Association between maternal lipids during pregnancy and risk of offspring's overweight and obesity at 3 years of age
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摘要:
目的 探讨孕期血脂水平与子代3岁儿童超重肥胖风险的关联，为儿童肥胖防控提供科学依据。 方法 纳入截至2021年9月广州出生队列研究中有孕期血脂检测以及子代3岁时体格生长数据的2 432对母子。孕13~19+6周(孕中期)和孕32~39+6周(孕晚期)的血脂指标包括高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、胆固醇(TC)。根据世界卫生组织5岁以下儿童生长标准，计算儿童年龄别体质量指数(BMI)Z评分；并以血脂Z分按四分位数分为Q1、Q2、Q3和Q4四组。采用线性回归分析孕期血脂水平与子代3岁时BMI Z分的关系，采用稳健Poisson回归评估母亲孕期血脂水平与子代3岁儿童超重肥胖风险的关联，模型均控制母亲受孕年龄、受教育程度、产次、孕前BMI和妊娠期糖尿病等因素。 结果 不同母亲孕前BMI的儿童超重肥胖风险检出率差异有统计学意义(χ2=22.85，P < 0.01)。线性回归分析结果显示，孕晚期TG Z分与子代3岁BMI Z分呈正相关(β=0.10，95%CI=0.02~0.18，P < 0.05)。稳健Poisson回归分析结果显示，与孕中期TC Q1组相比，孕中期Q4组与子代3岁时超重肥胖风险升高相关(RR=1.59，95%CI=1.04~2.44)；与孕晚期TG Q1组相比，孕晚期Q4组增加子代3岁时超重肥胖风险(RR=1.79，95%CI=1.02~3.12)(P值均 < 0.05)。 结论 孕中期母亲血清TC水平升高会增加子代3岁时的超重肥胖风险，孕晚期母亲血清TG水平与子代3岁时BMI和超重肥胖风险呈正相关。 Abstract:Objective To explore the association between maternal lipid levels during pregnancy and the risk of overweight and obesity in offspring at 3 years of age, providing scientific evidences for the prevention and control of childhood obesity. Methods A total of 2 432 mother-child pairs with maternal lipid tests during pregnancy and offspring's physical growth data at 3 years of age were included from the Borin in Guangzhou Cohort Study up to September 2021. Lipid indicators, including high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol(LDL-C), triglycerides (TG), and total cholesterol (TC), were measured at 13-19+6 weeks (mid-pregnancy) and 32-39+6 weeks (late pregnancy). Children's body mass index (BMI) Z score were calculated according to the World Health Organization's growth standards for children under 5 years old. The lipid Z score were divided into four quartiles: Q1, Q2, Q3 and Q4. Linear regression was used to analyze the relationship between maternal lipid levels during pregnancy and offspring's BMI Z score at 3 years of age. Poisson regression with a robust error variance was employed to evaluate the association between maternal lipid levels during pregnancy and the at-risk of overweight and obesity in offspring at 3 years of age, after adjusting for maternal age at conception, education level, parity, pre-pregnancy BMI and gestational diabetes mellitus. Results There was a statistically significnt difference in the detection rate of overweight and obesity risk among children with different mothers's pre-pregnancy BMI (χ2=22.85, P < 0.05). Linear regression analysis showed that TG levels in late-pregnancy were positively related to BMI Z score (β=0.10, 95%CI=0.02-0.18, P < 0.05). Poisson regression with a robust error variance indicated that, compared with the Q1 group of TC, the Q4 group of TC in mid-pregnancy was associated with an increased risk of overweight and obesity in offspring at 3 years of age (RR=1.59, 95%CI=1.04-2.44); compared with the Q1 group of TG, the Q4 group of TG during late-pregnancy increased the risk of overweight and obesity in offspring at 3 years of age (RR=1.79, 95%CI=1.02-3.12) (both P < 0.05). Conclusions Maternal serum TC level during mid-pregnancy can increase the risk of overweight and obesity in offspring at 3 years of age. Maternal serum TG levels during late-pregnancy is positively correlated with BMI and the risk of overweight and obesity in offspring at 3 years of age. -
Key words:
- Plasma lipid /
- Overweight /
- Obesity /
- Regression analysis /
- Child, preschool
1) 利益冲突声明 所有作者声明无利益冲突。2) 张丽芳和何兆聪为共同第一作者。 -
表 1 不同组别子代3岁儿童超重肥胖风险检出率比较
Table 1. Comparison of detection rates of overweight and obesity risk in offspring age 3 years old among different groups
组别 人数 超重肥胖风险人数 χ2值 P值 母亲受教育程度 高中及以下 192 21(10.93) 2.82 0.42 大专/专科 583 54(9.26) 本科 1 325 119(8.98) 研究生及以上 332 39(11.75) 母亲产次 初产妇 1 917 179(9.34) 0.51* 经产妇 514 53(10.31) 缺失 1 1(100.00) 母亲孕前BMI 正常 1 580 156(9.87) 22.85 < 0.01 消瘦 508 27(5.31) 超重 242 39(16.12) 肥胖 50 5(10.00) 缺失 52 6(11.54) 母亲GDM 否 2 066 196(9.49) 0.66* 是 362 37(10.22) 缺失 4 0 儿童性别 男 1 262 125(9.90) 0.32 0.57 女 1 170 108(9.23) 注： ()内数字为检出率/%；*为Fisher检验。 
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表 2 孕期血脂水平与子代3岁儿童BMI Z分的线性回归分析
Table 2. Linear regression analysis of maternal lipids during pregnancy and BMI Z score in offspring aged 3 years children
孕周 自变量 人数 模型1 模型2 β值(95%CI) P值 β值(95%CI) P值 13~19+6 HDL-C 1 586 -0.03(-0.08~0.02) 0.18 0.01(-0.04~0.06) 0.83 LDL-C 1 584 -0.02(-0.07~0.03) 0.51 -0.03(-0.08~0.02) 0.22 TC 1 586 -0.00(-0.05~0.05) 0.91 -0.01(-0.05~0.04) 0.85 TG 1 584 0.08(0.03~0.13) < 0.01 0.05(-0.01~0.10) 0.09 32~39+6 HDL-C 955 -0.06(-0.12~0.01) 0.10 -0.04(-0.10~0.03) 0.30 LDL-C 956 -0.07(-0.13~-0.01) 0.04 -0.05(-0.11~0.02) 0.15 TC 956 -0.02(-0.08~0.05) 0.61 0.01(-0.06~0.07) 0.82 TG 949 0.13(0.05~0.21) < 0.01 0.10(0.02~0.18) 0.02 注：模型1为未校正模型，模型2调整母亲受孕年龄、受教育程度、产次、孕前BMI、GDM等混杂因素。
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表 3 孕期血脂水平与子代3岁儿童超重肥胖风险关联的稳健Poisson回归分析
Table 3. Poisson regression with robust error variance the association between maternal lipids during pregnancy and risk of overweight or obesity in offspring aged 3 years child
孕周 自变量 人数 模型1 模型2 Q2 Q3 Q4 Q2 Q3 Q4 13~19+6 HDL-C 1 586 0.71(0.44~1.14) 0.91(0.59~1.42) 0.96(0.62~1.48) 0.76(0.47~1.22) 1.04(0.66~1.64) 1.16(0.74~1.82) LDL-C 1 584 1.00(0.62~1.59) 1.13(0.72~1.78) 1.09(0.69~1.73) 0.97(0.60~1.54) 1.15(0.73~1.81) 1.00(0.63~1.59) TC 1 586 1.16(0.73~1.86) 0.74(0.44~1.27) 1.61(1.04~2.48)* 1.15(0.72~1.84) 0.73(0.42~1.25) 1.59(1.04~2.44)* TG 1 584 0.92(0.56~1.53) 1.49(0.95~2.34) 1.24(0.78~1.98) 0.91(0.55~1.49) 1.36(0.86~2.15) 1.05(0.65~1.70) 32~39+6 HDL-C 955 1.20(0.72~2.01) 1.15(0.68~1.93) 1.23(0.74~2.06) 1.15(0.68~1.95) 1.20(0.72~2.01) 1.26(0.75~2.13) LDL-C 956 0.85(0.53~1.38) 0.75(0.46~1.24) 0.79(0.48~1.28) 0.89(0.55~1.43) 0.83(0.50~1.38) 0.84(0.50~1.42) TC 956 1.25(0.76~2.05) 0.96(0.57~1.64) 1.13(0.68~1.87) 1.26(0.77~2.07) 0.98(0.57~1.69) 1.16(0.68~1.98) TG 949 1.33(0.75~2.35) 1.43(0.82~2.51) 1.86(1.09~3.15)* 1.42(0.79~2.57) 1.38(0.75~2.53) 1.79(1.02~3.12)* 注：模型1为未校正模型，模型2调整母亲受孕年龄、受教育程度、产次、孕前BMI、GDM等混杂因素；*P < 0.05。
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