母亲孕前BMI和孕期增重对学龄前期儿童营养不良的影响

The influence of maternal BMI before pregnancy and weight gain during pregnancy on malnutrition in preschool children

目的分析母亲孕前BMI和孕期增重与学龄前儿童营养不良的关联,探讨学龄前儿童发生营养不良的生命早期影响因素,并制定干预策略。方法于2021年1—5月按街道、办园性质、等级对深圳市龙岗区幼儿园进行分层,按照每层10%的比例进行随机抽样,共选出51家幼儿园,共12505名学龄前儿童及其母亲纳入研究,由专业的保健医生测量身高、体重等体格数据,并使用自行设计的问卷对儿童及母亲进行调查,使用WHO标准对体格进行评价,运用多因素二分类logistic回归模型分析母亲孕前BMI和孕期增重与学龄前儿童营养不良的关系,以及儿童营养不良的其他影响因素。结果2021年该区学龄前期儿童营养不良发病率为2.8%(349/12505),低体重发病率为1.0%,生长迟缓发病率为1.8%,消瘦发病率为2.8%,多因素Logistic分析结果发现,母亲孕前低BMI的学龄前儿童发生营养不良的风险为母亲孕期正常BMI儿童的1.41倍(OR=1.41,95%CI=1.16-1.71),多因素分析未发现孕期增重对营养不良的影响。此外,儿童年龄、贫血、低出生体重儿、食物搭配(全是素菜;肉少菜少,主食多)、母亲BMI、母亲低学历(初中及以下、高中或中专)是营养不良的危险因素(P<0.05)。巨大儿、独生子女、每天户外活动(1-2小时、3-4小时)是营养不良的保护因素(P<0.05)。结论母亲孕前较高BMI是导致学龄前儿童营养不良的危险因素,因此应加强对妊娠期妇女营养状况的管理和指导,并加强托幼机构管理,以降低子代营养不良风险发生。

Objective To analyze the relationship between maternal BMI before pregnancy and weight gain during pregnancy and malnutrition of preschool children,explore the early life influencing factors of malnutrition in preschool children,and formulate intervention strategies.Methods We adoptedcluster sampling method stratified according to street,nature and grade of kindergartensfrom January to may 2021.A total of 12505 preschool children and their mothers from 51 kindergartens were selected by random sampling according to the proportion of 10%of each floor.Professional health doctors measured physical data such as height and weight,and a self-designed questionnaire was used to investigate children and mothers.The WHO standard was used to evaluate the physique,and the multivariate binary logistic regression model was used to analyze the relationship between maternal BMI before pregnancy,weight gain during pregnancy and malnutrition in preschool children,as well as other influencing factors.Results The incidence rate of malnutrition in preschool children was 2.8%(349/12505)in the year2021,the incidence rate of low weight was 1%,the incidence rate of growth retardation was 1.8%,andthe incidencerate of emaciation was 2.8%.The results of multivariate logistic analysis showed that the risk of malnutrition among preschool children whose mother with low BMI before pregnancy was 1.41 times to that ofchildrenwhose mother with normal BMI during pregnancy(OR=1.41,95%CI=1.16-1.71).Multivariate analysis did not find the influence of weight gain during pregnancy on malnutrition.In addition,children's age,anemia,low birth weight of infants,food mix(all vegetarian dishes;low meat and vegetables dishes;staple foods),mother's BMI and mother's low education level(junior middle school and below,senior high school or technical secondary school)were the risk factors of malnutrition(P<0.05).Macrosomia,outdoor activities(1-2 hours,3-4 hours)were the protective factors of malnutrition(P<0.05).Conclusions High BMI of mothers before pregnancy is a risk factor leading to malnutrition in preschool children.Therefore,the management and guidance of nutritional status of pregnant women and the management of nurseries and kindergartens should be strengthened to reduce the risk of malnutrition in their offspring.