Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore.
Int J Epidemiol. 2020 Oct 1;49(5):1591-1603. doi: 10.1093/ije/dyaa143.
Using longitudinal ultrasounds as an improved fetal growth marker, we aimed to investigate if fetal growth deceleration followed by rapid postnatal weight gain is associated with childhood cardiometabolic risk biomarkers in a contemporary well-nourished population.
We defined fetal growth deceleration (FGD) as ultrasound-measured 2nd-3rd-trimester abdominal circumference decrease by ≥0.67 standard deviation score (SDS) and rapid postnatal weight gain (RPWG) as 0-2-year-old weight increase by ≥0.67 SDS. In the GUSTO mother-offspring cohort, we grouped 797 children into four groups of FGD-only (14.2%), RPWG-only (23.3%), both (mismatch, 10.7%) or neither (reference, 51.8%). Adjusting for confounders and comparing with the reference group, we tested associations of these growth groups with childhood cardiometabolic biomarkers: magnetic resonance imaging (MRI)-measured abdominal fat (n = 262), liver fat (n = 216), intramyocellular lipids (n = 227), quantitative magnetic resonance-measured overall body fat % (BF%) (n = 310), homeostasis model assessment of insulin resistance (HOMA-IR) (n = 323), arterial wall thickness (n = 422) and stiffness (n = 443), and blood pressure trajectories (ages 3-6 years).
Mean±SD birthweights were: FGD-only (3.11 ± 0.38 kg), RPWG-only (3.03 ± 0.37 kg), mismatch (2.87 ± 0.31 kg), reference (3.30 ± 0.36 kg). FGD-only children had elevated blood pressure trajectories without correspondingly increased BF%. RPWG-only children had altered body fat partitioning, higher BF% [BF = 4.26%, 95% confidence interval (CI) (2.34, 6.19)], HOMA-IR 0.28 units (0.11, 0.45)] and elevated blood pressure trajectories. Mismatch children did not have increased adiposity, but had elevated ectopic fat, elevated HOMA-IR [0.29 units (0.04,0.55)] and the highest blood pressure trajectories. Associations remained even after excluding small-for-gestational-age infants from analyses.
Fetal growth deceleration coupled with rapid postnatal weight gain was associated with elevated childhood cardiometabolic risk biomarkers without correspondingly increased BF%.
本研究旨在利用纵向超声作为改良的胎儿生长标志物，探究在营养良好的当代人群中，胎儿生长减速（Fetal Growth Deceleration，FGD）后快速的出生后体重增长是否与儿童时期心血管代谢风险生物标志物相关。
我们将超声测量的 2 至 3 期腹围减少≥0.67 标准差评分（SDS）定义为胎儿生长减速（FGD），将 0-2 岁体重增加≥0.67 SDS 定义为快速出生后体重增长（Rapid Postnatal Weight Gain，RPWG）。在 GUSTO 母婴队列中，我们将 797 名儿童分为四组：FGD 组（14.2%）、RPWG 组（23.3%）、两者均有组（不匹配，10.7%）或两者均无组（参考组，51.8%）。我们通过调整混杂因素并与参考组比较，来检测这些生长组与儿童时期心血管代谢生物标志物的相关性：磁共振成像（Magnetic Resonance Imaging，MRI）测量的腹部脂肪（n=262）、肝脏脂肪（n=216）、肌内脂肪（n=227）、定量磁共振测量的总体体脂百分比（Body Fat Percentage，BF%）（n=310）、稳态模型评估的胰岛素抵抗（Homeostasis Model Assessment of Insulin Resistance，HOMA-IR）（n=323）、动脉壁厚度（n=422）和硬度（n=443），以及血压轨迹（3-6 岁）。
各组儿童的平均出生体重及标准差如下：FGD 组（3.11±0.38kg）、RPWG 组（3.03±0.37kg）、不匹配组（2.87±0.31kg）、参考组（3.30±0.36kg）。FGD 组儿童的血压轨迹升高，但 BF% 无相应增加。RPWG 组儿童的体脂分布发生改变，BF%较高[BF=4.26%，95%置信区间（Confidence Interval，CI）（2.34，6.19）]，HOMA-IR 升高 0.28 单位（0.11，0.45）]，血压轨迹也升高。不匹配组儿童的脂肪含量没有增加，但异位脂肪增加，HOMA-IR 升高[0.29 单位（0.04，0.55）]，血压轨迹最高。即使在排除了小于胎龄儿后，这些相关性仍然存在。
FGD 与快速的出生后体重增长相结合与儿童时期心血管代谢风险生物标志物升高相关，而 BF% 没有相应增加。
