Prioreschi Alessandra, Wrottesley Stephanie V, Said-Mohamed Rihlat, Nyati Lukhanyo, Newell Marie-Louise, Norris Shane A
SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Institute for Developmental Science and Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, UK.
J Dev Orig Health Dis. 2021 Feb;12(1):79-87. doi: 10.1017/S2040174420000045. Epub 2020 Feb 17.
The aim of this study was to identify social and biological drivers of fetal growth by examining associations with household, preconception, and pregnancy factors in a cohort from Soweto, South Africa. Complete data and ultrasound scans were collected on 519 women between 2013 and 2016 at 6 time points during pregnancy (<14, 14-18, 19-23, 24-28, 29-33 weeks, and 34-38 weeks). Household-level factors, preconception health, baseline body mass index (BMI), and demographic data were collected at the first visit. During pregnancy, gestational weight gain (GWG; kg/week) was calculated. At 24-28 weeks of gestation, oral glucose tolerance test was used to determine gestational diabetes mellitus (GDM) status, and hypertension status was characterised. Longitudinal growth in head circumference, abdominal circumference, biparietal diameter, and femur length were modelled using the Superimposition by Translation and Rotation, a shape-invariant model which produces growth curves against gestational age. A priori identified exposure variables were then included in a series of sex-stratified hierarchical regression models for each fetal growth outcome. No household-level factors were associated with fetal growth. Maternal BMI at baseline was positively associated with all outcome parameters in males and females. Both GWG (in males and females) and GDM (in males) were significant positive predictors of abdominal growth. Males showed more responsiveness to abdominal growth, while females were more responsive to linear growth. Thus, fetal growth was largely predicted by maternal biological factors, and sexual dimorphism in the responsiveness of fetal biometry to biological exposures was evident.
本研究的目的是通过调查南非索韦托一个队列中家庭、孕前和孕期因素之间的关联，来确定胎儿生长的社会和生物学驱动因素。2013年至2016年期间，在孕期的6个时间点（<14周、14 - 18周、19 - 23周、24 - 28周、29 - 33周和34 - 38周）收集了519名女性的完整数据和超声扫描结果。首次就诊时收集了家庭层面因素、孕前健康状况、基线体重指数（BMI）和人口统计学数据。孕期计算了孕期体重增加（GWG；kg/周）。在妊娠24 - 28周时，采用口服葡萄糖耐量试验确定妊娠期糖尿病（GDM）状态，并对高血压状态进行了特征描述。使用平移和旋转叠加法（一种形状不变模型，可生成相对于胎龄的生长曲线）对头围、腹围、双顶径和股骨长度的纵向生长进行建模。然后将预先确定的暴露变量纳入针对每个胎儿生长结局的一系列按性别分层的分层回归模型中。没有家庭层面因素与胎儿生长相关。基线时母亲的BMI与男性和女性的所有结局参数均呈正相关。GWG（男性和女性）和GDM（男性）均是腹部生长的显著正预测因子。男性对腹部生长的反应更强，而女性对线性生长的反应更强。因此，胎儿生长在很大程度上由母亲的生物学因素预测，并且胎儿生物测量对生物学暴露的反应存在明显的性别差异。
