.65-5.27），运动（MD，2.31；98.3%CI，0.93-3.69）和社会情绪（MD，5.55；98.3%可信区间（2.66~8.43）高于对照组。

结论和相关性

孕前、孕期和幼儿期的多领域干预使24个月大的儿童神经发育得到适度改善。这种促进儿童发展的干预措施值得进一步评估。

英文原文如下：

Abstracts

Importance  Multidomain interventions in pregnancy and early childhood have improved child neurodevelopment, but little is known about the effects of additional preconception interventions.

Objective  To evaluate the effect of a multifaceted approach including health; nutrition; water, sanitation, and hygiene (WASH); and psychosocial support interventions delivered during the preconception period and/or during pregnancy and early childhood on child neurodevelopment.

Design, Setting, and Participants  In this randomized trial involving low- and middle-income neighborhoods in Delhi, India, 13 500 participants were assigned to preconception interventions or routine care for the primary outcome of preterm births and childhood growth. Participants who became pregnant were randomized to pregnancy and early childhood interventions or routine care. Neurodevelopmental assessments, the trial's secondary outcome reported herein, were conducted in a subsample of children at age 24 months, including 509 with preconception, pregnancy, and early childhood interventions; 473 with preconception interventions alone; 380 with pregnancy and early childhood interventions alone; and 350 with routine care. This study was conducted from November 1, 2000, through February 25, 2022.

Interventions  Health, nutrition, psychosocial care and support, and WASH interventions delivered during preconception, pregnancy, and early childhood periods.

Main Outcomes and Measures  Cognitive, motor, language, and socioemotional performance at age 24 months, assessed using the Bayley Scales of Infant and Toddler Development 3 tool.

Results  The mean age of participants at enrollment was 23.8 years (SD, 3.0 years). Compared with the controls at age 24 months, children in the preconception intervention groups had higher cognitive scores (mean difference [MD], 1.16; 98.3% CI, 0.18-2.13) but had similar language, motor, and socioemotional scores as controls. Those receiving pregnancy and early childhood interventions had higher cognitive (MD, 1.48; 98.3% CI, 0.49-2.46), language (MD, 2.29; 98.3% CI, 1.07-3.50), motor (MD, 1.53; 98.3% CI, 0.65-2.42), and socioemotional scores (MD, 4.15; 98.3% CI, 2.18-6.13) than did controls. The pregnancy and early childhood group also had lower incidence rate ratios (RRs) of moderate to severe delay in cognitive (incidence RR, 0.62; 98.3% CI, 0.40-0.96), language (incidence RR, 0.73; 98.3% CI, 0.57-0.93), and socioemotional (incidence RR, 0.49; 98.3% CI, 0.24-0.97) development than did those in the control group. Children in the preconception, pregnancy, and early childhood intervention group had higher cognitive (MD, 2.60; 98.3% CI, 1.08-4.12), language (MD, 3.46; 98.3% CI, 1.65-5.27), motor (MD, 2.31; 98.3% CI, 0.93-3.69), and socioemotional (MD, 5.55; 98.3% CI, 2.66-8.43) scores than did those in the control group.

Conclusions and Relevance  Multidomain interventions during preconception, pregnancy and early childhood led to modest improvements in child neurodevelopment at 24 months. Such interventions for enhancing children's development warrant further evaluation.

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