Fraser Abigail, Tilling Kate, Macdonald-Wallis Corrie, Sattar Naveed, Brion Marie-Jo, Benfield Li, Ness Andy, Deanfield John, Hingorani Aroon, Nelson Scott M, Smith George Davey, Lawlor Debbie A
Medical Research Council Centre for Causal Analyses in Translational Epidemiology, Department of Social Medicine, University of Bristol, Bristol, UK.
Circulation. 2010 Jun 15;121(23):2557-64. doi: 10.1161/CIRCULATIONAHA.109.906081. Epub 2010 Jun 1.
We sought to examine the association of gestational weight gain (GWG) and prepregnancy weight with offspring adiposity and cardiovascular risk factors.
Data from 5154 (for adiposity and blood pressure) and 3457 (for blood assays) mother-offspring pairs from a UK prospective pregnancy cohort were used. Random-effects multilevel models were used to assess incremental GWG (median and range of repeat weight measures per woman: 10 [1, 17]). Women who exceeded the 2009 Institute of Medicine-recommended GWG were more likely to have offspring with greater body mass index, waist, fat mass, leptin, systolic blood pressure, C-reactive protein, and interleukin-6 levels and lower high-density lipoprotein cholesterol and apolipoprotein A1 levels. Children of women who gained less than the recommended amounts had lower levels of adiposity, but other cardiovascular risk factors tended to be similar in this group to those of offspring of women gaining recommended amounts. When examined in more detail, greater prepregnancy weight was associated with greater offspring adiposity and more adverse cardiovascular risk factors at age 9 years. GWG in early pregnancy (0 to 14 weeks) was positively associated with offspring adiposity across the entire distribution but strengthened in women gaining >500 g/wk. By contrast, between 14 and 36 weeks, GWG was only associated with offspring adiposity in women gaining >500 g/wk. GWG between 14 and 36 weeks was positively and linearly associated with adverse lipid and inflammatory profiles, with these associations largely mediated by the associations with offspring adiposity.
Greater maternal prepregnancy weight and GWG up to 36 weeks of gestation are associated with greater offspring adiposity and adverse cardiovascular risk factors. Before any GWG recommendations are implemented, the balance of risks and benefits of attempts to control GWG for short- and long-term outcomes in mother and child should be ascertained.
我们试图研究孕期体重增加（GWG）和孕前体重与子代肥胖及心血管危险因素之间的关联。
使用了来自英国一项前瞻性妊娠队列的5154对母婴数据（用于肥胖和血压研究）以及3457对母婴数据（用于血液检测）。采用随机效应多水平模型评估GWG的增量（每位女性重复体重测量的中位数和范围：10[1,17]）。超过2009年美国医学研究所推荐的GWG的女性，其后代更有可能具有更高的体重指数、腰围、脂肪量、瘦素、收缩压、C反应蛋白和白细胞介素-6水平，以及更低的高密度脂蛋白胆固醇和载脂蛋白A1水平。孕期体重增加未达推荐量的女性所生子女的肥胖水平较低，但该组其他心血管危险因素与孕期体重增加达推荐量的女性所生子女的情况相似。进一步详细研究发现，孕前体重较高与子代9岁时肥胖程度增加及更多不良心血管危险因素相关。孕早期（0至14周）的GWG与子代肥胖在整个分布范围内呈正相关，但在每周体重增加>500克的女性中这种关联更强。相比之下，在14至36周期间，GWG仅与每周体重增加>500克的女性的子代肥胖相关。14至36周期间的GWG与不良血脂和炎症指标呈正线性相关，这些关联很大程度上是由与子代肥胖的关联介导的。
母亲孕前体重较高以及妊娠36周前的GWG增加与子代肥胖程度增加及不良心血管危险因素相关。在实施任何GWG建议之前，应确定控制GWG对母婴短期和长期结局的风险和益处的平衡。
