量化英国基于人群队列的母婴孕期体重和吸烟状况变化对儿童超重和肥胖的影响。
Quantifying the effect of interpregnancy maternal weight and smoking status changes on childhood overweight and obesity in a UK population-based cohort.
机构信息
NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, United Kingdom.
出版信息
PLoS One. 2024 Oct 7;19(10):e0311677. doi: 10.1371/journal.pone.0311677. eCollection 2024.
BACKGROUND
Maternal preconception and pregnancy exposures have been linked to offspring adiposity. We aimed to quantify the effect of changes in maternal weight and smoking status between pregnancies on childhood overweight/obesity (≥ 85th centile) and obesity (≥ 95th centile) rates in second children.
METHODS
Records for 5612 women were drawn from a population-based cohort of routinely collected antenatal healthcare records (2003-2014) linked to measured child body mass index (BMI) age 4-5 years. We applied the parametric G-formula to estimate the effect of hypothetical changes between pregnancy-1 and pregnancy-2 compared to the natural course scenario (without change) on child-2 BMI.
RESULTS
Observed overweight/obesity and obesity in child-2 at age 4-5 years were 22.2% and 8·5%, respectively. We estimated that if all mothers started pregnancy-2 with BMI 18·5-24·9 kg/m² and all smokers stopped smoking, then child-2 overweight/obesity and obesity natural course estimates of 22.3% (95% CI 21.2-23.5) and 8·3% (7·6-9·1), would be reduced to 18.5% (17.4-19.9) and 6.2% (5.5-7.0), respectively. For mothers who started pregnancy-1 with BMI 18·5-24·9 kg/m², if all smokers stopped smoking, child-2 overweight/obesity and obesity natural course estimates of 17.3% (16.0-18.6) and 5·9% (5·0-6·7) would be reduced to 16.0% (14.6-17.3) and 4·9% (4·1-5·7), respectively. For mothers who started pregnancy-1 with BMI ≥30 kg/m², if BMI was 18·5-24·9 kg/m² prior to pregnancy-2, child-2 overweight/obesity and obesity natural course estimates of 38.6% (34.7-42.3) and 17·7% (15·1-20·9) would be reduced to 31.3% (23.8-40.0) and 12.5 (8.3-17.4), respectively. If BMI was 25.0-29.9 kg/m² prior to pregnancy-2, these estimates would be 34.5% (29.4-40.4) and 14.6% (11.2-17.8), respectively.
CONCLUSION
Interventions supporting women to lose/maintain weight and quit smoking between pregnancies could help reduce rates of overweight/obesity and obesity in second children. The most effective interventions may vary by maternal BMI prior to the first pregnancy.
背景
母体孕前和孕期的暴露与后代肥胖有关。我们旨在量化母亲在两次妊娠之间体重和吸烟状况的变化对第二胎儿童超重/肥胖（≥第 85 百分位）和肥胖（≥第 95 百分位）率的影响。
方法
从一项基于人群的常规收集产前保健记录的队列中提取了 5612 名女性的记录（2003-2014 年），并与 4-5 岁儿童的实测体重指数（BMI）相链接。我们应用参数 G 公式来估计与自然病程相比（无变化），妊娠 1 期到妊娠 2 期之间假设的变化对儿童 2 期 BMI 的影响。
结果
在 4-5 岁时，儿童 2 期超重/肥胖和肥胖的观察值分别为 22.2%和 8.5%。我们估计，如果所有母亲在妊娠 2 期开始时的 BMI 为 18.5-24.9kg/m²，并且所有吸烟者都停止吸烟，那么儿童 2 期超重/肥胖和肥胖的自然病程估计值为 22.3%（95%CI 21.2-23.5）和 8.3%（7.6-9.1），将分别降低至 18.5%（17.4-19.9）和 6.2%（5.5-7.0）。对于在妊娠 1 期开始时 BMI 为 18.5-24.9kg/m²的母亲，如果所有吸烟者都停止吸烟，那么儿童 2 期超重/肥胖和肥胖的自然病程估计值为 17.3%（16.0-18.6）和 5.9%（5.0-6.7），将分别降低至 16.0%（14.6-17.3）和 4.9%（4.1-5.7）。对于在妊娠 1 期开始时 BMI≥30kg/m²的母亲，如果在妊娠 2 期前 BMI 为 18.5-24.9kg/m²，那么儿童 2 期超重/肥胖和肥胖的自然病程估计值为 38.6%（34.7-42.3）和 17.7%（15.1-20.9），将分别降低至 31.3%（23.8-40.0）和 12.5%（8.3-17.4）。如果在妊娠 2 期前 BMI 为 25.0-29.9kg/m²，那么这些估计值将分别为 34.5%（29.4-40.4）和 14.6%（11.2-17.8）。
结论
支持女性在两次妊娠之间减肥/维持体重和戒烟的干预措施，可能有助于降低第二胎儿童超重/肥胖和肥胖的发生率。最有效的干预措施可能因母亲在第一次妊娠前的 BMI 而异。
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