The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland.
The Generation R Study Group, Erasmus MC, University Medical Center, Rotterdam, Netherlands; Department of Paediatrics, Erasmus MC, University Medical Center, Rotterdam, Netherlands.
Lancet Child Adolesc Health. 2018 Nov;2(11):812-821. doi: 10.1016/S2352-4642(18)30273-6. Epub 2018 Sep 7.
Gestational diabetes and gestational hypertensive disorders are associated with offspring obesity, but the role of maternal adiposity in these associations remains unclear. We aimed to investigate whether these pregnancy complications affect the odds of offspring obesity independently of maternal obesity.
We did an individual participant data (IPD) meta-analysis of mother-offspring pairs from prospective birth cohort studies that had IPD on mothers with singleton liveborn children born from 1989 onwards and had information available about maternal gestational diabetes, gestational hypertension or pre-eclampsia, and childhood body-mass index (BMI). We applied multilevel mixed-effects models to assess associations of gestational diabetes, gestational hypertension, and pre-eclampsia with BMI SD scores and the odds of overweight and obesity throughout childhood, adjusting for lifestyle characteristics (offspring's sex, maternal age, educational level, ethnicity, parity, and smoking during pregnancy). We then explored the extent to which any association was explained by maternal pre-pregnancy or early-pregnancy BMI.
160 757 mother-offspring pairs from 34 European or North American cohorts were analysed. Compared with uncomplicated pregnancies, gestational diabetes was associated with increased odds of overweight or obesity throughout childhood (odds ratio [OR] 1·59 [95% CI 1·36 to 1·86] for early childhood [age 2·0-4·9 years], 1·41 [1·26 to 1·57] for mid childhood [5·0-9·9 years], and 1·32 [0·97 to 1·78] for late childhood [10·0-17·9 years]); however, these associations attenuated towards the null following adjustment for maternal BMI (OR 1·35 [95% CI 1·15 to 1·58] for early childhood, 1·12 [1·00 to 1·25] for mid childhood, and 0·96 [0·71 to 1·31] for late childhood). Likewise, gestational hypertension was associated with increased odds of overweight throughout childhood (OR 1·19 [95% CI 1·01 to 1·39] for early childhood, 1·23 [1·15 to 1·32] for mid childhood, and 1·49 [1·30 to 1·70] for late childhood), but additional adjustment for maternal BMI largely explained these associations (1·01 [95% CI 0·86 to 1·19] for early childhood, 1·02 [0·95 to 1·10] for mid childhood, and 1·18 [1·03 to 1·36] for late childhood). Pre-eclampsia was associated with decreased BMI in early childhood only (difference in BMI SD score -0·05 SD score [95% CI -0·09 to -0·01]), and this association strengthened following additional adjustment for maternal BMI.
Although lowering maternal risk of gestational diabetes, gestational hypertension, and pre-eclampsia is important in relation to maternal and fetal pregnancy outcomes, such interventions are unlikely to have a direct impact on childhood obesity. Preventive strategies for reducing childhood obesity should focus on maternal BMI rather than on pregnancy complications.
EU's Horizon 2020 research and innovation programme (LifeCycle Project).
妊娠糖尿病和妊娠高血压疾病与后代肥胖有关，但母体肥胖在这些关联中的作用仍不清楚。我们旨在研究这些妊娠并发症是否会影响后代肥胖的几率，而与母体肥胖无关。
我们对来自前瞻性出生队列研究的母婴对子进行了个体参与者数据（IPD）荟萃分析，这些研究具有关于 1989 年以后出生的单胎活产儿母亲的 IPD，并提供了关于母亲妊娠期糖尿病、妊娠期高血压或子痫前期以及儿童体重指数（BMI）的信息。我们应用多水平混合效应模型来评估妊娠期糖尿病、妊娠期高血压和子痫前期与 BMI 标准差评分以及整个儿童期超重和肥胖的几率之间的关联，同时调整了生活方式特征（后代性别、母亲年龄、教育程度、种族、产次和怀孕期间吸烟）。然后，我们探讨了任何关联在多大程度上可以通过母体孕前或孕早期 BMI 来解释。
我们分析了来自 34 个欧洲或北美队列的 160757 对母婴对子。与无并发症妊娠相比，妊娠期糖尿病与整个儿童期超重或肥胖的几率增加相关（幼儿期[2-4.9 岁]的比值比[OR]为 1.59 [95%置信区间 1.36 至 1.86]，儿童中期[5.0-9.9 岁]为 1.41 [1.26 至 1.57]，儿童后期[10.0-17.9 岁]为 1.32 [0.97 至 1.78]）；然而，这些关联在调整母体 BMI 后趋于零（幼儿期的 OR 为 1.35 [95%CI 1.15 至 1.58]，儿童中期为 1.12 [1.00 至 1.25]，儿童后期为 0.96 [0.71 至 1.31]）。同样，妊娠期高血压与整个儿童期超重的几率增加相关（幼儿期的 OR 为 1.19 [95%CI 1.01 至 1.39]，儿童中期为 1.23 [1.15 至 1.32]，儿童后期为 1.49 [1.30 至 1.70]），但进一步调整母体 BMI 后，这些关联在很大程度上得到了解释（幼儿期为 1.01 [95%CI 0.86 至 1.19]，儿童中期为 1.02 [0.95 至 1.10]，儿童后期为 1.18 [1.03 至 1.36]）。子痫前期仅与幼儿期 BMI 降低有关（BMI 标准差评分差值-0.05 标准差评分[95%CI-0.09 至-0.01]），并且这种关联在进一步调整母体 BMI 后加强。
虽然降低妊娠期糖尿病、妊娠期高血压和子痫前期的母体风险与母婴妊娠结局有关，但此类干预措施不太可能对儿童肥胖产生直接影响。减少儿童肥胖的预防策略应侧重于母体 BMI，而不是妊娠并发症。
欧盟地平线 2020 研究和创新计划（LifeCycle 项目）。
