母亲孕前及分娩前超重肥胖对中学生超重肥胖影响的病例对照研究

Association between maternal pre-pregnancy and pre-delivery overweight with overweight and obesity of middle school students:a case-control study

目的探讨广州市母亲孕前及分娩前超重肥胖对子代中学时期超重肥胖的影响,为预防中学生肥胖提供科学依据。方法依托广州市中学生常规体检,抽取3所高中、3所初中共3384名学生,将体检中超重肥胖的中学生纳入超重肥胖组(642名),其余学生纳入对照组(2742名),对学生及家长进行问卷调查。使用倾向性评分匹配(propensity score matching,PSM)前后的数据进行χ^(2)检验和Logistic回归分析,对比匹配前后结果的变化。结果单因素分析显示,进行PSM前,超重肥胖组和对照组在性别、学段、是否挑食、肥胖家族史、家庭人均月收入、母亲分娩方式、是否为巨大儿和孕期增重情况差异均有统计学意义(χ^(2)值分别为42.38,10.64,14.47,26.85,10.58,13.59,15.53,20.64,P值均<0.05)。PSM后,孕前及分娩前超重肥胖组和对照组在学段、分娩方式上组间差异均无统计学意义(P值均>0.05)。Logistic回归分析显示,进行PSM前,母亲孕前超重肥胖的中学生超重肥胖风险是母亲孕前非超重肥胖的1.54倍(95%CI=1.01~2.36),而母亲在分娩前超重肥胖同样增加了中学生超重肥胖的风险(OR=2.35,95%CI=1.67~3.31)。在进行PSM后,母亲孕前(OR=2.17,95%CI=1.41~3.34)及分娩前超重肥胖(OR=2.99,95%CI=2.08~4.31)均明显增加中学生超重肥胖风险。结论母亲孕前和分娩前超重肥胖与中学生的超重肥胖风险增高有关联。

Objective To explore the association between maternal pre-pregnancy and pre-delivery overweight with overweight and obesity among offspring during adolescence in Guangzhou,and to provide evidence for child obesity prevention.Methods Based on the routine physical examination of primary and secondary school students in Guangzhou,random sampling was used to 6 middle schools and questionnaire survey was conducted among 3384 students and their parents.Students with overweight and obesity were included in the case group,and the other students were included in the control group.Propensity Score Matching(PSM)was adopted to reduce selection bias.Logistic regression model andχ^(2) test were used to analyze the data before and after PSM.Results The result of univariate analysis showed that there were statistically significant differences between overweight/obese group and the control group by gender,schooling stage(middle and high schools),picky eater,family history of obesity,family monthly income,delivery mode,high birthweight,and gestational weight gain before PSM(χ^(2)=42.38,10.64,14.47,26.85,10.58,13.59,15.53,20.64,P<0.05).After PSM,results showed that there were no statistically significant differences between overweight/obese group and the control group in middle and high schools,and mother delivery mode(P>0.05).Logistic regression analysis showed that the risk of overweight and obesity of maternal pre-pregnancy on adolescent offspring was 1.54 times higher than control group(95%CI=1.01-2.36)before PSM,and the overweight and obesity of maternal pre-delivery also increased the risk of overweight and obesity of adolescent offspring(OR=2.35,95%CI=1.67-3.31).After PSM,maternal overweight and obesity prepregnancy(OR=2.17,95%CI=1.41-3.34)and maternal overweight and obesity pre-delivery(OR=2.99,95%CI=2.08-4.31)significantly increased the risk of overweight and obesity in adolescent offspring.Conclusion Maternal overweight and obesity prepregnancy and pre-delivery are associated with increased risk of overweight and obesity in adolescent offspring.