探讨孕前体重和孕期体重增加在加拿大安大略省后代过敏疾病发展中的作用：一项基于人群的队列研究。
Examining the role of pre-pregnancy weight and gestational weight gain in allergic disease development among offspring: A population-based cohort study in Ontario, Canada.
机构信息
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
出版信息
Paediatr Perinat Epidemiol. 2022 Jan;36(1):144-155. doi: 10.1111/ppe.12806. Epub 2021 Aug 16.
BACKGROUND
Studies suggest maternal weight and weight gain during pregnancy may influence foetal immunological development. However, their role in the aetiology of allergic disease is unclear.
OBJECTIVES
We sought to examine the impact of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on the incidence of four common paediatric allergic diseases.
METHODS
We conducted a retrospective, population-based cohort study of all singleton live births in Ontario, Canada between 2012 and 2014, using maternal-newborn records from the provincial birth registry linked with health administrative databases. Neonates were followed up to 7 years for anaphylaxis, asthma, dermatitis and rhinitis, identified through validated algorithms based on healthcare encounters. We multiply imputed missing data and employed Cox proportional-hazards models to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CI). To test the robustness of our findings, we also conducted several sensitivity analyses, including probabilistic bias analyses for exposure and outcome misclassification. All methods were prespecified in a published protocol.
RESULTS
Of the 248,017 infants followed, 52% were born to mothers with a pre-pregnancy BMI in the normal range and only 19% were born to mothers with adequate weight gain during pregnancy. Incidence rates (per 100,000 person-days) for anaphylaxis, asthma, dermatitis and rhinitis were 0.22, 6.80, 12.41 and 1.54, respectively. Compared with normal BMI, maternal obesity was associated with increased hazards of asthma in offspring (aHR 1.08, 95% CI 1.05, 1.11), but decreased hazards of anaphylaxis (aHR 0.83, 95% CI 0.69, 0.99) and dermatitis (aHR 0.97, 95% CI 0.94, 0.99). In contrast, maternal underweight was associated with increased hazards of dermatitis (aHR 1.06, 95% CI 1.02, 1.10). We found no associations between pre-pregnancy BMI and rhinitis or GWG and any allergic outcome, and no evidence of effect measures modification by infant sex.
CONCLUSIONS
These findings provide support for the involvement of maternal pre-pregnancy BMI in paediatric allergic disease development.
背景
研究表明，孕妇体重和孕期体重增加可能会影响胎儿的免疫发育。然而，它们在过敏性疾病发病机制中的作用尚不清楚。
目的
我们旨在研究孕妇孕前体重指数（BMI）和孕期体重增加（GWG）对四种常见儿科过敏性疾病发病的影响。
方法
我们对 2012 年至 2014 年期间安大略省所有单胎活产儿进行了回顾性、基于人群的队列研究，使用省级出生登记处的母婴记录，并与健康管理数据库进行了链接。通过基于医疗保健就诊的验证算法，对新生儿进行了长达 7 年的过敏反应、哮喘、皮炎和鼻炎随访。我们采用多重插补法处理缺失数据，并采用 Cox 比例风险模型计算调整后的危险比（aHR）及其 95%置信区间（CI）。为了检验研究结果的稳健性，我们还进行了几项敏感性分析，包括针对暴露和结局错分的概率偏差分析。所有方法均在预先制定的方案中进行了规定。
结果
在所随访的 248017 名婴儿中，52%的婴儿母亲孕前 BMI 在正常范围内，只有 19%的婴儿母亲孕期体重增加正常。过敏反应、哮喘、皮炎和鼻炎的发病率（每 10 万人日）分别为 0.22、6.80、12.41 和 1.54。与正常 BMI 相比，肥胖母亲所生子女哮喘发病风险增加（aHR 1.08，95%CI 1.05，1.11），而过敏反应（aHR 0.83，95%CI 0.69，0.99）和皮炎（aHR 0.97，95%CI 0.94，0.99）发病风险降低。相比之下，体重不足的母亲所生婴儿患皮炎的风险增加（aHR 1.06，95%CI 1.02，1.10）。我们没有发现孕前 BMI 与鼻炎或 GWG 与任何过敏结局之间的关联，也没有发现婴儿性别对效应测量值的影响。
结论
这些发现为孕妇孕前 BMI 参与儿童过敏性疾病的发生提供了支持。
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