孕前BMI、妊娠期糖尿病与儿童4岁时肥胖相关指标关联的出生队列研究

曹慧; 严双琴; 蔡智玲; 汪素美; 谢亮亮; 陈茂林; 陈敬芳; 徐叶清; 潘维君; 伍晓艳; 黄锟; 陶芳标

Abstract

曹慧,严双琴,蔡智玲,汪素美,谢亮亮,陈茂林,陈敬芳,徐叶清,潘维君,伍晓艳,黄锟,陶芳标.孕前BMI、妊娠期糖尿病与儿童4岁时肥胖相关指标关联的出生队列研究[J].Chinese journal of Epidemiology,2020,41(8):1303-1307

孕前BMI、妊娠期糖尿病与儿童4岁时肥胖相关指标关联的出生队列研究

Pre-pregnancy BMI, gestational diabetes and different indicators of childhood obesity at the age of four: a prospective cohort study

Received:August 22, 2019

DOI：10.3760/cma.j.cn112338-20190822-00617

KeyWord: 体质指数妊娠期糖尿病儿童肥胖

English Key Word: Body mass index Gestational diabetes Children Obesity

FundProject:国家自然科学基金青年科学基金（81602872）；中国疾病预防控制中心妇幼保健中心母婴营养与健康研究项目（2019FYH024）

Author Name	Affiliation	E-mail
Cao Hui	Department of Child Health Care, Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243000, China
Yan Shuangqin	Department of Child Health Care, Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243000, China
Cai Zhiling	Department of Child Health Care, Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243000, China
Wang Sumei	Department of Child Health Care, Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243000, China
Xie Liangliang	Department of Child Health Care, Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243000, China
Chen Maolin	Perinatal Center of Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243000, China
Chen Jingfang	Perinatal Center of Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243000, China
Xu Yeqing	Department of Child Health Care, Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243000, China
Pan Weijun	Perinatal Center of Ma'anshan Maternal and Child Health Hospital of Anhui Province, Ma'anshan 243000, China
Wu Xiaoyan	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University Key Laboratory of Population Health Across Life Cycle, Ministry of Education Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
Huang Kun	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University Key Laboratory of Population Health Across Life Cycle, Ministry of Education Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China
Tao Fangbiao	Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University Key Laboratory of Population Health Across Life Cycle, Ministry of Education Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, National Health Commission Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei 230032, China	fbtao@126.com

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Abstract:

目的探讨孕前BMI、妊娠期糖尿病（GDM）与儿童4岁时肥胖相关指标的关联。方法基于已经建立的“马鞍山市优生优育队列”，对2013年10月至2015年4月出生的单胎活产儿，随访至4岁。在孕期首次填写问卷调查孕前身高、体重，在24～28周接受75 g口服糖耐量试验进行GDM诊断。在儿童4岁时测量身高、体重、腰围和体成分。组间比较采用χ²检验、方差分析或t检验，采用logistic回归模型与广义线性模型分析孕前超重/肥胖、孕前患有GDM与儿童肥胖相关特征的关系。结果儿童4岁时超重、肥胖率分别为13.08%、6.03%。控制孕期和儿童人口统计学变量后，孕前母亲超重/肥胖者儿童在4岁时发生肥胖、腰围超标、腰围身高比超标的风险要高，其OR值（95% CI）分别为3.27（2.15～4.98）、2.32（1.72～3.14）和2.29（1.73～3.02）；且与体成分指标（骨骼肌、体脂肪、体脂百分比）相关（P<0.05）。孕期母亲患有GDM者，儿童4岁时肥胖发生风险要比母亲未患有GDM者高1.78倍（OR=1.78，95% CI：1.14～2.79）；但是孕期母亲患有GDM对4岁儿童腰围超标、腰围身高比超标发生风险并无影响，与体成分指标（骨骼肌、体脂肪、体脂百分比）无统计学关联。结论孕前母亲超重/肥胖、孕期患有GDM是4岁儿童肥胖的独立危险因素，且孕前BMI与儿童体成分的各项指标相关。

English Abstract:

Objective To examine the relationship between pre-pregnancy BMI, gestational diabetes (GDM) and different indicators of childhood obesity at the age of 4. Methods Based on Ma'anshan Birth Cohort Study, singleton children who were born in Ma'anshan of Anhui province from October 2013 to April 2015, were followed for 4 years, consecutively. During the first questionnaire survey, data including pre-pregnancy weight, height and socio-demography were collected. During 24-28 week of gestation, 75 g oral glucose tolerance test was conducted for them. Childhood height, weight, waist circumference and body composition were measured at the age of 4. Comparisons between groups were performed using chi-square test, analysis of variance or t-test. The relationship between pre-pregnancy overweight/obesity, GDM and childhood obesity-related characteristics were analyzed by logistic regression model and generalized linear model analysis. Results The prevalence rates of overweight and obesity in children at the age of 4 were 13.08% and 6.03%, respectively. After adjustment for characteristics related to mothers and their children, significantly increased risk of obesity (OR=3.27, 95%CI:2.15-4.98), larger waist circumference (OR=2.32, 95%CI:1.72-3.14) and higher waist-to-weight ratio (OR=2.29, 95%CI:1.73-3.02) were seen in the offspring of women with pre-pregnancy overweight/obesity. Body composition (skeletal muscle, body fat, body fat percentage) of the offspring were strongly correlated with pre-pregnancy overweight/obesity of the mothers (P<0.05). Maternal GDM was associated with higher risk of childhood obesity (OR=1.78, 95%CI:1.14-2.79), on mothers without GDM during pregnancy. However, neither larger waist circumference, or higher waist-to-weight ratio seemed to increase the risk. Moreover, maternal GDM was not associated with body composition measures (skeletal muscle, body fat, body fat percentage). Conclusion Pre-pregnancy BMI and maternal GDM were independent risk factors for obesity in 4-year-old children, and pre-pregnancy BMI was correlated with various indicators of body composition in children.

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