Sridhar Sneha B, Darbinian Jeanne, Ehrlich Samantha F, Markman Margot A, Gunderson Erica P, Ferrara Assiamira, Hedderson Monique M
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Am J Obstet Gynecol. 2014 Sep;211(3):259.e1-8. doi: 10.1016/j.ajog.2014.02.030. Epub 2014 Apr 13.
The objective of the study was to evaluate the association between gestational weight gain, per the 2009 Institute of Medicine (IOM) recommendations, and offspring overweight/obesity at 2-5 years of age.
This was a prospective cohort study of 4145 women who completed a health survey (2007-2009) and subsequently delivered a singleton at Kaiser Permanente Northern California (2007-2010). Childhood overweight/obesity was defined as a body mass index (BMI) z-score of the 85th percentile or greater of the Centers for Disease Control and Prevention child growth standards. Gestational weight gain was categorized according to the 2009 IOM recommendations. Logistic regression was used; meeting the IOM recommendations was the referent.
Exceeding the IOM recommendations was associated with a 46% increase in odds of having an overweight/obese child (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.17-1.83), after adjusting for maternal prepregnancy BMI, race/ethnicity, age at delivery, education, child age, birthweight, gestational age at delivery, gestational diabetes, parity, infant sex, total metabolic equivalents, and dietary pattern. The OR (95% CI) for childhood overweight/obesity among women gaining below the IOM recommendations was 1.23 (0.88-1.71). The associations between gaining outside the IOM recommendations and childhood obesity were stronger among women with a normal prepregnancy BMI (OR, 1.63; 95% CI, 1.03-2.57) (below); OR, 1.79; 95% CI, 1.32-2.43) (exceeded).
Gestational weight gain outside the IOM recommendations is associated with increased odds of childhood overweight/obesity, independent of several potential confounders and mediators. Gestational weight gain had a greater impact on childhood overweight/obesity among normal-weight women, suggesting that the effect may be independent of genetic predictors of obesity.
本研究的目的是根据2009年医学研究所（IOM）的建议，评估孕期体重增加与2至5岁后代超重/肥胖之间的关联。
这是一项对4145名女性进行的前瞻性队列研究，这些女性完成了一项健康调查（2007 - 2009年），随后在北加利福尼亚州凯撒医疗集团（2007 - 2010年）产下单胎。儿童超重/肥胖定义为根据疾病控制与预防中心儿童生长标准，体重指数（BMI）z评分处于第85百分位或更高。孕期体重增加根据2009年IOM建议进行分类。使用逻辑回归分析；以符合IOM建议作为参照。
在调整了产妇孕前BMI、种族/族裔、分娩年龄、教育程度、孩子年龄、出生体重、分娩时孕周、妊娠期糖尿病、产次、婴儿性别、总代谢当量和饮食模式后，超出IOM建议与生出超重/肥胖儿童的几率增加46%相关（优势比[OR]，1.46；95%置信区间[CI]，1.17 - 1.83）。孕期体重增加低于IOM建议的女性中，儿童超重/肥胖的OR（95%CI）为1.23（0.88 - 1.71）。在孕前BMI正常的女性中，孕期体重增加超出IOM建议与儿童肥胖之间的关联更强（低于建议：OR，1.63；95%CI，1.03 - 2.57）；（超出建议：OR，1.79；95%CI，1.32 - 2.43）。
孕期体重增加超出IOM建议与儿童超重/肥胖几率增加相关，独立于多个潜在的混杂因素和中介因素。孕期体重增加对体重正常女性的儿童超重/肥胖影响更大，这表明该影响可能独立于肥胖的遗传预测因素。
