孕前BMI和妊娠期糖尿病对儿童脂肪重积聚时相提前的独立和联合效应

Independent and combined effects of pre-pregnancy BMI and gestational diabetes on early adiposity rebound timing in children

目的探讨孕前BMI、妊娠期糖尿病(GDM)与儿童脂肪重积聚(AR)时相提前的关联。方法基于已经建立的马鞍山优生优育队列,本研究共纳入2896对母子对,收集孕妇孕前身高、体重、24~28周GDM情况,在婴儿42天、3月龄、6月龄、9月龄以及1岁后每6个月进行1次随访,连续追踪随访至6岁,获得其身长/高、体重等资料。采用多因素logistic回归分析孕前BMI、GDM与儿童AR时相提前的关联强度,并通过相乘、相加模型分析孕前BMI及GDM对于儿童AR时相提前的发生是否存在交互作用。结果母亲孕前体重不足、体重正常、超重和肥胖者分别占23.2%(672例)、66.4%(1923例)、8.7%(251例)和1.7%(50例);GDM患病率为12.4%。儿童AR年龄为(4.38±1.08)岁,AR时相提前的儿童占39.3%。多因素logistic回归结果显示,孕前超重(OR=1.67,95%CI:1.27~2.19)、肥胖(OR=3.05,95%CI:1.66~5.56)以及孕期患有GDM(OR=1.40,95%CI:1.11~1.76)是AR时相提前发生的危险因素,而孕前体重不足(OR=0.60,95%CI:0.49~0.73)是AR时相提前发生的保护因素。与仅孕前超重/肥胖或孕期患有GDM相比,孕前超重/肥胖与孕期患有GDM并存,AR时相提前的发生风险更高,OR值(95%CI)分别为2.03(1.20~3.44)、3.43(1.06~11.12)。相乘模型和相加模型分析显示,孕前BMI和孕期患有GDM对儿童AR时相提前无交互作用。结论母亲孕前较高的BMI和孕期患有GDM是儿童AR时相提前发生的独立危险因素,两者并存的风险更高,但无统计学交互作用。

Objective To examine the independent and combined effects of pre-pregnancy BMI and gestational diabetes(GDM)on early adiposity rebound(AR)timing in children.Methods Based on the"Ma'anshan Birth Cohort Study",2896 eligible maternal and infant pairs were recruited.In the cohort,we collected pre-pregnancy height,weight,24 to 28 weeks GDM diagnosis,follow-up at 42 days,three months,six months,nine months of age,and every six months after one year of age,and continuously followed up to 6 years old,and obtained the child's length/height,weight,and other data.The intensity of the association between pre-pregnancy BMI,GDM,and early AR timing was analyzed by the multivariate logistic regression model.Multiplication and additive models were used to analyze how pre-pregnancy BMI and GDM influenced early AR timing in children.Results The prevalence of underweight,average weight,overweight,and obesity before pregnancy were 23.2%(672),66.4%(1923),8.7%(251),and 1.7%(50).The prevalence of GDM was 12.4%.We found that 39.3%of children had AR,and the average age at AR was(4.38±1.08).The results of multifactorial logistic regression analysis showed that pre-pregnancy overweight(OR=1.67,95%CI:1.27-2.19),pre-pregnancy obesity(OR=3.05,95%CI:1.66-5.56),and maternal GDM(OR=1.40,95%CI:1.11-1.76)were risk factors for early AR timing in children.In contrast,pre-pregnancy underweight(OR=0.60,95%CI:0.49-0.73)was a protective factor for early AR timing in children.Compared with the different effects of pre-pregnancy overweight/obesity and maternal GDM alone,the combined effect caused a higher risk of early AR timing in children,with OR values(95%CI)were 2.03(1.20-3.44),3.43(1.06-11.12),respectively.The multiplication and additive models showed no interaction between pre-pregnancy BMI and GDM-influenced early AR timing in children.Conclusion Higher pre-pregnancy BMI and maternal GDM are the independent risk factors for the early AR timing in children,and the co-occurrence of the two is higher risks,but there was no statistical interaction.