不同孕期增重速率与子代0-2岁BMIZ轨迹的关联  

Associations of Gestational Weight Gain During Different Trimesters with Offspring Body Mass Index Z-score Trajectory from Birth to Two Years Old

作　　者：许青 熊欣 夏玮 徐顺清[1] 李媛媛 荆涛 Xu Qing;Xiong Xin;Xia Wei(Key Laboratory of Environment and Health,Ministry of Education&Ministry of Environmental protection,and State key Laboratory of Environmental Health,School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学公共卫生学院国家环境卫生重点实验室,教育部与环境保护部环境卫生重点实验室,武汉430030 [2]华中科技大学公共卫生学院环境医学研究所,武汉430030

出　　处：《华中科技大学学报（医学版）》2021年第5期609-614,625,共7页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金委员会重点支持项目(No.91643207);生态环境部环境保护项目(No.2111101);华中科技大学中央高校基本科研基金资助项目(No.2018KFYXMPT00);华中科技大学学术前沿青年团队项目(No.2018QYTD12,No.2018QYTD06)。

摘　　要：目的基于大样本人群出生队列研究,探索不同孕期增重速率与子代出生至2岁内体格发育轨迹的关联,为健康风险防控提供科学依据。方法纳入2013年10月至2015年4月于武汉市妇女儿童保健中心行健康体检的1831对母婴对,并随访至子代2岁。按照美国医学研究所2009年指南对不同孕期增重速率进行分类。采用基于组的轨迹模型估算儿童0~2岁的身体质量指数Z分数(BMIZ)轨迹。采用多项Logistic回归估算不同孕期增重速率与子代BMIZ轨迹的关联。结果通过BMIZ轨迹模拟识别出5个组:稳定慢生长组、赶上生长组、生长适宜组、稳定快生长组和生长过快组。以孕早期增重速率适宜的孕妇作为对照组,孕早期增重速率过低可显著增加子代出现赶上生长轨迹(OR=1.45,95%CI:1.13~1.87)和稳定快生长轨迹(OR=1.22,95%CI:1.01~1.47)的风险,而孕早期增重速率过高可显著降低子代出现赶上生长轨迹的可能性(OR=0.72,95%CI:0.58~0.89)。以孕晚期增重速率适宜的孕妇作为对照组,孕晚期增重速率过高与降低子代出现稳定慢生长轨迹的风险有关(OR=0.76,95%CI:0.59~0.98)。结论过低或过高的孕期增重速率可影响子代BMIZ发育轨迹,提示孕妇控制合理孕期增重对子代健康的重要性。Objective Based on a prospective birth cohort study,the study aimed to explore the associations of gestational weight gain rate(GWGR)during different trimesters with offspring growth trajectory form birth to two years old and provide suggestions for health risk prevention in later life.Methods A total of 1831 mother-child pairs were enrolled with two-year follow-up in Wuhan Medical and Healthcare Center for Women and Children during October 2013 and April 2015.GWGR was categorized as inadequate,adequate,and excessive according to the guidelines released by the US Institute of Medicine in 2009.Group-based trajectory modelling was applied to estimate offspring body mass index z-score(BMIZ)trajectory from birth to two years old.Multinomial logistic regression was applied to estimate the associations of GWGR in each trimester with offspring BMIZ trajectory.Results Five BMIZ trajectory classes were identified:stable low BMIZ,catch-up growth BMIZ,stable median BMIZ,stable high BMIZ,high and increasing BMIZ.Compared with adequate GWGR in the first trimester,inadequate GWGR in the first trimester was associated with an increased risk of catch-up growth(OR=1.45,95%CI:1.13-1.87)and stable high BMIZ(OR=1.22,95%CI:1.01-1.47),respectively.Excessive GWGR in the first trimester was associated with a decreased risk of catch-up growth(OR=0.72,95%CI:0.58-0.89).Compared with adequate GWGR in the third trimester,excessive GWGR in the third trimester was associated with a decreased risk of stable low BMIZ(OR=0.76,95%CI:0.59-0.98).Conclusion Inadequate or excessive GWGR could affect offspring growth trajectory.It is important to control appropriate gestational weight gain during pregnancy.

关 键 词：孕期增重 身体质量指数Z分数 生长发育轨迹 

分 类 号：R715.3[医药卫生—妇产科学]