Wagner Kathryn A, Chen Zhen, Hinkle Stefanie N, Gleason Jessica L, Lee Wesley, Grobman William A, Owen John, Newman Roger B, Skupski Daniel W, He Dian, Sherman Seth, Gore-Langton Robert E, Zhang Cuilin, Grewal Jagteshwar, Grantz Katherine L
Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States.
Biostatistics and Bioinformatics Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States.
Am J Clin Nutr. 2025 Feb;121(2):367-375. doi: 10.1016/j.ajcnut.2024.12.007. Epub 2025 Jan 16.
Inadequate and excessive gestational weight gain (GWG) are associated with increased risk of newborn small- and large-for-gestational-age, respectively, and future offspring adiposity. However, the relationship between GWG and three-dimensional (3D) measures of fetal body composition and organ volumes, which may provide greater insight into fetal growth via measurement of soft tissue, remains unknown.
The objective of this study was to examine the relationship between trimester-specific GWG and 3D fetal body composition and organ volume measurements.
In a diverse, US prospective pregnancy cohort, trimester-specific GWG was calculated as difference between maternal weight at beginning and end of each trimester, and categorized as inadequate, adequate, or excessive, per 2009 Institute of Medicine (IOM) guidelines. Up to five 3D ultrasound scans were completed across gestation, from which fetal body composition and organ volume measurements were obtained (n = 2675 pregnancies). The associations between trimester-specific GWG categories and 3D fetal body composition and organ volumes were assessed at 15, 29, and 39 weeks.
Excessive compared with adequate GWG, in first and second trimesters was associated with larger abdominal circumference (n = 2430; 1st trimester: 1.29 cm, 95% CI: 0.74, 1.84; 2nd trimester: 2.98 cm, 95% CI: 1.62, 4.34) and abdominal area (n = 2401; 1st trimester: 22.04 mm, 95% CI: 0.48, 43.60; 2nd trimester: 162.34 mm, 95% CI: 76.25, 248.44), whereas excessive GWG in the first trimester was associated with larger arm subcutaneous tissue thickness (n = 1921; 0.01 cm, 95% CI: 0.00, 0.01). There was a trend toward increased fetal arm, thigh, kidney, and liver volumes and abdominal subcutaneous tissue, although differences did not reach the level of statistical significance for these structures.
Excessive GWG was associated with greater fetal size primarily manifested by a pattern of fat accumulation across the fetal arm and abdomen. Future studies should examine whether these fetal changes have functional implications for childhood adiposity and metabolic dysfunction. This trial was registered at https://clinicaltrials.gov as NCT00912132 and NCT03266198.
孕期体重增加不足和过多分别与小于胎龄儿和大于胎龄儿出生风险增加以及后代未来肥胖相关。然而，孕期体重增加与胎儿身体成分和器官体积的三维（3D）测量之间的关系尚不清楚，而通过软组织测量可能会更深入地了解胎儿生长情况。
本研究的目的是探讨孕期各阶段的孕期体重增加与3D胎儿身体成分和器官体积测量之间的关系。
在美国一个多样化的前瞻性妊娠队列中，孕期各阶段的孕期体重增加计算为每个孕期开始和结束时孕妇体重的差值，并根据2009年医学研究所（IOM）指南分为不足、适当或过多。整个孕期完成多达五次3D超声扫描，从中获得胎儿身体成分和器官体积测量值（n = 2675例妊娠）。在孕15、29和39周时评估孕期各阶段孕期体重增加类别与3D胎儿身体成分和器官体积之间的关联。
与适当的孕期体重增加相比，孕早期和孕中期过多的孕期体重增加与更大的腹围相关（n = 2430；孕早期：1.29 cm，95%CI：0.74，1.84；孕中期：2.98 cm，95%CI：1.62，4.34）和腹部面积相关（n = 2401；孕早期：22.04 mm，95%CI：0.48，43.60；孕中期：162.34 mm，95%CI：76.25，248.44），而孕早期过多的孕期体重增加与更大的上臂皮下组织厚度相关（n = 1921；0.01 cm，95%CI：0.00，0.01）。胎儿的手臂、大腿、肾脏和肝脏体积以及腹部皮下组织有增加的趋势，尽管这些结构的差异未达到统计学显著水平。
过多的孕期体重增加与更大的胎儿尺寸相关，主要表现为胎儿手臂和腹部脂肪堆积的模式。未来的研究应检查这些胎儿变化是否对儿童肥胖和代谢功能障碍有功能影响。该试验已在https://clinicaltrials.gov注册，注册号为NCT00912132和NCT03266198。
