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母亲孕前BMI和孕期增重对学龄前儿童超重肥胖的影响
作者:邵婷 陶慧慧 倪玲玲 孙艳丽 严双琴 顾春丽 曹慧 黄锟 郝加虎 陶芳标

摘要:

目的  分析母亲孕前BMI和孕期增重与学龄前儿童超重肥胖的关联,探讨学龄前儿童发生超重肥胖的生命早期影响因素。方法  孕妇和孕期基本信息来源于中国安徽出生队列(C-ABCS)中的马鞍山市出生队列,该队列于2008年10月至2010年10月在马鞍山市4家市级医疗卫生机构接受孕期保健的孕妇中招募研究对象,共计5 084名孕妇及4 669名单胎活产儿进入队列。于2014年4月至2015年4月对该队列进行随访,最终3 797名儿童纳入本次分析。相应性别及月龄儿童BMI高于WHO标准中BMI第85百分位数界定为超重,高于第95百分位数界定为肥胖(排除病理性及继发性肥胖者);参考2009年美国医学研究所(IOM)新修订的孕期增重推荐值判定母亲孕期增重情况。运用多因素二分类非条件logistic回归模型分析母亲孕前BMI和孕期增重与学龄前儿童超重肥胖的关系。结果  随访到的3 797名母亲中,孕前低体重、正常,超重和肥胖者分别占22.6%(858名)、70.3%(2 671名)、6.2%(234名)和0.9%(34名)。有孕期增重数据的3 563名母亲中,孕期增重不足、适宜和过度者分别占12.4%(443名)、25.9% (922名)和61.7%(2 198名)。学龄前儿童超重率为11.5% (437名),肥胖率为10.8%(411名)。控制分娩孕周、儿童性别、月龄、出生体重、6月龄母乳喂养和目前家庭月收入混杂因素后,母亲孕前超重肥胖(OR=2.01,95%CI:1.53~2.65)和孕期增重过度(OR= 1.65 ,95%CI:1.35~2.03)是学龄前儿童超重肥胖的危险因素;孕前低体重是保护因素(OR=0.49, 95% CI:0.39~0.62)。母亲孕前较高的BMI和孕期增重不适宜对儿童超重肥胖存在联合作用:与仅母亲孕前超重肥胖、孕期增重过度或孕期增重不足的单独作用相比,母亲孕前超重肥胖合并孕期增重过度或母亲孕前超重肥胖合并孕期增重不足,子代发生超重肥胖的风险更高,OR (95%CI)值分别为2.90 (1.97~4.28)、3.17 (1.44~6.97)。结论  母亲孕前较高的BMI和不适宜的孕期增重是导致学龄前儿童超重肥胖的危险因素;孕妇应采取科学的方法调整孕前BMI,并根据孕前BMI控制孕期增重,以在生命早期预防学龄前儿童超重肥胖的发生。

关键词:儿童,学龄前;怀孕期间;超重;肥胖症;队列研究

Abstract:

Objective  To examine the effect of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) with childhood overweight and adiposity, and to explore possible early life risk factors for obesity in preschool children.Methods  Basic information of pregnant women and gestation period came from the Ma'anshan Birth Cohort Study, a part of the China-Anhui Birth Cohort Study (C-ABCS). Pregnant women in routine health care from four municipal medical and health institutions were enrolled voluntarily during October 2008 and October 2010 in Ma'anshan City. A total of 5 084 pregnant women and 4 669 singleton live births were included in this study. Between April 2014 and April 2015, 3 797 children were followed up. Children whose BMI were >85th percentiles for age and genders of World Health Organization (WHO) reference were considered as overweight, and >95th percentiles for age and genders cut-off values were considered as obesity (pathological and secondary causes of obesity were excluded). Gestational weight gain was defined according to the Institute of Medicine (IOM) guidelines. Univariate and binary regression model analysis was used to examine the effect of pre-pregnancy BMI and GWG with childhood overweight and adiposity.Results  Of the 3 797 pregnant women, the prevalence of underweight, normal weight, overweight and obesity were respectively 22.6% (n=858), 70.3% (n=2 671), 6.2% (n=234) and 0.9% (n=34). There were 3 563 pregnant women who were obtained gestational weight gain data, the prevalence of inadequate GWG, appropriate GWG, excessive GWG were respectively 12.4% (n=443), 25.9% (n=922) and 61.7% (n=2 198). The prevalence of overweight and obesity were 11.5% (n=437) and 10.8% (n= 411) in preschool children, respectively. After adjusting confounding factors including age at delivery, genders of children, children age, birth weight, breastfeeding and household economic status, binary logistic regression analysis showed that pre-pregnancy overweight and obesity(OR=2.01, 95% CI: 1.53-2.65), excessive GWG(OR=1.65, 95% CI: 1.35-2.03) were risk factors for overweight and obesity, and pre-pregnancy underweight was protective factor for childhood overweight and obesity (OR=0.49, 95% CI: 0.39-0.62). Joint associations of pre-pregnancy BMI and inappropriate GWG were also noticed in the study: compared to only pre-pregnancy higher BMI or excessive GWG or indequate GWG, combination of high pre-pregnancy BMI and excessive GWG or high pre-pregnancy BMI and inadequate GWG, adverse effects on childhood overweight and obesity were much higher,OR (95%CI) values were 2.90(1.97-4.28), 3.17(1.44-6.97) respectively.Conclusion  Both high pre-pregnancy BMI and inappropriate GWG are associated with greater offspring BMI. Pregnant women should achieve appropriate weight gain and help prevent obesity in their children.

Key words: Child, preschool;Peripartum period;Overweight;Obesity;Cohort studies

发表日期:2016/2

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2016.02.005.T001:表1 影响学龄前儿童超重肥胖的单因素分析[n(%)]

    10.3760/cma.j.issn.0253-9624.2016.02.005.T001:表1 影响学龄前儿童超重肥胖的单因素分析[n(%)]

  • 10.3760/cma.j.issn.0253-9624.2016.02.005.T002:表2 母亲孕前BMI和孕期增重与学龄前儿童超重肥胖关系的多因素logistic回归模型分析

    10.3760/cma.j.issn.0253-9624.2016.02.005.T002:表2 母亲孕前BMI和孕期增重与学龄前儿童超重肥胖关系的多因素logistic回归模型分析

  • 10.3760/cma.j.issn.0253-9624.2016.02.005.T003:表3 母亲孕前BMI合并孕期增重与学龄前儿童超重和肥胖关系的多因素logistic回归模型分析[OR (95%CI)值]

    10.3760/cma.j.issn.0253-9624.2016.02.005.T003:表3 母亲孕前BMI合并孕期增重与学龄前儿童超重和肥胖关系的多因素logistic回归模型分析[OR (95%CI)值]

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