母亲孕前BMI、孕期增重和妊娠期糖尿病与婴幼儿BMI轨迹关联的前瞻性队列研究

Association of maternal pre-pregnancy BMI,gestational weight gain,and gestational diabetes mellitus with BMI trajectory in early childhood:a prospective cohort study

目的探讨母亲孕前BMI、孕期增重和妊娠期糖尿病(GDM)与婴幼儿BMI轨迹的关联。方法共纳入北大通州出生队列的1227对母子对,收集孕妇孕前体重、身高、孕期增重和GDM信息,分别在婴幼儿刚出生、1、3、6、9、12、18、24、30和36月龄进行随访,获取其身长/身高、体重等资料。使用基于纵向数据的k-means聚类方法识别婴幼儿BMI轨迹分组,采用logistic回归模型分析孕前BMI、孕期增重和GDM与婴幼儿BMI轨迹的关联,并通过相乘和相加交互作用分析探讨母亲孕前超重/肥胖和孕期增重过多对婴幼儿处于BMI高轨迹的影响是否存在交互作用。结果母亲孕前超重和肥胖者分别占21.2%(260名)和6.6%(81名);孕期增重过多者占57.7%(708名);GDM患病率为30.9%(379名)。婴幼儿BMI轨迹分为低、中、高轨迹,各占30.5%、45.4%和24.1%。控制潜在的混杂因素后,发现母亲孕前超重(OR=1.54,95%CI:1.12~2.12)、孕前肥胖(OR=2.33,95%CI:1.41~3.85)和孕期增重过多(OR=1.47,95%CI:1.10~1.97)是婴幼儿处于BMI高轨迹的危险因素,但GDM与婴幼儿BMI轨迹无统计学关联(P>0.05)。与母亲孕前超重/肥胖(OR=1.90,95%CI:1.17~3.09)和孕期增重过多(OR=1.45,95%CI:1.03~2.04)的单独作用相比,母亲孕前超重/肥胖和孕期增重过多并存时婴幼儿处于BMI高轨迹的风险更高(OR=2.38,95%CI:1.60~3.54),但相乘和相加模型分析结果均显示,孕前超重/肥胖和孕期增重过多之间无交互作用。结论孕前超重/肥胖和孕期增重过多是婴幼儿处于BMI高轨迹的独立危险因素,本研究为生命早期肥胖预防提供科学依据。

Objective To examine the associations of pre-pregnancy body mass index(BMI),gestational weight gain,and gestational diabetes mellitus(GDM)with early childhood BMI trajectories.Methods A total of 1227 mother-child pairs from the Peking University Birth Cohort in Tongzhou were included in this study.In the cohort,maternal pre-pregnancy weight,height,gestational weight gain,and GDM diagnosis were collected.The children were followed up at birth and at 1,3,6,9,12,18,24,30,and 36 months of age to obtain height/length and weight data.The longitudinal data-based k-means clustering algorithm was used to identify early childhood BMI trajectory groups.The associations of maternal pre-pregnancy BMI,gestational weight gain,and GDM with early childhood BMI trajectories were analyzed using the logistic regression model.We further explored whether there is an interaction effect between pre-pregnancy overweight/obesity and excessive gestational weight gain on the risk of the high BMI trajectory in early childhood through multiplicative and additive interaction analyses.Results The prevalence rates of overweight and obesity before pregnancy were 21.2%(260 cases)and 6.6%(81 cases)respectively.The prevalence of excessive gestational weight gain and GDM was 57.7%(708 cases)and 30.9%(379 cases).The early childhood BMI trajectories were named low,medium,and high trajectories,accounting for 30.5%,45.4%and 24.1%,respectively.After controlling potential confounding factors,it was found that pre-pregnancy overweight(OR=1.54,95%CI:1.12-2.12),obesity(OR=2.33,95%CI:1.41-3.85),and excessive gestational weight gain(OR=1.47,95%CI:1.10-1.97)were risk factors for being in the high BMI trajectory in early childhood.GDM was not significantly associated with early childhood BMI trajectories(P>0.05).Compared with the independent effects of pre-pregnancy overweight/obesity(OR=1.90,95%CI:1.17-3.09)and excessive gestational weight gain(OR=1.45,95%CI:1.03-2.04),the risk of being in the high BMI trajectory in early childhood was greater when the two factors coexisted(OR=2.38,95%CI:1.60-3.54).However,both the multiplicative and additive models showed no interaction effect between pre-pregnancy overweight/obesity and excessive gestational weight gain.Conclusions Maternal pre-pregnancy overweight/obesity and excessive gestational weight gain are independent risk factors for children being in the high BMI trajectory in early childhood,providing scientific evidence for obesity prevention.