生命最初7年的生长与肥胖和孕期母亲血糖水平的关系：一项前瞻性队列研究
Growth and obesity through the first 7 y of life in association with levels of maternal glycemia during pregnancy: a prospective cohort study.
作者信息
Zhu Yeyi, Olsen Sjurdur F, Mendola Pauline, Yeung Edwina H, Vaag Allan, Bowers Katherine, Liu Aiyi, Bao Wei, Li Shanshan, Madsen Camilla, Grunnet Louise G, Granström Charlotta, Hansen Susanne, Martin Kelly, Chavarro Jorge E, Hu Frank B, Langhoff-Roos Jens, Damm Peter, Zhang Cuilin
机构信息
From the Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Rockville, MD;
Centre for Fetal Programming, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark;
出版信息
Am J Clin Nutr. 2016 Mar;103(3):794-800. doi: 10.3945/ajcn.115.121780. Epub 2016 Jan 27.
BACKGROUND
Given the long-term adverse sequelae of childhood obesity, identification of early life factors related to fetal growth and childhood obesity is warranted. Investigation on growth and obesity in early life in association with intrauterine exposure to maternal hyperglycemia, a common metabolic pregnancy complication, is of public health significance and clinical implications.
OBJECTIVE
We investigated the association of fasting plasma glucose (FPG) concentrations during pregnancy with offspring growth and risk of overweight/obesity through age 7 y, after adjustment for confounders, including maternal prepregnancy obesity status.
DESIGN
FPG concentrations at 28 gestational weeks (IQR: 22-32 wk) were extracted from medical records for 661 pregnancies complicated by gestational diabetes mellitus in the Danish National Birth Cohort (1996-2002). Offspring's ponderal index was derived from birth weight and length; age- and sex-specific body mass index (BMI) z scores at 5 mo, 12 mo, and 7 y were calculated based on WHO reference data. Relations between FPG and offspring growth and obesity were assessed by linear and Poisson regression with robust standard errors, adjusting for maternal prepregnancy BMI and sociodemographic and perinatal factors.
RESULTS
At birth, maternal FPG during pregnancy was significantly associated with offspring ponderal index (β = 0.46; 95% CI: 0.14, 0.78 per 1-mmol/L increase) and risk of macrosomia (birth weight >4000 g) (RR = 1.21; 95% CI: 1.07, 1.38 per 1-mmol/L increase). At 7 y, higher maternal FPG concentrations were significantly associated with increased BMI z scores (β = 0.20; 95% CI: 0.04, 0.36) and elevated risk of overweight/obesity (RR = 1.21; 95% CI: 1.01, 1.50). Additional adjustment for birth weight and childhood lifestyle factors did not appreciably alter results. No associations were observed at 5 or 12 mo.
CONCLUSION
Among women with gestational diabetes mellitus, maternal FPG concentrations during pregnancy were significantly and positively associated with offspring birth size and overweight/obesity risk at 7 y, adjusting for maternal prepregnancy BMI.
背景
鉴于儿童肥胖的长期不良后果，有必要确定与胎儿生长和儿童肥胖相关的早期生活因素。研究早期生活中的生长和肥胖与孕期宫内暴露于母体高血糖（一种常见的妊娠代谢并发症）之间的关系具有公共卫生意义和临床意义。
目的
在调整混杂因素（包括母亲孕前肥胖状况）后，我们调查了孕期空腹血糖（FPG）浓度与后代生长及7岁前超重/肥胖风险之间的关联。
设计
从丹麦国家出生队列（1996 - 2002年）中661例并发妊娠期糖尿病的妊娠医疗记录中提取妊娠28周时的FPG浓度（四分位间距：22 - 32周）。根据出生体重和身长计算后代的 ponderal 指数；根据世界卫生组织参考数据计算5个月、12个月和7岁时按年龄和性别划分的体重指数（BMI）z评分。通过线性回归和泊松回归以及稳健标准误评估FPG与后代生长和肥胖之间的关系，并对母亲孕前BMI以及社会人口统计学和围产期因素进行调整。
结果
出生时，孕期母亲FPG与后代ponderal指数显著相关（β = 0.46；95%置信区间：每升高1 mmol/L为0.14，0.78）以及巨大儿（出生体重>4000 g）风险相关（相对风险 = 1.21；95%置信区间：每升高1 mmol/L为1.07，1.38）。在7岁时，母亲FPG浓度较高与BMI z评分升高显著相关（β = 0.20；95%置信区间：0.04，0.36）以及超重/肥胖风险升高相关（相对风险 = 1.21；95%置信区间：1.01，1.50）。对出生体重和儿童生活方式因素进行额外调整后，结果没有明显改变。在5个月或12个月时未观察到关联。
结论
在患有妊娠期糖尿病的女性中，调整母亲孕前BMI后，孕期母亲FPG浓度与后代出生大小以及7岁时的超重/肥胖风险显著正相关。
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