Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China.
Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.
BJOG. 2021 Sep;128(10):1615-1624. doi: 10.1111/1471-0528.16698. Epub 2021 Apr 6.
To examine the longitudinal associations of fetal growth with adverse child growth outcomes and to assess whether maternal metabolic factors modify the associations.
Prospective cohort study.
Born in Guangzhou Cohort Study, China.
A total of 4818 mother-child pairs.
Fetal growth was assessed according to estimated fetal weight (EFW) from 22 weeks of gestation until birth and the measurement of the birthweight. Fetal growth Z-scores were computed from random effects in the multilevel linear spline models to represent fetal size in early pregnancy (22 weeks of gestation) and growth in mid-pregnancy (22-27 weeks of gestation), early third trimester (28-36 weeks of gestation) and late third trimester (≥37 weeks of gestation).
Z-scores for childhood stunting, low weight, overweight or obesity, length/height for age (LAZ/HAZ), weight for age (WAZ) and body mass index for age (BMIZ) at the age of 3 years. Adjusted associations were examined using multiple Poisson or linear regression models.
Increased Z-scores of fetal size in early pregnancy and growth in mid-pregnancy and early third trimester were associated with a higher risk of childhood overweight or obesity (risk ratios 1.25-1.45). Fetal growth in each period was negatively associated with stunting and low weight, with the strongest associations observed for fetal size in early pregnancy and growth in mid-pregnancy. The results for continuous outcomes (LAZ/HAZ, WAZ and BMIZ) were similar. The associations of fetal growth with overweight or obesity in childhood were stronger among mothers who were underweight and who were overweight or obese than among mothers of normal weight.
Accelerated fetal growth before 37 weeks of gestation is associated with children who are overweight or obese, whereas the critical period for stunting and low weight occurs before 28 weeks of gestation.
Fetal growth during different periods is differentially associated with childhood stunting, underweight and overweight or obesity.
探讨胎儿生长与儿童不良生长结局的纵向关联，并评估母体代谢因素是否会改变这种关联。
前瞻性队列研究。
中国广州出生队列研究。
共有 4818 对母婴。
根据 22 孕周至分娩时的估计胎儿体重（EFW）和出生体重评估胎儿生长情况。采用多水平线性样条模型中的随机效应计算胎儿生长 Z 分数，以代表妊娠早期（22 孕周）和妊娠中期（22-27 孕周）、妊娠晚期（28-36 孕周）和晚期妊娠（≥37 孕周）的胎儿大小。
3 岁时儿童生长迟缓、体重不足、超重或肥胖、年龄别身高（LAZ/HAZ）、年龄别体重（WAZ）和年龄别体重指数（BMIZ）Z 分数。采用多元 Poisson 或线性回归模型检验调整后的关联。
妊娠早期胎儿大小和妊娠中期及妊娠晚期胎儿生长的 Z 分数增加与儿童超重或肥胖的风险增加相关（风险比 1.25-1.45）。每个时期的胎儿生长与生长迟缓、体重不足呈负相关，妊娠早期胎儿大小和妊娠中期胎儿生长与生长迟缓、体重不足的相关性最强。连续结局（LAZ/HAZ、WAZ 和 BMIZ）的结果相似。在体重不足和超重或肥胖的母亲中，胎儿生长与儿童超重或肥胖的关联强于体重正常的母亲。
37 周前加速胎儿生长与超重或肥胖儿童有关，而生长迟缓、体重不足的关键期发生在 28 周前。
不同时期的胎儿生长与儿童生长迟缓、体重不足和超重或肥胖呈不同的关联。
