Departments of Obstetrics & Gynaecology and Pediatrics, Perinatal Epidemiology Research Unit, Dalhousie University, Halifax, NS, Canada.
Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, McMaster University, Hamilton, ON, Canada.
Int J Obes (Lond). 2019 Apr;43(4):735-743. doi: 10.1038/s41366-018-0149-3. Epub 2018 Jul 13.
BACKGROUND/OBJECTIVE: The association between maternal pre-pregnancy obesity and adverse child health outcomes is well described, but there are few data on the relationship with offspring health service use. We examined the influence of maternal pre-pregnancy obesity on offspring health care utilization and costs over the first 18 years of life.
This was a population-based retrospective cohort study of children (n = 35,090) born between 1989 and 1993 and their mothers, who were identified using the Nova Scotia Atlee Perinatal Database and linked to provincial administrative health data from birth through 2014. The primary outcome was health care utilization as determined by the number and cost of physician visits, hospital admissions and days, and high utilizer status (>95th percentile of physician visits). The secondary outcome was health care utilization by ICD chapter. Maternal pre-pregnancy weight was categorized as normal weight, overweight, or obese. Multivariable-adjusted regression models were used to examine the association between maternal weight status and offspring health care use.
Children of mothers with pre-pregnancy obesity had more physician visits (10%), hospital admissions (16%), and hospital days (10%) than children from mothers of normal weight over the first 18 years of life. Offspring of mothers with obesity had C$356 higher physician costs and C$1415 hospital costs over 18 years than offspring of normal weight mothers. Children of mothers with obesity were 1.74 times more likely to be a high utilizer of health care and had higher rates of physician visits and hospital stays for nervous system and sense organ disorders, respiratory disorders, and gastrointestinal disorders compared to children of normal weight mothers.
Our findings suggest that maternal pre-pregnancy overweight and obesity are associated with slightly higher offspring health care utilization and costs in the first 18 years of life.
背景/目的：母体孕前肥胖与儿童健康不良结局之间存在关联，这一点已得到充分证实，但关于其与后代健康服务利用之间关系的数据却很少。本研究旨在调查母体孕前肥胖对后代生命最初 18 年的健康护理利用和费用的影响。
这是一项基于人群的回顾性队列研究，研究对象为 1989 年至 1993 年间出生的儿童（n=35090）及其母亲。通过新斯科舍省阿特利围产期数据库确定儿童及其母亲，从出生到 2014 年通过省级行政健康数据与儿童相联系。主要结局是根据就诊次数、住院次数和天数以及高利用率（就诊次数超过第 95 百分位数）来确定的健康护理利用情况。次要结局是按 ICD 章次划分的健康护理利用情况。母体孕前体重分为正常体重、超重和肥胖。采用多变量调整回归模型来检验母体体重状况与后代健康护理利用之间的关系。
在生命最初 18 年中，与正常体重母亲的后代相比，母亲孕前肥胖的儿童就诊次数（多 10%）、住院次数（多 16%）和住院天数（多 10%）更多。与正常体重母亲的后代相比，肥胖母亲的后代就诊费用高 356 加元，住院费用高 1415 加元。肥胖母亲的后代成为高利用率健康护理者的可能性高 1.74 倍，且就诊次数和住院天数更高的疾病为神经系统和感觉器官疾病、呼吸系统疾病和胃肠道疾病，而这些疾病在正常体重母亲的后代中发病率较低。
本研究结果表明，母体孕前超重和肥胖与后代生命最初 18 年的健康护理利用率和费用略高有关。
