妊娠期贫血与早产儿脑损伤关系的研究进展

Research Progress on the Relationship between Anemia during Pregnancy and Brain Injury in Preterm Infants

摘要: 妊娠期贫血是孕期常见并发症，其中以缺铁性贫血最为多见。贫血不仅影响孕妇自身健康，还可能通过降低母体携氧能力、干扰胎盘氧气和营养物质交换、减少胎儿铁储备等途径，对胎儿神经系统发育产生不利影响。早产儿脑组织仍处于快速发育阶段，脑血管自动调节、抗氧化防御及髓鞘形成等功能尚不完善，对缺氧缺血、炎症反应和铁缺乏更加敏感，因此更容易出现脑白质损伤、脑室内出血及缺氧缺血相关脑损伤。近年来，人们对早产儿脑损伤防控意识逐渐增强，孕期高危因素识别和围产期综合管理更加被关注。本文围绕妊娠期贫血的流行病学现状、胎儿脑发育对氧供和铁代谢的依赖、妊娠期贫血与早产儿不良结局的关系、潜在机制及筛查干预策略进行综述，以期为早产儿脑损伤的产前预防和围产期管理提供参考。

Abstract: Anemia during pregnancy is a common pregnancy complication, with iron-deficiency anemia being the most prevalent type. Anemia not only affects maternal health but may also adversely influence fetal nervous system development by reducing maternal oxygen-carrying capacity, impairing placental exchange of oxygen and nutrients, and decreasing fetal iron stores. In preterm infants, brain tissue remains in a stage of rapid development, while cerebral vascular autoregulation, antioxidant defense, and myelination are not yet fully mature. As a result, preterm infants are more vulnerable to hypoxia-ischemia, inflammatory responses, and iron deficiency, and are therefore more likely to develop white matter injury, intraventricular hemorrhage, and hypoxic-ischemic brain injury. In recent years, increasing attention has been paid to the prevention and control of brain injury in preterm infants, as well as to the identification of high-risk factors during pregnancy and comprehensive perinatal management. This article reviews the epidemiological status of anemia during pregnancy, the dependence of fetal brain development on oxygen supply and iron metabolism, the relationship between anemia during pregnancy and adverse outcomes in preterm infants, potential mechanisms, and screening and intervention strategies, with the aim of providing a reference for prenatal prevention and perinatal management of brain injury in preterm infants.