Department of Obstetrics and Gynecology, Hangzhou Women's Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, China.
Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China; Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China.
J Pediatr. 2020 Nov;226:118-122.e1. doi: 10.1016/j.jpeds.2020.07.011. Epub 2020 Jul 6.
To examine whether the association of prepregnancy body mass index (BMI) with fetal macrosomia is mediated through maternal circulating lipid concentrations during pregnancy.
In this prospective cohort, 3011 eligible pregnant women were enrolled. Information on demographic characteristics were collected using questionnaires, and anthropometrics and laboratory tests were performed at 24 weeks of gestation and before delivery. Macrosomia was defined as birth weight ≥4000 g. Logistic regression and multivariable linear regression, adjusted for age, fetal sex, education, gestational weight gain, fasting blood glucose, gestational diabetes, gestational hypertension, gestational age at delivery, delivery mode, and parity, were used to assess the mediation path between prepregnancy BMI, maternal serum lipids, and fetal macrosomia.
A total of 2454 participants with completed records were included in the final analyses. Among the maternal circulating lipid biomarkers, only triglyceride was significantly associated with both prepregnancy BMI and fetal macrosomia risk, adjusting for potential confounders. Mediation analyses demonstrated that the direct effect of prepregnancy BMI on fetal macrosomia was 0.0085 (95% CI, 0.0003-0.018; P < .05), the indirect effect mediated through maternal serum triglycerides was 0.0016 (95% CI, 0.0007-0.0029; P < .001), and the estimated proportion of mediated effect was 15.7% (P < .05).
Maternal circulating triglycerides mediate the association of prepregnancy BMI with the risk of fetal macrosomia.
探讨孕妇妊娠期间循环脂质浓度是否在孕前体重指数（BMI）与胎儿巨大儿之间起中介作用。
在这项前瞻性队列研究中，共纳入 3011 名符合条件的孕妇。使用问卷收集人口统计学特征信息，在 24 周妊娠和分娩前进行人体测量和实验室检查。巨大儿定义为出生体重≥4000g。采用逻辑回归和多变量线性回归，调整年龄、胎儿性别、教育程度、妊娠体重增加、空腹血糖、妊娠期糖尿病、妊娠期高血压、分娩时的胎龄、分娩方式和产次，评估孕前 BMI、孕妇血清脂质与胎儿巨大儿之间的中介途径。
共有 2454 名记录完整的参与者纳入最终分析。在母体循环脂质生物标志物中，只有甘油三酯与孕前 BMI和胎儿巨大儿风险均显著相关，调整了潜在的混杂因素。中介分析表明，孕前 BMI 对胎儿巨大儿的直接效应为 0.0085（95%CI，0.0003-0.018；P<.05），通过母体血清甘油三酯介导的间接效应为 0.0016（95%CI，0.0007-0.0029；P<.001），中介效应的估计比例为 15.7%（P<.05）。
母体循环甘油三酯介导了孕前 BMI 与胎儿巨大儿风险之间的关联。
