Houghton L C, Ester W A, Lumey L H, Michels K B, Wei Y, Cohn B A, Susser E, Terry M B
Department of Epidemiology, Columbia University, Mailman School of Public Health, 722W 168th Street, New York, NY 10032, USA.
Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH, The Hague, The Netherlands.
Am J Obstet Gynecol. 2016 Aug;215(2):246.e1-246.e8. doi: 10.1016/j.ajog.2016.02.034. Epub 2016 Feb 18.
Exceeding the Institute of Medicine guidelines for pregnancy weight gain increases childhood and adolescent obesity. However, it is unknown if these effects extend to midlife.
We sought to determine if exceeding the Institute of Medicine guidelines for pregnancy weight gain increases risk of overweight/obesity in daughters 40 years later.
This cohort study is based on adult offspring in the Child Health and Development Studies and the Collaborative Perinatal Project pregnancy cohorts originally enrolled in the 1960s. In 2005 through 2008, 1035 daughters in their 40s were recruited to the Early Determinants of Mammographic Density study. We classified maternal pregnancy weight gain as greater than vs less than or equal to the 2009 clinical guidelines. We used logistic regression to compare the odds ratios of daughters being overweight/obese (body mass index [BMI] ≥25) at a mean age of 44 years between mothers who did not gain or gained more than pregnancy weight gain guidelines, accounting for maternal prepregnant BMI, and daughter body size at birth and childhood. We also examined potential family related confounding through a comparison of sisters using generalized estimating equations, clustered on sibling units and adjusted for maternal age and race.
Mothers who exceeded guidelines for weight gain in pregnancy were more likely to have daughters who were overweight/obese in their 40s (odds ratio [OR], 3.4; 95% confidence interval {CI}, 2.0-5.7). This magnitude of association translates to a relative risk (RR) increase of 50% (RR = 1.5; 95% CI, 1.3-1.6). The association was of the same magnitude when examining only the siblings whose mother exceeded guidelines in 1 pregnancy and did not exceed the guidelines in the other pregnancy. The association was stronger with increasing maternal prepregnancy BMI (P trend < .001). Compared to mothers with BMI <25 who did not exceed guidelines, the relative risks (RR) for having an overweight/obese adult daughter were 1.3 (95% CI, 1.1-1.7), 1.7 (95% CI, 1.4-2.1) and 1.8 (95% CI, 1.5-2.1), respectively, if mothers exceeded guidelines and their prepregnancy BMI was <25, overweight (BMI 25-<30), or obese (BMI >30). This pattern held irrespective of daughters' weight status at birth, at age 4 years, or at age 20 years.
Our findings support that obesity prevention before pregnancy and strategies to maintain weight gain during pregnancy within the IOM guidelines might reduce the risk of being overweight in midlife for the offspring.
超过医学研究所关于孕期体重增加的指导标准会增加儿童期和青少年期肥胖的风险。然而，这些影响是否会延续到中年尚不清楚。
我们试图确定超过医学研究所关于孕期体重增加的指导标准是否会增加40年后女儿超重/肥胖的风险。
这项队列研究基于儿童健康与发展研究以及20世纪60年代最初招募的围产期协作项目妊娠队列中的成年后代。2005年至2008年，1035名40多岁的女儿被招募到乳房X线密度早期决定因素研究中。我们将母亲孕期体重增加分为大于或小于或等于2009年临床指南。我们使用逻辑回归比较母亲孕期体重增加未达到或超过指南标准的女儿在平均44岁时超重/肥胖（体重指数[BMI]≥25）的比值比，同时考虑母亲孕前BMI以及女儿出生时和儿童期的体型。我们还通过使用广义估计方程比较姐妹来检查潜在的家庭相关混杂因素，以姐妹单位为聚类并调整母亲年龄和种族。
孕期体重增加超过指南标准的母亲更有可能生育40多岁时超重/肥胖的女儿（比值比[OR]为3.4；95%置信区间{CI}为2.0 - 5.7）。这种关联程度相当于相对风险（RR）增加50%（RR = 1.5；95% CI为1.3 - 1.6）。仅检查母亲在一次妊娠中超过指南标准而在另一次妊娠中未超过指南标准的姐妹时，关联程度相同。随着母亲孕前BMI的增加，关联更强（P趋势<0.001）。与孕前BMI <2且未超过指南标准的母亲相比，如果母亲超过指南标准且孕前BMI <25、超重（BMI 25 - <30）或肥胖（BMI>30），生育超重/肥胖成年女儿的相对风险（RR）分别为1.3（95% CI为1.1 - 1.7）、1.7（95% CI为1.4 - 2.1）和1.8（95% CI为1.5 - 2.1）。无论女儿出生时、4岁时或20岁时的体重状况如何，这种模式都成立。
我们的研究结果支持，孕前预防肥胖以及在医学研究所指南范围内维持孕期体重增加的策略可能会降低后代中年超重的风险。
