Relationship between prepregnancy body mass index weight gain during pregnancy and offspring body composition during preschool age
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摘要:
目的 探索孕前体质量指数、孕期增重与子代学龄前期肥胖和体成分的关系，为指导母亲从孕前开始合理控制体重和预防儿童肥胖提供依据。 方法 于2020年9—12月在天津市3所幼儿园招募1 333名学龄前儿童。结构化问卷收集儿童生活方式信息；检测儿童身高、体重、体脂肪组织质量，计算体脂肪百分比(FM%)、脂肪质量指数(FMI)、非脂肪质量指数(FFMI)。获取儿童母亲孕产期医疗记录，将母亲按孕前体重状态和孕期增重分组。采用χ2检验、t检验、线性回归模型及Logistic回归方法分析不同组间儿童肥胖及体成分差异。 结果 纳入研究的学龄前儿童超重及肥胖检出率为12.7%和7.7%。调整母亲分娩年龄及产次，儿童出生孕周、性别及年龄和生活方式后，母亲孕前BMI、孕期增重与子代学龄前期的肥胖及体成分指标的相关性均有统计学意义(P值均 < 0.05)。孕前正常体重母亲孕期增重过多会增加子代高FM%及高FMI的风险(OR值分别为1.81，1.68，P值均 < 0.05)；孕前超重肥胖母亲，子代肥胖风险及体成分与母亲孕期增重相关性均无统计学意义。 结论 母亲孕前体重状态、孕期增重与子代学龄前期肥胖及体成分均存在关联。建议母亲孕前及孕产期合理控制体重。 Abstract:Objective To explore the relationship between prepregnancy body mass index, weight gain during pregnancy with preschool obesity and body composition in offspring, so as to provide evidence for gestational weight gain and childhood obesity prevention. Methods A total of 1 333 preschool children were recruited from 3 kindergartens in Tianjin from September to December 2020. Structured questionnaire was used to collect children's lifestyle information. Height, weight and body fat mass of children were assessed, and body fat percentage (FM%), fat mass index (FMI) and non-fat mass index (FFMI) were calculated. Maternal medical records were collected and the mothers were grouped according to their prepregnancy weight status and weight gain during pregnancy. χ2 test, t test, linear regression model and Logistic regression were used to analyze the differences of obesity and body composition among different groups. Results The prevalence of overweight and obesity in preschoolers was 12.7% and 7.7%. After adjusting maternal age and delivery, gestational age, gender, age and lifestyle of children, the correlation between maternal pre-pregnancy BMI, gestational weight gain with obesity and body composition indexes of children in preschool age was statistically significant (P < 0.05). For mothers with normal weight before pregnancy, excessive weight gain during pregnancy increased risk of high FM% and high FMI in offspring (OR=1.81, 1.68, P < 0.05). There was no significant correlation between maternal weight gain during pregnancy with offspring obesity and body composition among mothers with prepregnant overweight or obesity. Conclusion Maternal weight status before pregnancy and weight gain during pregnancy are correlated with obesity and body composition in the preschool age of offspring. It is suggested that mothers should maintain appropriate weight status before and during pregnancy. -
Key words:
- Mothers /
- Body mass index /
- Body composition /
- Regression analysis /
- Child, preschool
1) 利益冲突声明 所有作者声明无利益冲突。2) 陈宜人与王晶为共同第一作者 -
表 1 不同组别研究对象基本指标比较(x ±s)
Table 1. Comparison of basic in dicators of different groups of subjects(x ±s)
组别 分组 人数 统计值 母亲 儿童 分娩年龄/岁 孕前BMI/(kg·m-2) 孕期增重/kg 出生孕周 年龄/岁 BMI/(kg·m-2) WHtR FM% FMI/(kg·m-2) FFMI/(kg·m-2) 母亲孕前体重 正常 1 077 29.32±4.22 21.17±2.08 15.88±5.46 38.81±1.35 5.06±1.10 15.56±1.84 0.48±0.04 16.98±6.68 2.74±1.47 12.82±0.77 超重肥胖 256 30.45±4.57 27.63±2.38 12.08±5.96 38.52±1.59 5.07±1.08 16.75±2.57 0.50±0.05 19.99±8.55 3.54±2.12 13.19±0.84 t值 -2.51 -1 879.59 96.46 8.51 -1.20 -72.38 -46.24 -37.42 -46.59 -46.71 P值 < 0.01 < 0.01 < 0.01 < 0.01 0.89 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 母亲孕期增重 过少 260 30.28±4.17 23.09±2.97 7.38±3.06 38.55±1.57 5.03±1.14 15.62±1.93 0.48±0.04 17.09±6.57 2.78±1.53 12.84±0.85 适宜 394 30.19±4.25 22.12±3.06 13.05±2.25 38.67±1.42 5.03±1.09 15.63±1.89 0.48±0.04 16.70±6.76 2.71±1.50 12.91±0.79 过多 679 28.87±4.29 22.31±3.56 19.34±3.89 38.88±1.31 5.09±1.08 15.95±2.17 0.49±0.04 18.23±7.56 3.04±1.75 12.90±0.79 F值 16.72 7.20 1 328.83 6.33 0.29 4.23 4.94 6.45 5.68 0.70 P值 < 0.01 < 0.01 < 0.01 0.02 0.75 0.02 0.05 < 0.01 < 0.01 0.56 
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表 2 不同组别研究对象基本特征分布及儿童超重肥胖检出率比较
Table 2. Comparison of distribution of subjects and the detection rate of overweight and obesity in children in different groups
组别 分组 人数 统计值 母亲分娩年龄/岁 母亲产次 儿童性别 儿童超重 儿童肥胖 < 35 ≥35 1 2 3 4 男 女 母亲孕前体重 正常 1 077 967(89.79) 110(10.21) 662(61.47) 395(36.68) 20(1.86) 0 547(50.79) 530(49.21) 129(12.99) 84(7.80) 超重肥胖 256 211(82.42) 45(17.58) 119(46.48) 131(51.17) 5(1.95) 1(0.39) 130(50.78) 126(49.22) 44(22.45) 60(23.44) χ2值 10.92 23.16 < 0.01 11.78 52.49 P值 < 0.01 < 0.01 1.00 < 0.01 < 0.01 母亲孕期增重 过少 260 226(86.92) 34(13.08) 136(52.31) 119(45.77) 5(1.92) 0 138(53.08) 122(46.92) 33(13.75) 20(7.69) 适宜 394 344(87.31) 50(12.69) 213(54.06) 171(43.40) 10(2.54) 0 201(51.02) 193(48.98) 48(13.45) 37(9.39) 过多 679 608(89.54) 71(10.46) 432(63.62) 236(34.76) 10(1.47) 1(0.15) 338(49.78) 341(50.22) 92(15.54) 87(12.81) χ2值 1.87 16.52 0.83 0.94 6.27 P值 0.33 < 0.01 0.66 0.63 0.04 注： ()内数字为构成比或检出率/%。
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表 3 母亲孕前BMI、孕期增重与学龄前儿童体成分之间的线性回归分析[B值(B值95%CI)，n=1 333]
Table 3. Linear regression associations between pre-pregnancy BMI gestational weight gain and body composition in preschool children[B(B 95%CI), n=1 333]
自变量 BMI WHtR FM% FMI FFMI 孕前体重 0.194(0.160~0.229) 0.003(0.003~0.004) 0.509(0.389~0.630) 0.129(0.102~0.157) 0.064(0.051~0.077) 孕期增重 0.037(0.017~0.056) 0.001(0.000~0.001) 0.109(0.039~0.180) 0.026(0.010~0.042) 0.010(0.003~0.018) 注： P值均 < 0.05。
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表 4 母亲孕前体重状态、孕期增重与学龄前儿童超重或肥胖及体成分组间Logistic回归分析[OR值(OR值95%CI)，n=1 333]
Table 4. Logistic regression associations between pre-pregnancy weight status、Gestational weight gain groups and overweight/ obesity in preschool children[OR(OR 95%CI), n=1 333]
自变量 选项 高WHtR 高FM% 高FMI 高FFMI 低FFMI 超重 肥胖 孕前体重状态 超重肥胖 2.59(1.80~3.74)** 2.87(1.01~4.11)** 2.90(2.02~4.17)** 2.14(1.48~3.08)** 0.54(0.34~0.86)** 2.00(1.33~3.02)** 4.03(2.71~5.98)** 孕期增重 过少 0.74(0.45~1.23) 1.10(0.67~1.81) 1.03(0.62~1.70) 0.98(0.62~1.56) 1.63(1.03~2.58)* 0.91(0.56~1.48) 0.63(0.35~1.14) 过多 1.44(0.99~2.10) 1.77(1.20~2.62)** 1.64(1.10~2.44)* 1.12(0.77~1.62) 1.41(0.97~2.05) 1.02(0.69~1.51) 1.37(0.90~2.11) 注： * P < 0.05，** P < 0.01。
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表 5 母亲孕前不同体重状态孕期增重与学龄前儿童超重或肥胖及体成分组间的Logistic回归分析[OR值(OR值95%CI)，n=1 333]
Table 5. Pre-pregnancy weight status, Logistic regression associations between Gestational weight gain groups and in preschool children[OR(OR 95%CI), n=1 333]
孕前体重 孕前增重 高WHtR 高FM% 高FMI 高FFMI 低FFMI 超重 肥胖 正常 过少 0.81(0.45~1.47) 1.56(0.89~2.74) 1.48(0.82~2.66) 1.28(0.76~2.14) 1.67(1.03~2.70)* 0.84(0.48~1.46) 0.90(0.45~1.82) 过多 1.39(0.89~2.15) 1.81(1.14~2.89)* 1.68(1.04~2.74)* 1.12(0.72~1.72) 1.53(1.02~2.29)* 0.87(0.56~1.34) 1.42(0.83~2.43) 超重肥胖 过少 0.67(0.24~1.85) 0.48(0.16~1.43) 0.55(0.19~1.57) 0.87(0.31~2.41) 0.57(0.13~2.55) 2.44(0.73~8.20) 0.41(0.13~1.23) 过多 1.30(0.61~2.79) 1.30(0.59~2.86) 1.38(0.65~2.92) 1.37(0.62~3.02) 0.83(0.29~2.38) 2.09(0.73~5.98) 1.10(0.50~2.38) 注： * P < 0.05。
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