协作围产期项目中的母亲孕前肥胖与儿童神经发育
Maternal prepregnancy obesity and child neurodevelopment in the Collaborative Perinatal Project.
作者信息
Huang Lisu, Yu Xiaodan, Keim Sarah, Li Ling, Zhang Lin, Zhang Jun
机构信息
MOE-Shanghai Key Laboratory of Children's Environmental Health and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, Columbus, OH, USA and Department of Pediatrics and Division of Epidemiology, Ohio State University, Columbus, OH, USA and Department of Obstetrics, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaMOE-Shanghai Key Laboratory of Children's Environmental Health and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, Columbus, OH, USA and Department of Pediatrics and Division of Epidemiology, Ohio State University, Columbus, OH, USA and Department of Obstetrics, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
MOE-Shanghai Key Laboratory of Children's Environmental Health and Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Research Institute at Nationwide Children's Hospital, Center for Biobehavioral Health, Columbus, OH, USA and Department of Pediatrics and Division of Epidemiology, Ohio State University, Columbus, OH, USA and Department of Obstetrics, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
Int J Epidemiol. 2014 Jun;43(3):783-92. doi: 10.1093/ije/dyu030. Epub 2014 Feb 24.
OBJECTIVES
To examine the association between maternal prepregnancy weight and child neurodevelopment, and the effect of gestational weight gain.
METHODS
Using the U.S. Collaborative Perinatal Project data, 1959-76, a total of 30,212 women with a calculable prepregnancy body mass index (BMI) and gestational weight gain, and term singleton children followed up for more than 7 years were included in this study. Intelligence quotient (IQ) was measured at 7 years of age by Wechsler Intelligence Scales.
RESULTS
Maternal prepregnancy BMI displayed inverted U-shaped associations with child IQ after adjustment for maternal age, maternal education levels, maternal race, marital status, socioeconomic status, smoking during pregnancy, parity and study center. Women with BMI at around 20 kg/m2 appeared to have the highest offspring IQ scores. After controlling for familial factors in the siblings' sample, maternal obesity (BMI≥30.0 kg/m2) was associated with lower Full-scale IQ (adjusted ß=-2.0, 95% confidence interval -3.5 to -0.5), and Verbal scale IQ (adjusted ß=-2.5, 95% confidence interval -4.0 to -1.0), using BMI of 18.5-24.9 kg/m2 as the reference category. Compared with children born to normal-weight women who gained 21-25 lb. during pregnancy, those born to obese women who gained more than 40 lb. had 6.5 points deficit in IQ after adjustment for potential confounders.
CONCLUSIONS
Maternal prepregnancy obesity was associated with lower child IQ, and excessive weight gain accelerated the association. With obesity rising steadily, these results appear to raise serious public health concerns.
目的
研究孕前体重与儿童神经发育之间的关联，以及孕期体重增加的影响。
方法
本研究使用了1959 - 1976年美国围产期协作项目的数据，纳入了总共30212名有可计算的孕前体重指数（BMI）和孕期体重增加情况、且其足月单胎子女随访时间超过7年的女性。儿童7岁时通过韦氏智力量表测量智商（IQ）。
结果
在调整了母亲年龄、母亲教育水平、母亲种族、婚姻状况、社会经济地位、孕期吸烟、产次和研究中心等因素后，母亲孕前BMI与儿童IQ呈倒U形关联。BMI约为20 kg/m²的女性所生子女的IQ得分似乎最高。在兄弟姐妹样本中控制家族因素后，以BMI为18.5 - 24.9 kg/m²作为参照类别，母亲肥胖（BMI≥30.0 kg/m²）与较低的全量表IQ（校正β=-2.0，95%置信区间-3.5至-0.5）以及言语量表IQ（校正β=-2.5，95%置信区间-4.0至-1.0）相关。与孕期体重增加21 - 25磅的正常体重女性所生子女相比，孕期体重增加超过40磅的肥胖女性所生子女在调整潜在混杂因素后IQ有6.5分的差距。
结论
母亲孕前肥胖与儿童较低的IQ相关，且体重过度增加会加剧这种关联。随着肥胖率稳步上升，这些结果似乎引发了严重的公共卫生问题。
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