Yan Ming-Fei, Strodl Esben, Yang Wei-Kang, Yin Xiao-Na, Wen Guo-Min, Sun Deng-Li, Xian Dan-Xia, Zhao Ya-Fen, Chen Wei-Qing
Department of Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou, China.
School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia.
Front Pediatr. 2025 Jun 27;13:1608521. doi: 10.3389/fped.2025.1608521. eCollection 2025.
Childhood obesity has become a global public health crisis. Previous studies have shown that nutritional supplementation during pregnancy may be protective against offspring obesity. However, the research in this area is still emerging and the impact of moderators, such as birth weight, upon outcomes has not been fully explored. This study aimed to examine the combined effect of maternal supplementation with iron, calcium, folic acid, and multivitamin during pregnancy on the risk of obesity in Chinese preschoolers born macrosomia.
A total of 6,031 singleton children, born macrosomia, aged 3-6.5 years old were recruited from Longhua District in Shenzhen of China in 2021. Their mothers were asked to complete a structured questionnaire for collecting the sociodemographic characteristics of the child and parents, the child's birth-related characteristics, and maternal supplementation with iron, calcium, folic acid, and multivitamins during pregnancy. The children's weight and height were measured using a standardized method by well-trained medical staff from the Women's and Children's Hospital of Longhua District of Shenzhen.
After controlling for confounding variables, including other nutrients, the results of a series of logistic regressions showed that only iron supplementation (AOR = 0.75, 95% CI = 0.60-0.92) during pregnancy was negatively associated with the presence of obesity in preschoolers born macrosomia in boys. In contrast, there was no independent associations between maternal prenatal ingestion of iron, calcium, folic acid, or multivitamin supplements and obesity in preschool girls born macrosomia. Examination of interaction effects through crossover analyses showed that maternal supplementation with both iron and calcium (AOR = 0.68, 95% CI = 0.49-0.94), and both iron and multivitamins (AOR = 0.64, 95% CI = 0.48-0.86) during pregnancy significantly reduced the risk of obesity in male preschoolers born macrosomia. Furthermore, interaction analysis found a multiplicative interaction between maternal iron and multivitamin supplementation during pregnancy on the risk of obesity in male preschoolers born macrosomia (IOR = 0.52, 95% CI = 0.35-0.79).
Our findings suggest that iron supplementation during pregnancy may reduce the risk of obesity in preschoolers born macrosomia in boys, with this effect enhanced with the combined ingestion of calcium and multivitamin supplementation.
儿童肥胖已成为全球公共卫生危机。先前的研究表明，孕期营养补充可能对后代肥胖具有预防作用。然而，该领域的研究仍在不断涌现，诸如出生体重等调节因素对结果的影响尚未得到充分探讨。本研究旨在探讨孕期母亲补充铁、钙、叶酸和多种维生素对中国巨大儿出生的学龄前儿童肥胖风险的综合影响。
2021年从中国深圳龙华区招募了6031名单胎巨大儿出生的儿童，年龄在3至6.5岁之间。他们的母亲被要求完成一份结构化问卷，以收集孩子和父母的社会人口学特征、孩子的出生相关特征，以及母亲孕期补充铁、钙、叶酸和多种维生素的情况。深圳龙华区妇幼保健院训练有素的医务人员使用标准化方法测量了孩子们的体重和身高。
在控制了包括其他营养素在内的混杂变量后，一系列逻辑回归结果显示，孕期仅补充铁（优势比[AOR]=0.75，95%置信区间[CI]=0.60 - 0.92）与巨大儿出生的男童学龄前肥胖的存在呈负相关。相比之下，母亲孕期摄入铁、钙、叶酸或多种维生素补充剂与巨大儿出生的女童学龄前肥胖之间没有独立关联。通过交叉分析对交互作用的检验表明，孕期母亲同时补充铁和钙（AOR = 0.68，95% CI = 0.49 - 0.94）以及同时补充铁和多种维生素（AOR = 0.64，95% CI = 0.48 - 0.86）可显著降低巨大儿出生的男童学龄前肥胖的风险。此外，交互作用分析发现，孕期母亲补充铁和多种维生素对巨大儿出生的男童学龄前肥胖风险存在相乘交互作用（交互作用比[IOR]=0.52，95% CI = 0.35 - 0.79）。
我们的研究结果表明，孕期补充铁可能会降低巨大儿出生的男童学龄前肥胖的风险，同时补充钙和多种维生素会增强这种效果。
