Hivert Marie-France, Rifas-Shiman Sheryl L, Gillman Matthew W, Oken Emily
Department of Population Medicine, Obesity Prevention Program, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA.
Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
Obesity (Silver Spring). 2016 Jul;24(7):1546-53. doi: 10.1002/oby.21511.
It is unclear how specific periods of gestational weight gain (GWG) during pregnancy relate to childhood adiposity. The goal of this study was to assess the differential impact of GWG timing on childhood body composition.
In 979 mother-child pairs from the pre-birth Project Viva cohort, trimester-specific GWG was calculated using clinically recorded weights. Outcomes included body mass index (BMI) z-score, dual X-ray absorptiometry fat mass index (kg/m(2) ), and fat-free mass index (kg/m(2) ) in mid-childhood. Linear regression models were used to assess associations of each trimester's GWG (per 0.2 kg/week) with childhood outcomes, adjusted for maternal prepregnancy BMI, sociodemographic variables, lifestyle, and GWG in prior trimester(s).
Mean (SD) first trimester GWG was 0.22 (0.22) kg/week, second trimester 0.49 (0.18) kg/week, and third trimester 0.47 (0.20) kg/week. Faster first trimester GWG was associated with higher BMI z-score (0.06 units [95% CI: 0.01-0.12] per 0.2 kg/week) and with higher adiposity according to all indices; associations were strongest in women with prepregnancy BMI >30 kg/m(2) . Faster second trimester GWG was associated with higher BMI z-score (0.11 [0.04-0.18]), fat mass (fat mass index = 0.16 [0.02-0.31] kg/m(2) ), and lean mass (fat-free mass index = 0.11 [0.01-0.22] kg/m(2) ). Third trimester GWG was not associated with childhood adiposity.
These results reinforce the importance of addressing appropriate GWG in early pregnancy.
孕期特定时间段的体重增加（GWG）与儿童肥胖之间的关系尚不清楚。本研究的目的是评估GWG时间对儿童身体成分的不同影响。
在来自“生命孕育前项目”队列的979对母婴中，使用临床记录的体重计算孕期各阶段的GWG。结局指标包括儿童中期的体重指数（BMI）z评分、双能X线吸收法脂肪量指数（kg/m²）和去脂体重指数（kg/m²）。采用线性回归模型评估孕期各阶段的GWG（每0.2 kg/周）与儿童结局之间的关联，并对母亲孕前BMI、社会人口学变量、生活方式以及前几个孕期的GWG进行了调整。
孕早期GWG的均值（标准差）为0.22（0.22）kg/周，孕中期为0.49（0.18）kg/周，孕晚期为0.47（0.20）kg/周。孕早期GWG越快，BMI z评分越高（每0.2 kg/周增加0.06个单位[95%置信区间：0.01 - 0.12]），并且根据所有指标，肥胖程度也越高；在孕前BMI>30 kg/m²的女性中，这种关联最为强烈。孕中期GWG越快，BMI z评分越高（0.11[0.04 - 0.18]），脂肪量（脂肪量指数 = 0.16[0.02 - 0.31]kg/m²）和瘦体重（去脂体重指数 = 0.11[0.01 - 0.22]kg/m²）也越高。孕晚期GWG与儿童肥胖无关。
这些结果强化了在孕早期控制适当GWG的重要性。
