| Objectives The purpose of this study was to describe the prevalence of refractive error in children at 6 years in Ma’anshan city,Anhui province.And to clarify the relationship between adverse birth outcomes,infant growth and development trajectory in the early life and refractive error of 6-year-old children.MethodsBased on the Ma’anshan Birth Chort(MABC),the Maternal and Child Health Record Form were used to collect the information of maternal pregnancy.Children’s Health Record Form was used to collect information on general demographic and social characteristics of children,and physical development information from birth to 72 months old was recorded.And at the age of 6 years,the distanse vision was tested with the national standard logarithmic visual acuity chart(GB 11533-2011).The refraction information of the children with distanse vision less than 5.0 was obtained by mydriatic refractometry.A total of 3 273 singleton live birth children were included in this study.After excluding 8 children with incomplete birth information and 255 children with insufficient physical examination times,3 010 children could be used for growth trajectory fitting.Latent growth model(LCGM)was used to fit the growth trajectories of BMI,height,and weight.After excluding 976 children who did not receive visual acuity measurement,2 034 children were finally included in the analysis.Chi-square test was used to compare the distribution of refractive errors among children with different demographic and sociological characteristics and maternal factors.According to the severity of visual impairment of the worst eye in both eyes(mild,moderate and severe),one-way analysis of variance was used to compare the difference of spherical equivalent(SE)of the right eye between the normal group and the ametropic group at 6 years old.Logistic regression model was used to analyze the association between children’s physical development indicators from birth to 6 years old,various types of growth and development and refractive errors at the age of 6 years.ResultsThe detection rates of myopia(SE ≤-0.50 D),hyperopia(SE ≥ 2.00 D)and astigmatism(|cylinder power| ≥ 1.50 D)in preschool children were 4.4%,7.5% and7.7% respectively.The growth trajectory of infant BMI could be divided into three patterns: appropriate growth,rapid growth and slow growth.The growth trajectory of height could also be divided into three patterns: appropriate growth,rapid growth and slow growth.However,there only two patterns of body weight growth trajectory were found: appropriate growth and slow growth.Multivariate Logistic regression results showed that excessive gestational weight gain increased the risk of myopia in children aged 6 years(RR = 1.75,95%CI: 0.999,3.074).Preterm birth was positively associated with myopia(RR = 2.47,95%CI: 1.09,5.59),hyperopia(RR = 2.48,95%CI: 1.30,4.47),and astigmatism(RR = 2.18,95%CI:1.12,4.25).Placental abruption at delivery was positively associated with myopia(RR= 13.48,95%CI: 2.21,18.40),hyperopia(RR = 11.51,95%CI: 2.30,57.54)and astigmatism(RR = 11.20,95%CI: 2.24,55.97).No significant association was found between other adverse birth outcomes such as low birth weight,SGA,and fetal asphyxia and refractive errors in 6-year-old children.Excessive growth of BMI-for-age z-score(BMI Z)at birth and at 24 months,36 months,42 months,48 months,60 months,66 months,and 72 months significantly increased the risk of astigmatism in children.The height-for-age z-score(HAZ)overgrowth at 24 months of age increases the risk of myopia,and weight-for-age z-score(HAZ)overgrowth at 66 and 72 months of age increases the risk of astigmatism.Excessive growth of WAZ at 48,66,and 72 months of age increases the risk of astigmatism in children.However,there was no statistically significant association between the growth trajectory of BMI,height,and weight of infants and children and refractive errors in 6-year-old children.Six-year-old children were stratified according to the severity of binocular vision impairment before and after mydriasis.Binocular vision impairment was divided into mild(the lowest distance vision of both eyes was 4.9),moderate(the lowest distance vision of both eyes was 4.6-4.8),and severe(the lowest distance vision of both eyes was ≤ 4.5)was 18.9%,12.9% and 1.3%,respectively.The overall SE trend of the normal vision group and the myopia group gradually decreased,while the SE trend of the hyperopia group gradually increased,and the differences were statistically significant,that is,the more severe the poor vision,the more severe the myopia and hyperopia.ConclusionsMyopia,hyperopia and astigmatism have a certain detection rate in 6-year-old children in Ma’anshan city.With the aggravation of poor vision,the degree of myopia and hyperopia is deeper.Premature birth,excessive weight gain during pregnancy and placental abruption are the risk factors for myopia in children.Premature birth and placental abruption are also risk factors for hyperopia and astigmatism in children.Rapid growth after birth increases the risk of astigmatism in children.There is no significant association between growth trajectories from birth to 72 months and refractive error in children at the age of 6 years. |
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