母亲孕前及分娩前超重肥胖对中学生超重肥胖影响的病例对照研究

梁健平; 贡梓军; 梁月朗; 郭嘉佳; 杨杰文; 刘丽; 姚振江

doi:10.16835/j.cnki.1000-9817.2022.02.025

母亲孕前及分娩前超重肥胖对中学生超重肥胖影响的病例对照研究

doi: 10.16835/j.cnki.1000-9817.2022.02.025

1.
广东省广州市中小学卫生健康促进中心学校卫生部, 510180
2.
广东药科大学公共卫生学院流行病与卫生统计学系
3.
广州市社会福利院(广州市儿童综合康复中心)

基金项目:

2018年广州市教育科学规划课题项目 201811644

广州市教育科学规划2017年度重点课题项目 1201721333

2018年度国家自然科学基金资助项目 81874271

详细信息

作者简介:
梁健平(1983-)，女，广东广州人，硕士，副主任医师，主要研究方向为青少年生长发育及健康教育

通讯作者:
姚振江，E-mail：zhjyao2001@yahoo.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R723.14 R179 G478
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- 被引次数: 0
出版历程
- 收稿日期: 2021-07-28
- 修回日期: 2021-11-20
- 网络出版日期: 2022-02-24
- 刊出日期: 2022-02-25

Association between maternal pre-pregnancy and pre-delivery overweight with overweight and obesity of middle school students: a case-control study

1.
School Health Department, Guangzhou Primary and Secondary School Health Promotion Center, Guangzhou (510180), China

摘要

摘要: 目的探讨广州市母亲孕前及分娩前超重肥胖对子代中学时期超重肥胖的影响, 为预防中学生肥胖提供科学依据。方法依托广州市中学生常规体检, 抽取3所高中、3所初中共3 384名学生, 将体检中超重肥胖的中学生纳入超重肥胖组(642名), 其余学生纳入对照组(2 742名), 对学生及家长进行问卷调查。使用倾向性评分匹配(propensity score matching, PSM)前后的数据进行χ²检验和Logistic回归分析, 对比匹配前后结果的变化。结果单因素分析显示, 进行PSM前, 超重肥胖组和对照组在性别、学段、是否挑食、肥胖家族史、家庭人均月收入、母亲分娩方式、是否为巨大儿和孕期增重情况差异均有统计学意义(χ²值分别为42.38, 10.64, 14.47, 26.85, 10.58, 13.59, 15.53, 20.64, P值均 < 0.05)。PSM后, 孕前及分娩前超重肥胖组和对照组在学段、分娩方式上组间差异均无统计学意义(P值均>0.05)。Logistic回归分析显示, 进行PSM前, 母亲孕前超重肥胖的中学生超重肥胖风险是母亲孕前非超重肥胖的1.54倍(95%CI=1.01~2.36), 而母亲在分娩前超重肥胖同样增加了中学生超重肥胖的风险(OR=2.35, 95%CI=1.67~3.31)。在进行PSM后, 母亲孕前(OR=2.17, 95%CI=1.41~3.34)及分娩前超重肥胖(OR=2.99, 95%CI=2.08~4.31)均明显增加中学生超重肥胖风险。结论母亲孕前和分娩前超重肥胖与中学生的超重肥胖风险增高有关联。
- 母亲 /
- 超重 /
- 肥胖症 /
- 病例对照研究 /
- 回归分析 /
- 学生
Abstract: Objective To explore the association between maternal pre-pregnancy and pre-delivery overweight with overweight and obesity among offspring during adolescence in Guangzhou, and to provide evidence for child obesity prevention. Methods Based on the routine physical examination of primary and secondary school students in Guangzhou, random sampling was used to 6 middle schools and questionnaire survey was conducted among 3 384 students and their parents. Students with overweight and obesity were included in the case group, and the other students were included in the control group. Propensity Score Matching (PSM) was adopted to reduce selection bias. Logistic regression model and χ² test were used to analyze the data before and after PSM. Results The result of univariate analysis showed that there were statistically significant differences between overweight/obese group and the control group by gender, schooling stage (middle and high schools), picky eater, family history of obesity, family monthly income, delivery mode, high birthweight, and gestational weight gain before PSM(χ²=42.38, 10.64, 14.47, 26.85, 10.58, 13.59, 15.53, 20.64, P < 0.05). After PSM, results showed that there were no statistically significant differences between overweight/obese group and the control group in middle and high schools, and mother delivery mode(P>0.05). Logistic regression analysis showed that the risk of overweight and obesity of maternal pre-pregnancy on adolescent offspring was 1.54 times higher than control group (95%CI=1.01-2.36) before PSM, and the overweight and obesity of maternal pre-delivery also increased the risk of overweight and obesity of adolescent offspring(OR=2.35, 95%CI=1.67-3.31). After PSM, maternal overweight and obesity pre-pregnancy (OR=2.17, 95%CI=1.41-3.34) and maternal overweight and obesity pre-delivery(OR=2.99, 95%CI=2.08-4.31) significantly increased the risk of overweight and obesity in adolescent offspring. Conclusion Maternal overweight and obesity pre-pregnancy and pre-delivery are associated with increased risk of overweight and obesity in adolescent offspring.
- Mothers /
- Overweight /
- Obesity /
- Case-control studies /
- Regression analysis /
- Students
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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图 1 匹配前后母亲孕前协变量间标准偏差

Figure 1. Standardized bias across covariates about overweight and obesity of maternal pre-pregnancy after PSM

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图 2 匹配前后母亲分娩前协变量间标准偏差

Figure 2. Standardized bias across covariates about overweight and obesity of maternal pre-delivery after PSM

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表 1 PSM前超重肥胖组与对照组中学生不同人口学特征分布比较

Table 1. Comparison of basic information between overweight and obesity group and control group before PSM

组别	人数	学段			性别		挑食		肥胖家族史
组别	人数	初中		高中	女	男	是	否	是		否
肥胖超重组	642	438(68.22)		204(31.78)	211(32.87)	431(67.13)	117(18.22)	525(81.78)	135(21.03)		507(78.97)
对照组	2 742	1 681(61.31)		1 061(38.69)	1 290(47.05)	1 452(52.95)	695(25.35)	2 047(74.65)	357(13.02)		2 385(86.98)
χ²值		10.64			42.38			14.47			26.85
P值		< 0.01			< 0.01			< 0.01			< 0.01

组别	人数	家庭人均月收入/元^*			母亲分娩方式		巨大儿		母亲孕期增重
组别	人数	≤5 000	5 001~9 999	≥10 000	自然分娩	剖宫产	是	否	不足	合理	过度
肥胖超重组	642	81(13.66)	278(46.88)	234(39.46)	261(40.65)	381(59.35)	62(9.66)	580(90.34)	281(43.77)	151(23.52)	210(32.71)
对照组	2 742	484(19.31)	1 126(44.91)	897(35.78)	1 336(48.72)	1 406(51.28)	150(5.47)	2 592(94.53)	1 181(43.07)	860(31.36)	701(25.57)
χ²值		10.58			13.59		15.53		20.64
P值		0.01			0.02		0.01		< 0.01
注： ()内数字为构成比/%; *表示该项目有缺失数据。

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表 2 PSM后母亲孕前及分娩前超重肥胖组与对照组中学生不同人口学特征分布比较

Table 2. Comparison of basic information between overweight and obesity group and control group after PSM

母亲孕前及分娩前	组别	人数	统计值	学段			性别		挑食		肥胖家族史
母亲孕前及分娩前	组别	人数	统计值	初中		高中	女	男	是	否	是		否
孕前	肥胖超重组	593		192(32.38)		401(67.62)	192(32.38)	401(67.62)	107(18.04)	486(81.96)	126(21.25)		467(78.75)
	对照组	1 052		352(33.46)		700(66.54)	389(36.98)	663(63.02)	125(11.88)	927(88.12)	99(9.41)		953(90.59)
			χ²值	0.20			3.51		11.89		45.01
			P值	0.65			0.06		< 0.01		< 0.01
分娩前	肥胖超重组	593		192(32.38)		401(67.62)	192(32.38)	401(67.62)	107(18.04)	486(81.96)	126(21.25)		467(78.75)
	对照组	1 057		352(33.30)		705(66.70)	397(37.56)	660(62.44)	122(11.54)	935(88.46)	103(9.74)		954(90.26)
			χ²值	0.15			4.44		13.44		42.06
			P值	0.70			0.04		< 0.01		< 0.01

母亲孕前及分娩前	组别	人数	统计值	家庭人均月收入/元			母亲分娩方式		巨大儿		母亲孕期增重
母亲孕前及分娩前	组别	人数	统计值	≤5 000	5 001~9 999	≥10 000	自然分娩	剖宫产	是	否	不足	合理	过度
孕前	肥胖超重组	593		81(13.66)	278(46.88)	234(39.46)	360(60.71)	233(39.29)	59(9.95)	534(90.05)	259(43.68)	134(22.60)	200(33.73)
	对照组	1 052		71(6.75)	530(50.38)	451(42.87)	414(39.35)	638(60.65)	46(4.37)	1 006(95.63)	510(48.48)	300(28.52)	242(23.00)
			χ²值	21.60			0.00		19.74		23.14
			P值	< 0.01			0.98		< 0.01		< 0.01
分娩前	肥胖超重组	593		81(13.66)	278(46.88)	234(39.46)	360(60.71)	233(39.29)	59(9.95)	534(90.05)	259(43.68)	134(22.60)	200(33.73)
	对照组	1 057		74(7.00)	546(51.66)	437(41.34)	408(38.60)	649(61.40)	47(4.45)	1 010(95.55)	491(46.45)	284(26.87)	282(26.68)
			χ²值	19.99			0.08		19.14		9.84
			P值	< 0.01			0.78		< 0.01		0.01
注： ()内数字为构成比/%。

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表 3 匹配后母亲孕前及分娩前共同倾向评分情况

Table 3. The number of different common propensity score groups before pregnancy and delivery after PSM

母亲孕前及分娩前	组别	人数	< 0.1	0.1~ < 0.2	0.2~ < 0.3	0.3~ < 0.4	0.4~ < 0.5	0.5~ < 0.6	0.6~0.7
孕前	对照组	1 052	46	512	384	62	35	7	6
	超重肥胖组	593	22	235	207	73	39	11	6
分娩前	对照组	1 057	44	524	385	77	20	6	1
	超重肥胖组	593	24	232	218	83	29	6	1

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