Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410078, China.
National Health Committee Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha 410028, China.
Nutrients. 2022 Aug 16;14(16):3347. doi: 10.3390/nu14163347.
The purpose of this study is to investigate whether the link between pre-pregnancy overweight/obesity and risk of macrosomia is mediated by both gestational diabetes mellitus (GDM) and high maternal triglyceride (mTG) levels. This prospective study finally included 29,415 singleton term pregnancies. The outcome of interest was macrosomia (≥4000 g). High mTG levels were denoted as values ≥90th percentile. GDM was diagnosed using a standard 75 g 2 h oral glucose tolerance test. The mediation analysis was conducted using log-binomial regression while controlling for maternal age, education, parity, gestational weight gain, gestational hypertension, smoking, drinking and infant sex. Overall, 15.9% of pregnant women were diagnosed with GDM, and 4.3% were macrosomia. Mediation analysis suggested that overweight had a total effect of 0.009 (95% CI, 0.006-0.013) on macrosomia, with a direct effect of 0.008 (95% CI, 0.004-0.012) and an indirect effect of 0.001 (95% CI, 0.001-0.002), with an estimated proportion of 11.1% mediated by GDM and high mTG levels together. Furthermore, we also discovered a total effect of obesity on macrosomia of 0.038 (95% CI, 0.030-0.047), consisting of a direct effect of 0.037 (95% CI, 0.028-0.045) and an indirect effect of 0.002 (95% CI, 0.001-0.002), with an estimated proportion of 5.3% mediated by GDM and high mTG levels combined. Both GDM and high mTG levels enhanced the risk of macrosomia independently and served as significant mediators in the relationship between pre-pregnancy overweight/obesity and macrosomia.
本研究旨在探讨孕前超重/肥胖与巨大儿风险之间的关联是否通过妊娠期糖尿病（GDM）和高母体甘油三酯（mTG）水平来介导。本前瞻性研究最终纳入了 29415 例单胎足月妊娠。感兴趣的结局是巨大儿（≥4000g）。高 mTG 水平定义为第 90 百分位数以上的值。GDM 的诊断采用标准的 75g 2h 口服葡萄糖耐量试验。使用对数二项回归进行中介分析，同时控制母体年龄、教育程度、产次、妊娠体重增加、妊娠期高血压、吸烟、饮酒和婴儿性别。总体而言，15.9%的孕妇被诊断为 GDM，4.3%为巨大儿。中介分析表明，超重对巨大儿的总效应为 0.009（95%CI，0.006-0.013），直接效应为 0.008（95%CI，0.004-0.012），间接效应为 0.001（95%CI，0.001-0.002），估计有 11.1%通过 GDM 和高 mTG 水平共同介导。此外，我们还发现肥胖对巨大儿的总效应为 0.038（95%CI，0.030-0.047），其中直接效应为 0.037（95%CI，0.028-0.045），间接效应为 0.002（95%CI，0.001-0.002），估计有 5.3%通过 GDM 和高 mTG 水平共同介导。GDM 和高 mTG 水平均独立增加了巨大儿的风险，并在孕前超重/肥胖与巨大儿之间的关系中充当重要的中介因素。
