孕期体重过度增加的时间与出生时后代肥胖的关系。
Timing of excessive pregnancy-related weight gain and offspring adiposity at birth.
机构信息
Physical Activity and Diabetes Laboratory, Faculty of Physical Education and Recreation, the Women and Children's Health Research Institute, and the Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada; the R. Samuel McLaughlin Foundation-Exercise & Pregnancy Laboratory, School of Kinesiology, Faculty of Health Sciences, the Department of Anatomy and Cell Biology, Schulich School of Medicine, and the Children's Health Research Institute, Western University, London, Ontario, Canada; and the Nutrition Program, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
出版信息
Obstet Gynecol. 2013 Aug;122(2 Pt 1):255-261. doi: 10.1097/AOG.0b013e31829a3b86.
OBJECTIVE
To evaluate whether the timing of excessive maternal weight gain in a cohort of women following current guidelines for healthy living during pregnancy affects neonatal adiposity at birth.
METHODS
One hundred seventy-two healthy women who were at least 18 years old with body mass indexes (BMIs) of at least 18.5 were recruited between 16 weeks and 20 weeks of gestation. The cohort followed healthy living guidelines during pregnancy and were retrospectively grouped according to 2009 Institute of Medicine guidelines for weight gain in the first and second halves of pregnancy: 1) appropriate gestational weight gain (ie, within Institute of Medicine recommendations) in the first and second halves of pregnancy ("overall appropriate"); 2) appropriate gestational weight gain in the first half of pregnancy and excessive gestational weight gain in the second half of pregnancy ("late excessive"); 3) excessive gestational weight gain in the first half of pregnancy and appropriate gestational weight gain in the second half of pregnancy ("early excessive"); and 4) excessive gestational weight gain throughout pregnancy ("overall excessive"). Primary measures included neonatal weight, length, BMI, and body fat at birth measured 6-18 hours after delivery. Neonatal body fat greater than 14% was considered excessive.
RESULTS
Neonates of women who gained excessively in the first half of pregnancy exhibited greater heel-crown length, birth weight, and excessive body fat ("early excessive" 17.5±3.1%, "overall excessive" 18.7±3.3%) compared with those born to women who gained appropriately ("overall appropriate" 13.2±4.1%; "late excessive" 14.7±3.3%; P<.01). Neonates of women who gained excessively in the first half of pregnancy had an increased risk (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.35-5.17) of elevated body fat at birth compared with neonates of women with total excessive weight gain (OR 1.49, 95% CI 0.80-2.79).
CONCLUSION
Timing of excessive weight gain is an important factor influencing neonatal morphometrics. Prevention of early excessive weight gain should be encouraged in the period before conception and reinforced early in pregnancy.
LEVEL OF EVIDENCE
II.
目的
评估在当前孕期健康生活指南下，大量孕妇体重增加的时机是否会影响新生儿出生时的脂肪量。
方法
在妊娠 16 周到 20 周期间，招募了 172 名年龄至少 18 岁且体重指数（BMI）至少为 18.5 的健康女性。该队列在孕期遵循健康生活指南，并根据 2009 年美国医学研究所（IOM）关于孕期前半期和后半期体重增加的指南进行回顾性分组：1）孕期前半期和后半期的体重增加均在 IOM 推荐范围内（即符合 IOM 建议）（“整体合适”）；2）孕期前半期体重增加合适，后半期体重增加过多（“晚期过多”）；3）孕期前半期体重增加过多，后半期体重增加合适（“早期过多”）；4）整个孕期体重增加过多（“整体过多”）。主要测量指标包括新生儿出生时 6-18 小时后测量的体重、身长、BMI 和体脂。新生儿体脂大于 14%被认为是过多。
结果
与孕期前半期增重合适的女性所生的新生儿相比，孕期前半期增重过多的女性的新生儿具有更大的跟-顶长度、出生体重和过多的体脂（“早期过多”为 17.5%±3.1%，“整体过多”为 18.7%±3.3%）（P<.01）。与总增重过多的女性相比，孕期前半期增重过多的女性的新生儿出生时体脂增加的风险更高（优势比[OR]2.64，95%置信区间[CI]1.35-5.17）（OR 1.49，95%CI 0.80-2.79）。
结论
体重增加的时机是影响新生儿形态的一个重要因素。应在受孕前和妊娠早期鼓励预防早期过度增重。
证据水平
II。
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