妊娠期体质量增加在母乳喂养时间与幼儿神经行为发展关联中的作用

doi:10.3969/j.issn.1674-8115.2026.02.007

上海交通大学学报（医学版） ›› 2026, Vol. 46 ›› Issue (2): 188-199.doi: 10.3969/j.issn.1674-8115.2026.02.007

• 论著 · 临床研究 • 上一篇

妊娠期体质量增加在母乳喂养时间与幼儿神经行为发展关联中的作用

薛玥¹^,², 徐健¹^,²^,³^,⁴^,⁵(), 江怡宁¹^,²^,⁶, 郁珽¹^,², 林燕芬³^,⁴^,⁶, 张怡静³^,⁴^,⁶, Luo Zhongcheng³^,⁴^,⁷

^1.上海交通大学医学院附属国际和平妇幼保健院儿保康复科，上海 200030
^2.上海市胚胎源性疾病重点实验室，上海 200030
^3.教育部-上海市环境与儿童健康重点实验室，上海 200092
^4.上海交通大学医学院附属新华医院儿科，上海 200092
^5.上海交通大学公共卫生学院妇女儿童健康系，上海 201318
^6.浙江大学医学院附属儿童医院儿科，杭州 310052
^7.加拿大多伦多大学妇产科学部，卫生政策、管理与评估研究所，西奈山医院Lunenfeld-Tanenbaum研究所Prosserman群体健康研究中心，多伦多 M5T 3L9

收稿日期:2025-05-05 接受日期:2025-10-30 出版日期:2026-02-28 发布日期:2026-02-28
通讯作者: 徐健，主任医师，博士；电子信箱：sonia0616@sjtu.edu.cn。
基金资助:
国家自然科学基金(82473657)

Role of gestational weight gain in the association between breastfeeding duration and toddler neurodevelopment

Xue Yue¹^,², Xu Jian¹^,²^,³^,⁴^,⁵(), Jiang Yining¹^,²^,⁶, Yu Ting¹^,², Lin Yanfen³^,⁴^,⁶, Zhang Yijing³^,⁴^,⁶, Luo Zhongcheng³^,⁴^,⁷

^1.Department of Child Health and Rehabilitation, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
^2.Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China
^3.Key Laboratory of Environment and Children's Health, Ministry of Education & Shanghai Municipality, Shanghai 200092, China
^4.Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
^5.Department of Maternal and Child Health, Shanghai Jiao Tong University School of Public Health, Shanghai 201318, China
^6.Department of Pediatrics, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
^7.Department of Obstetrics and Gynecology, Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto M5T 3L9, Canada

Received:2025-05-05 Accepted:2025-10-30 Online:2026-02-28 Published:2026-02-28
Contact: XU Jian, E-mail: sonia0616@sjtu.edu.cn.
Supported by:
National Natural Science Foundation of China(82473657)

摘要/Abstract

摘要：

目的·探讨妊娠期体质量增加（gestational weight gain，GWG）在母乳喂养持续时间与幼儿神经发育关联中的作用，并探讨育龄妇女维持母乳喂养的适宜的GWG水平。方法·利用2010—2012年在上海市开展的前瞻性出生队列，于孕中晚期招募后，随访到产后24~36个月，收集GWG、母乳喂养持续时间及相关混杂因素等信息。采用格赛尔婴幼儿发育量表的发育商和中国幼儿气质量表得分评估幼儿的神经认知行为发育。采用两段式线性回归，评估不同GWG分层（过多、不足/适宜）下母乳喂养时间与幼儿神经发育间关联的差异，以及GWG与母乳喂养持续时间之间的关系。结果·共纳入225对母婴对，平均母乳喂养时间为7.4个月。校正混杂因素后发现，GWG过多时，当母乳喂养<6个月时，母乳喂养时间与幼儿的语言的发育商水平呈正相关，与气质的趋避性和适应性得分呈负相关（均P<0.05）；当母乳喂养≥6月时，相关性均不显著（喂养<6月与喂养≥6月比较，P_{对数似然比}均<0.05）。而当GWG适宜或不足时，没有观察到关联的显著差异（喂养<6月与喂养≥6月比较，P_{对数似然比}均≥0.05）。GWG≥17.5 kg时，随着GWG增加，母乳喂养持续时间明显缩短。结论·GWG对母乳喂养持续时间与幼儿神经发育水平间的关联存在潜在影响。GWG过多时，鼓励母乳喂养时间达到6个月或6个月内尽可能长，有利于促进婴幼儿的神经发育。GWG控制在17.5 kg以下，有助于产后更长时间的母乳喂养。

关键词: 妊娠期体质量增加, 母乳喂养, 幼儿, 认知发育, 气质

Abstract:

Objective ·To explore the role of gestational weight gain (GWG) in the association between breastfeeding duration and offspring neurodevelopment, and to identify appropriate GWG to sustain breastfeeding among reproductive-age women. Methods ·A prospective birth cohort study was conducted in Shanghai from 2010 to 2012. Mothers were recruited during mid- to late pregnancy and followed up until 24‒36 months postpartum, and information on GWG, breastfeeding duration, and related confounders was collected. Toddler neurodevelopment was assessed by the developmental quotient (DQ) of the Gesell Developmental Schedules (GDS) and scores from the Chinese Toddler Temperament Scale (CTTS). Two-piece-wise linear regression analyses were conducted (due to non-linear relationships) on the associations between breastfeeding duration and toddler neurodevelopment under different GWG stratifications, and between GWG and breastfeeding duration. Results ·A total of 225 mother-infant pairs were included in this study, and the mean breastfeeding duration was 7.4 months. After adjustment for related confounders, significant differences in the associations of breastfeeding duration with neurodevelopment were observed among mother-child pairs under different GWG stratifications. For pairs with excessive GWG, when breastfeeding duration was <6 months, longer duration was significantly associated with higher DQ in the language domains of GDS, and with lower scores in the approach-withdrawal and adaptability domains of CTTS, compared with the non-significant associations observed when the duration was ≥6 months (<6 months vs ≥6 months: P_{log-likelihood-ratio}-values<0.05). However, no significant differences (<6 months vs ≥6 months) were observed in the associations under appropriate/inadequate GWG. Significantly shorter breastfeeding duration was observed with increasing GWG when GWG was ≥17.5 kg. Conclusion ·GWG impacts the association between breastfeeding duration and toddler neurodevelopment. For offspring exposed to excessive maternal GWG during pregnancy, longer breastfeeding duration within 6 months or breastfeeding duration of ≥6 months is especially important for optimal neurodevelopment. GWG<17.5 kg is favorable for sustained breastfeeding.

Key words: gestational weight gain, breastfeeding, child, cognitive development, temperament

中图分类号:

R473.71

薛玥, 徐健, 江怡宁, 郁珽, 林燕芬, 张怡静, Luo Zhongcheng. 妊娠期体质量增加在母乳喂养时间与幼儿神经行为发展关联中的作用[J]. 上海交通大学学报（医学版）, 2026, 46(2): 188-199.

Xue Yue, Xu Jian, Jiang Yining, Yu Ting, Lin Yanfen, Zhang Yijing, Luo Zhongcheng. Role of gestational weight gain in the association between breastfeeding duration and toddler neurodevelopment[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(2): 188-199.

图/表 5

参考文献 54

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Variable	Demographic characteristic	Breastfeeding duration/month	Unadjusted association with breastfeeding duration [β(95%CI)]
Per capita family income level/n(%)
<2 000 yuan/month	12 (5.3)	7.2±5.0	Reference
2 000‒4 999 yuan/month	64 (28.4)	7.2±5.2	0 (-2.9, 2.9)
5 000‒10 000 yuan/month	91 (40.4)	7.4±4.8	0.2 (-2.7, 3.0)
>10 000 yuan/month	58 (25.8)	7.7±4.0	0.5 (-2.4, 3.4)
Maternal factor
Maternal age at enrollment/n(%)
<25 years	19 (8.4)	5.1±3.5	Reference
≥25 years and <30 years	127 (56.4)	7.2±4.5	2.1 (-0.1, 4.4)
≥30 years	79 (35.1)	8.3±5.1	3.2 (0.9, 5.6)^①
Maternal educational degree/n(%)
Junior middle school or lower	15 (6.7)	8.5±4.7	Reference
Senior middle school	20 (8.9)	6.4±5.6	-2.1 (-5.2, 1.0)
University or college level	162 (72.0)	7.2±4.6	-1.4 (-3.8, 1.1)
Postgraduate level	28 (12.4)	8.7±4.1	0.1 (-2.8, 3.1)
Pre-pregnancy BMI/kg·m^-2	22.1±2.9	‒	0 (-0.2, 0.2)
Pre-pregnancy BMI group/n(%)
Underweight	17 (7.6)	7.4±3.0	Reference
Normal weight	157 (69.8)	7.6±4.8	0.9 (-1.5, 3.2)
Overweight	40 (17.8)	7.3±4.3	0.6 (-2.0, 3.3)
Obesity	11 (4.9)	5.7±6.9	-1.0 (-4.5, 2.6)
GSI during pregnancy/score	1.2±0.2	‒	-1.1 (-4.0, 1.8)
GSI at around 30 months postpartum/score	1.3±0.3	‒	-1.2 (-3.2, 0.9)
Gestational weeks/week	39.4±1.2	‒	0 (-0.5, 0.5)
Mode of delivery/n(%)
Vaginal	76 (33.8)	7.8±5.0	Reference
Caesarean section with indications	72 (32.0)	7.7±4.1	-0.1 (-1.6, 1.5)
Caesarean section without indications	77 (34.2)	6.7±4.9	-1.1 (-2.6, 0.4)
Parity/n(%)
Primiparous	214 (95.1)	7.3±4.6	Reference
Multiparous	11 (4.9)	8.3±7.0	1.0 (-2.0, 3.9)
GWG/kg	15.0±4.7	‒	-0.1 (-0.2, 0.1)
GWG group/n(%)
Appropriate/inadequate GWG	92 (42.8)	7.3±4.3	Reference
Excessive GWG	123 (57.2)	7.5±5.0	0.3 (-1.0, 1.6)
Maternal daily working hours after maternity leave/n(%)
>8 h	109 (48.7)	6.9±4.2	Reference
5‒8 h	90 (40.2)	7.2±4.5	0.3 (-1.0, 1.6)
<5 h	25 (11.2)	10.0±6.5	3.1 (1.1, 5.2)^②
Living with children per week/n(%)
7 d	166 (74.4)	8.0±4.8	Reference
≤6 d	57 (25.6)	5.6±3.9	-2.4 (-3.8, -1.0)^③
Offspring′s characteristic
Infant sex/n(%)
Boy	99 (44.0)	7.6±5.1	Reference
Girl	126 (56.0)	7.2±4.4	-0.4 (-1.6, 0.9)
Birth weight/kg	3.5±0.4	‒	0 (0, 0)

Variable	Demographic characteristic	Breastfeeding duration/month	Unadjusted association with breastfeeding duration [β(95%CI)]
Per capita family income level/n(%)
<2 000 yuan/month	12 (5.3)	7.2±5.0	Reference
2 000‒4 999 yuan/month	64 (28.4)	7.2±5.2	0 (-2.9, 2.9)
5 000‒10 000 yuan/month	91 (40.4)	7.4±4.8	0.2 (-2.7, 3.0)
>10 000 yuan/month	58 (25.8)	7.7±4.0	0.5 (-2.4, 3.4)
Maternal factor
Maternal age at enrollment/n(%)
<25 years	19 (8.4)	5.1±3.5	Reference
≥25 years and <30 years	127 (56.4)	7.2±4.5	2.1 (-0.1, 4.4)
≥30 years	79 (35.1)	8.3±5.1	3.2 (0.9, 5.6)^①
Maternal educational degree/n(%)
Junior middle school or lower	15 (6.7)	8.5±4.7	Reference
Senior middle school	20 (8.9)	6.4±5.6	-2.1 (-5.2, 1.0)
University or college level	162 (72.0)	7.2±4.6	-1.4 (-3.8, 1.1)
Postgraduate level	28 (12.4)	8.7±4.1	0.1 (-2.8, 3.1)
Pre-pregnancy BMI/kg·m^-2	22.1±2.9	‒	0 (-0.2, 0.2)
Pre-pregnancy BMI group/n(%)
Underweight	17 (7.6)	7.4±3.0	Reference
Normal weight	157 (69.8)	7.6±4.8	0.9 (-1.5, 3.2)
Overweight	40 (17.8)	7.3±4.3	0.6 (-2.0, 3.3)
Obesity	11 (4.9)	5.7±6.9	-1.0 (-4.5, 2.6)
GSI during pregnancy/score	1.2±0.2	‒	-1.1 (-4.0, 1.8)
GSI at around 30 months postpartum/score	1.3±0.3	‒	-1.2 (-3.2, 0.9)
Gestational weeks/week	39.4±1.2	‒	0 (-0.5, 0.5)
Mode of delivery/n(%)
Vaginal	76 (33.8)	7.8±5.0	Reference
Caesarean section with indications	72 (32.0)	7.7±4.1	-0.1 (-1.6, 1.5)
Caesarean section without indications	77 (34.2)	6.7±4.9	-1.1 (-2.6, 0.4)
Parity/n(%)
Primiparous	214 (95.1)	7.3±4.6	Reference
Multiparous	11 (4.9)	8.3±7.0	1.0 (-2.0, 3.9)
GWG/kg	15.0±4.7	‒	-0.1 (-0.2, 0.1)
GWG group/n(%)
Appropriate/inadequate GWG	92 (42.8)	7.3±4.3	Reference
Excessive GWG	123 (57.2)	7.5±5.0	0.3 (-1.0, 1.6)
Maternal daily working hours after maternity leave/n(%)
>8 h	109 (48.7)	6.9±4.2	Reference
5‒8 h	90 (40.2)	7.2±4.5	0.3 (-1.0, 1.6)
<5 h	25 (11.2)	10.0±6.5	3.1 (1.1, 5.2)^②
Living with children per week/n(%)
7 d	166 (74.4)	8.0±4.8	Reference
≤6 d	57 (25.6)	5.6±3.9	-2.4 (-3.8, -1.0)^③
Offspring′s characteristic
Infant sex/n(%)
Boy	99 (44.0)	7.6±5.1	Reference
Girl	126 (56.0)	7.2±4.4	-0.4 (-1.6, 0.9)
Birth weight/kg	3.5±0.4	‒	0 (0, 0)

Schedule	x±s	Single linear regression		Piece-wise linear regression				Likelihood ratio test
		Single linear regression		Breastfeeding<6 month		Breastfeeding≥6 month		Likelihood ratio test
		β (95%CI)	P value	β (95%CI)	P value	β (95%CI)	P value	P value
DQ of GDS
Gross motor	106.8±12.0	0 (-0.4, 0.4)	0.950	0.2 (-0.8, 1.1)	0.733	0 (-0.6, 0.5)	0.854	0.719
Fine motor	97.0±12.8	0 (-0.4, 0.5)	0.872	0.4 (-0.7, 1.4)	0.504	-0.1 (-0.7, 0.5)	0.748	0.492
Adaptive	113.4±9.9	0.1 (-0.2, 0.4)	0.668	0.4 (-0.3, 1.2)	0.273	-0.1 (-0.5, 0.4)	0.721	0.293
Language	112.8±14.8	0.3 (-0.2, 0.7)	0.304	1.0 (-0.1, 2.2)	0.082	-0.1 (-0.7, 0.6)	0.837	0.131
Interpersonal	104.4±12.5	0.2 (-0.1, 0.6)	0.210	1.0 (0.1, 2.0)	0.030	-0.1 (-0.6, 0.4)	0.779	0.059
Temperament scores of CTTS
Activity level	3.2±0.6	0 (0, 0)	0.941	0 (-0.1, 0)	0.186	0 (0, 0)	0.372	0.140
Biological rhythms	2.6±0.6	0 (0, 0)	0.799	0 (-0.1, 0)	0.126	0 (0, 0)	0.391	0.104
Approach-withdrawal	3.0±0.8	0 (-0.1, 0)	0.026	-0.1 (-0.1, 0)	0.015	0 (0, 0)	0.586	0.080
Adaptability	2.9±0.7	0 (-0.1, 0)	0.009	-0.1 (-0.1, 0)	0.002	0 (0, 0)	0.623	0.023
Intensity of reaction	3.9±0.6	0 (0, 0)	0.281	0 (-0.1, 0)	0.084	0 (0, 0)	0.885	0.141
Mood	2.6±0.6	0 (0, 0)	0.298	0 (-0.1, 0)	0.636	0 (0, 0)	0.462	0.955
Persistence	2.8±0.6	0 (0, 0)	0.355	0 (-0.1, 0)	0.267	0 (0, 0)	0.882	0.402
Attention	3.8±0.6	0 (0, 0)	0.478	0 (0, 0.1)	0.779	0 (0, 0)	0.594	0.992
Sensitivity	3.9±0.7	0 (0, 0)	0.854	0 (-0.1, 0.1)	0.833	0 (0, 0)	0.970	0.877

Schedule	x±s	Single linear regression		Piece-wise linear regression				Likelihood ratio test
		Single linear regression		Breastfeeding<6 month		Breastfeeding≥6 month		Likelihood ratio test
		β (95%CI)	P value	β (95%CI)	P value	β (95%CI)	P value	P value
DQ of GDS
Gross motor	106.8±12.0	0 (-0.4, 0.4)	0.950	0.2 (-0.8, 1.1)	0.733	0 (-0.6, 0.5)	0.854	0.719
Fine motor	97.0±12.8	0 (-0.4, 0.5)	0.872	0.4 (-0.7, 1.4)	0.504	-0.1 (-0.7, 0.5)	0.748	0.492
Adaptive	113.4±9.9	0.1 (-0.2, 0.4)	0.668	0.4 (-0.3, 1.2)	0.273	-0.1 (-0.5, 0.4)	0.721	0.293
Language	112.8±14.8	0.3 (-0.2, 0.7)	0.304	1.0 (-0.1, 2.2)	0.082	-0.1 (-0.7, 0.6)	0.837	0.131
Interpersonal	104.4±12.5	0.2 (-0.1, 0.6)	0.210	1.0 (0.1, 2.0)	0.030	-0.1 (-0.6, 0.4)	0.779	0.059
Temperament scores of CTTS
Activity level	3.2±0.6	0 (0, 0)	0.941	0 (-0.1, 0)	0.186	0 (0, 0)	0.372	0.140
Biological rhythms	2.6±0.6	0 (0, 0)	0.799	0 (-0.1, 0)	0.126	0 (0, 0)	0.391	0.104
Approach-withdrawal	3.0±0.8	0 (-0.1, 0)	0.026	-0.1 (-0.1, 0)	0.015	0 (0, 0)	0.586	0.080
Adaptability	2.9±0.7	0 (-0.1, 0)	0.009	-0.1 (-0.1, 0)	0.002	0 (0, 0)	0.623	0.023
Intensity of reaction	3.9±0.6	0 (0, 0)	0.281	0 (-0.1, 0)	0.084	0 (0, 0)	0.885	0.141
Mood	2.6±0.6	0 (0, 0)	0.298	0 (-0.1, 0)	0.636	0 (0, 0)	0.462	0.955
Persistence	2.8±0.6	0 (0, 0)	0.355	0 (-0.1, 0)	0.267	0 (0, 0)	0.882	0.402
Attention	3.8±0.6	0 (0, 0)	0.478	0 (0, 0.1)	0.779	0 (0, 0)	0.594	0.992
Sensitivity	3.9±0.7	0 (0, 0)	0.854	0 (-0.1, 0.1)	0.833	0 (0, 0)	0.970	0.877

Regression	Unadjusted effect of GWG		Adjusted effect of GWG
Regression	β (95%CI)	P value	β (95%CI)	P value
Single linear regression	-0.1 (-0.2, 0.1)	0.423	-0.1 (-0.2, 0.1)	0.397
Piece-wise linear regression
β1 (GWG<17.5 kg)	0.1 (-0.1, 0.4)	0.222	0.1 (-0.1, 0.3)	0.311
β2 (GWG≥17.5 kg)	-0.4 (-0.7, -0.1)	0.019	-0.4 (-0.7, -0.1)	0.024
Likelihood ratio test P value		0.026		0.026

妊娠期体质量增加在母乳喂养时间与幼儿神经行为发展关联中的作用

Role of gestational weight gain in the association between breastfeeding duration and toddler neurodevelopment

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