母亲妊娠前体重指数、出生体重与子女 I 型糖尿病发病风险的关系：队列研究的剂量-反应荟萃分析。

Pre-pregnancy body mass index in mothers, birth weight and the risk of type I diabetes in their offspring: A dose-response meta-analysis of cohort studies.

机构信息

Obstetrics Department, Affiliated Hospital of Chengde Medical College, Chengde City, 067100, China.

Clinical Laboratory, Staff Hospital of Chengde Iron & Steel Group Co., LTD., Chengde City, 067102, China.

出版信息

J Gynecol Obstet Hum Reprod. 2021 Feb;50(2):101921. doi: 10.1016/j.jogoh.2020.101921. Epub 2020 Sep 28.

DOI:10.1016/j.jogoh.2020.101921

PMID:32992035

Abstract

BACKGROUND

The incidence of type I diabetes among children has increased significantly and the relationship between maternal pre-pregnancy Body Mass Index (BMI), Birth weight and risk of Type 1 diabetes in children (T1DMC) is controversial.

OBJECTIVE

This dose-response meta-analysis was performed to investigate the association between maternal Pre-Pregnancy Body-Mass Index, Birth Weight and the Risk of Childhood Type I Diabetes.

SEARCH STRATEGY

A comprehensive systematic search was conducted in MEDLINE/PubMed, SCOPUS, Cochrane, and Web of Science databases from inception to April 2019. Key search terms included "body mass index" OR "Birth weight" AND "Type 1 diabetes".

SELECTION CRITERIA

Peer-reviewed studies that reporting association between BMI or birth weight and type I diabetes in a retrospective or prospective study by appropriate estimates such as the hazard ratio (HR), risk ratio (RR), or odds ratio (OR) and the corresponding 95 % confidence intervals (CI).

DATA COLLECTION AND ANALYSIS

MOOSE guidelines were followed. Data were extracted by 2 researchers, independently. Combined hazard ratios (HRs) was evaluated by DerSimonian and Laird Random-effects model.

RESULTS

Two studies continuing four arms with 1,209,122 participants were eligible for pre-pregnancy BMI section meta-analysis and six studies were eligible for inclusion, providing 10,340,036 participants for birth weight section meta-analysis. Pooled results demonstrated a significant association between obesity and risk of T1DMC (HR: 1.30, 95 % CI: 1.16-1.46, I2 = 7%). The combined HR (95 % CI) showed lower risk of T1DMC in low birth weight infants (HR: 0.78, 95 % CI: 0.69-0.88, I2 = 0%) and higher risk of T1DMC in the high birth weight infants versus the normal category of birth weight (HR: 1.08, 95 % CI: 1.00-1.17, I2 = 31 %). There was a significant non-linear association between birth weight and risk of T1DMC in children (Coef =-0.00032, p = 0.001).

CONCLUSIONS AND RELEVANCE

This systematic review and meta-analysis identified high maternal BMI and High birth weight (HBW) increase risk of childhood T1DMC.

摘要

背景

儿童 1 型糖尿病的发病率显著增加，而母亲孕前体重指数（BMI）、出生体重与儿童 1 型糖尿病（T1DMC）风险之间的关系存在争议。

目的

本剂量-反应荟萃分析旨在探讨母亲孕前体重指数、出生体重与儿童 1 型糖尿病风险之间的关系。

搜索策略

从 MEDLINE/PubMed、SCOPUS、Cochrane 和 Web of Science 数据库全面系统地检索了从成立到 2019 年 4 月的文献。关键搜索词包括“体重指数”或“出生体重”和“1 型糖尿病”。

选择标准

报告 BMI 或出生体重与回顾性或前瞻性研究中 1 型糖尿病之间关联的同行评议研究，适当的估计值，如危险比（HR）、风险比（RR）或优势比（OR）和相应的 95%置信区间（CI）。

数据收集与分析

遵循 MOOSE 指南。由两名研究人员独立提取数据。通过 DerSimonian 和 Laird 随机效应模型评估合并危险比（HR）。

结果

两项研究继续进行了四个部分，共有 1209122 名参与者，符合孕前 BMI 部分荟萃分析的条件，六项研究符合纳入条件，为出生体重部分荟萃分析提供了 10340036 名参与者。汇总结果表明，肥胖与 T1DMC 风险显著相关（HR：1.30，95%CI：1.16-1.46，I2=7%）。合并 HR（95%CI）显示，低出生体重婴儿患 T1DMC 的风险较低（HR：0.78，95%CI：0.69-0.88，I2=0%），而高出生体重婴儿患 T1DMC 的风险高于正常出生体重婴儿（HR：1.08，95%CI：1.00-1.17，I2=31%）。儿童出生体重与 T1DMC 风险之间存在显著的非线性关系（Coef=-0.00032，p=0.001）。