父母孕前体质指数与巨大儿的关联研究  

Association of parental pre-pregnancy body mass index with macrosomia

作　　者：杨贵红[1] 魏剑晖 邓芳[1] 李运飞[1] 焦玲[1] 秦家碧[2] YANG Guihong;WEI Jianhui;DENG Fang;LI Yunfei;JIAO Ling;QIN Jiabi(Hunan Children’s Hospital,Changsha,Hunan 410007,China;Department of Epidemiology and Health Statistics,Xiangya School of Public Health,Central South University,Changsha,Hunan 410078,China)

机构地区：[1]湖南省儿童医院,湖南长沙410007 [2]中南大学湘雅公共卫生学院流行病与卫生统计学系,湖南长沙410078

出　　处：《实用预防医学》2023年第12期1462-1469,共8页Practical Preventive Medicine

基　　金：湖南省卫健委一般资助课题(B202314046866);国家自然科学基金面上项目(82073653);湖南省杰出青年基金项目(2022JJ10087)。

摘　　要：目的探究父母孕前体质指数(body mass index,BMI)及其交互作用与巨大儿发生的关联,为孕龄夫妇体重管理及巨大儿防控提供科学依据。方法本研究采用前瞻性队列研究设计,以2014年8月—2019年12月在7所妇幼保健医院进行孕早期产检的孕妇及其丈夫作为研究对象构建队列,并通过调查问卷,医院病历信息管理系统及随访调查收集信息。采用logistic回归、限制性立方样条模型以及相乘交互作用模型来探究父母孕前BMI及其交互作用与巨大儿的关联以及剂量-反应关系。结果本研究队列共纳入34104对符合条件的夫妇,其中母亲孕前消瘦者4920名(占14.43%),体重正常者23925名(占70.15%),超重者4334名(占12.71%),肥胖者925名(占2.71%);孕前父亲消瘦者1442名(占4.23%),体重正常者18118名(占53.13%),超重者10592名(占31.06%),肥胖者3952名(占11.59%)。研究人群中巨大儿共1374例,发生率为4.03%(3.82%~4.24%)。在调整可能的混杂因素后,多因素logistic分析结果显示母亲孕前超重(RR=1.351,95%CI:1.160~1.573)和肥胖(RR=3.883,95%CI:3.164~4.765)会增加后代发生巨大儿的风险,而母亲孕前消瘦(RR=0.781,95%CI:0.643~0.950)、孕前父亲超重(RR=0.844,95%CI:0.743~0.957)会降低后代发生巨大儿的风险;剂量-反应关系分析显示母亲孕前BMI与巨大儿之间呈逐渐升高的“J”形非线性剂量-反应关系,而孕前父亲BMI与巨大儿之间不存在剂量-反应关系;交互作用分析显示:孕前母亲超重/肥胖伴父亲消瘦(RR=1.966,95%CI:1.208~3.200)、母亲超重/肥胖伴父亲正常(RR=1.691,95%CI:1.422~2.010)以及母亲超重/肥胖伴父亲超重/肥胖(RR=1.577,95%CI:1.301~1.912)会增加巨大儿的风险;而孕前母亲消瘦伴父亲正常(RR=0.661,95%CI:0.503~0.868)以及母亲正常伴父亲超重/肥胖(RR=0.788,95%CI:0.683~0.908)会降低巨大儿的风险。结论父母孕前不良的BMI可能会影响后代发生巨大儿的风险,应在孕前对计划妊娠的夫妇进Objective To explore the association between parental pre-pregnancy body mass index(BMI)and its interaction with the incidence of macrosomia,and to provide a scientific basis for body weight management of pregnant couples as well as macrosomia prevention and control.Methods A prospective cohort study design was used in this study.We constructed a cohort of pregnant women and their husbands undergoing first-trimester prenatal examination in seven maternal and child health care hospitals from August 2014 to December 2019 to serve as the study subjects.And the information was collected through questionnaires,hospital information management system for medical records and follow-up surveys.Logistic regression,restricted cubic spline model and multiplicative interaction model were employed to explore the association of parental pre-pregnancy BMI and its interaction with macrosomia and dose-response relationship.Results A total of 34,104 eligible couples were enrolled into this study,of which 4,920(14.43%)mothers were underweight before pregnancy,23,925(70.15%)mothers had normal body weight,4,334(12.71%)mothers were overweight and 925(2.71%)mothers obese.1,442(4.23%)fathers were underweight before pregnancy,18,118(53.13%)fathers had normal body weight,10,592(31.06%)fathers were overweight and 3,952(11.59%)obese.A total of 1,374 cases of macrosomia were found in the study population,with the prevalence rate being 4.03%(3.82%-4.24%).After adjusting for possible confounders,multifactorial logistic analysis revealed that maternal pre-pregnancy overweight(RR=1.351,95%CI:1.160-1.573)and obesity(RR=3.883,95%CI:3.164-4.765)could increase the risk of macrosomia in the offspring,while maternal pre-pregnancy underweight(RR=0.781,95%CI:0.643-0.950)and paternal pre-pregnancy overweight(RR=0.844,95%CI:0.743-0.957)could reduce the risk of macrosomia in the offspring.Dose-response relationship analysis displayed a gradually rising“J”-shaped non-linear dose-response relationship between maternal pre-pregnancy BMI and macrosomia,whil

关 键 词：体质指数 巨大儿 剂量-反应关系 交互作用 前瞻性队列研究 

分 类 号：R722[医药卫生—儿科]