母亲孕前体质量指数和孕早期血脂与学龄前儿童超重肥胖风险的关联

国汐如; 吕瑾莨; 苏涛; 韩娜; 王璐; 计岳龙; 王海俊

doi:10.16835/j.cnki.1000-9817.2025239

母亲孕前体质量指数和孕早期血脂与学龄前儿童超重肥胖风险的关联

doi: 10.16835/j.cnki.1000-9817.2025239

1.
北京大学公共卫生学院妇幼卫生学系，北京 100191
2.
北京市通州区妇幼保健院产科

基金项目:

北京市自然科学基金项目 QY23073

国家自然科学基金项目 82473640

详细信息

作者简介:
国汐如(2002-)，女，吉林松原人，在读硕士，主要研究方向为妇幼保健学

通讯作者:
王海俊，E-mail: whjun@pku.edu.cn

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R723.4 R715.3
计量
- 文章访问数: 10
- HTML全文浏览量: 5
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2025-02-18
- 修回日期: 2025-04-01
- 网络出版日期: 2025-08-30
- 刊出日期: 2025-08-25

Association between body mass index during pre-pregnancy and maternal lipid levels during early pregnancy with the risk of overweight and obesity in preschool children

1.
Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China

摘要

摘要: 目的探究母亲孕前体质量指数(BMI)与学龄前儿童超重肥胖风险的关联，以及母亲孕早期血脂在孕前BMI与儿童超重肥胖风险之间的中介作用，为学龄前儿童肥胖预防策略的制定提供科学依据。方法基于2018年6月—2022年9月北大-通州前瞻性出生队列研究，纳入1 292对母子，将学龄前儿童3岁时BMI-Z评分>1定义为3岁时有超重肥胖风险组(n=173)，≤1定义为无超重肥胖风险组(n=1 119)。应用多因素Logistic回归分析母亲孕前BMI、孕早期血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、TC/HDL-C、TG/HDL-C、LDL-C/HDL-C]与3岁儿童超重肥胖风险的关联，探究孕早期血脂在孕前BMI与3岁儿童超重肥胖之间的中介效应。结果有超重肥胖风险组和无超重肥胖风险组儿童母亲孕前BMI水平、孕早期LDL-C及TC/HDL-C、LDL-C/HDL-C差异均有统计学意义(χ²/Z值分别为19.01，2.48，2.48，2.71，P值均 < 0.05)。多因素Logistic回归分析结果显示，母亲孕前BMI升高，孕早期LDL-C、TC/HDL-C、LDL-C/HDL-C升高均会增加3岁儿童超重肥胖的发生风险(OR值分别为1.09，1.42，1.49，1.60，P值均 < 0.05)。母亲孕早期LDL-C、TC/HDL-C、LDL-C/HDL-C在孕前BMI与3岁儿童超重肥胖风险之间的中介效应均有统计学意义(P值均 < 0.05)，中介效应占比分别为7.3%，10.2%，23.5%。结论母亲孕早期高血脂在孕前肥胖与学龄前儿童肥胖之间有部分中介作用，母亲孕前肥胖和孕早期高血脂均是学龄前儿童肥胖的风险因素。
- 母亲 /
- 人体质量指数 /
- 血脂异常 /
- 超重 /
- 肥胖症 /
- 回归分析 /
- 儿童, 学龄前
Abstract: Objective To analyze the relationship between body mass index(BMI) during pre-pregnancy, maternal lipid levels during early pregnancy and childhood overweight and obesity, as well as the mediating role of maternal lipid levels during early pregnancy in pre-pregnancy BMI and childhood overweight and obesity, providing scientific evidence for developing obesity prevention strategies in preschool children. Methods Using data from Peking University Birth Cohort in Tongzhou (PKUBC-T) collected between June 2018 and September 2022, the study included 1 292 mother-child pairs. Participants were stratified into two groups based on children's BMI-Z scores at age 3: an overweight/obesity risk group (BMI-Z>1, n=173) and a non-overweight/obesity risk group (BMI-Z≤1, n=1 119).Multivariate Logistic regression was conducted to analyze the associations between pre-pregnancy BMI, maternal lipid levels[total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), TC/HDL-C, TG/HDL-C, LDL-C/HDL-C] during early pregnancy and childhood overweight and obesity. The mediating effect of maternal lipid levels during early pregnancy on pre-pregnancy BMI and childhood overweight and obesity was further explored. Results There were statistically significant differences in pregnancy BMI levels, early pregnancy blood LDL-C, TC/HDL-C, LDL-C/HDL-C levels between the overweight and obesity risk group and the non overweight and obesity risk group (χ²/Z=19.01, 2.48, 2.48, 2.71, all P < 0.05). Multivariate Logistic regression analysis showed that pre-pregnancy BMI, LDL-C, TC/HDL-C and LDL-C/HDL-C in early pregnancy were significantly associated with childhood overweight and obesity (OR=1.09, 1.42, 1.49, 1.60, all P < 0.05). LDL-C, TC/HDL-C and LDL-C/HDL-C in early pregnancy played a significant mediating role on pre-pregnancy BMI and childhood obesity and the mediating effects accounted for 7.3%, 10.2%, 23.5% of the total effects, respectively (all P < 0.05). Conclusions Maternal hyperlipidemia during early pregnancy partially mediated the association between pre-pregnancy obesity and childhood obesity. Both pre-pregnancy obesity and maternal hyperlipidemia during early pregnancy are risk factors for obesity in preschool children.
- Mothers /
- Body mass index /
- Dyslipidemias /
- Overweight /
- Obeysity /
- Regression analysis /
- Child, preschool
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 不同组别儿童母亲孕早期血脂指标比较[M(P₂₅, P₇₅)]

Table 1. Comparison of early pregnancy blood lipid indicators among different groups of mothers[M(P₂₅, P₇₅)]

组别	人数	TC/(mmol·L^-1)	TG/(mmol·L^-1)	HDL-C/(mmol·L^-1)	LDL-C/(mmol·L^-1)	TC/HDL-C	TG/HDL-C	LDL-C/HDL-C
有超重肥胖风险	173	4.07(3.62, 4.53)	1.08(0.86, 1.46)	1.63(1.44, 1.87)	2.36(1.99, 2.76)	2.38(2.10, 2.85)	0.66(0.49, 0.91)	1.34(1.14, 1.76)
无超重肥胖风险	1 119	3.97(3.57, 4.45)	1.07(0.85, 1.37)	1.72(1.48, 1.93)	2.21(1.88, 2.63)	2.33(2.03, 2.70)	0.62(0.47, 0.84)	1.29(1.05, 1.63)
Z值		1.41	0.96	-1.86	2.48	2.48	1.49	2.71
P值		0.16	0.34	0.06	0.01	0.01	0.14	0.01

下载: 导出CSV

表 2 不同组别儿童母亲基本特征比较

Table 2. Comparison of demographic characteristics distribution among different groups

组别	人数	孕前BMI水平				早产		产次		妊娠期糖尿病	妊娠期高血压
组别	人数	低体重	正常	超重	肥胖	是	否	初产妇	经产妇	妊娠期糖尿病	妊娠期高血压
有超重肥胖风险组	173	12(6.94)	91(52.60)	45(26.01)	25(14.45)	10(5.78)	163(94.22)	104(60.12)	69(39.88)	63(36.42)	12(6.94)
无超重肥胖风险组	1 119	99(8.85)	720(64.34)	228(20.38)	72(6.43)	51(4.56)	1 068(95.44)	673(60.14)	446(39.86)	382(34.14)	78(6.97)
χ²值		19.01				0.26		< 0.01		0.25	< 0.01
P值		< 0.01				0.61		1.00		0.62	1.00
注： ()内数字为构成比或患病率/%。

下载: 导出CSV

参考文献(25)

[1]	NORRIS T, MANSUKOSKI L, GILTHORPE M S, et al. Early childhood weight gain: latent patterns and body composition outcomes[J]. Paediatr Perinat Epidemiol, 2021, 35(5): 557-568. doi: 10.1111/ppe.12754
[2]	MANNINO A, SARAPIS K, MOSCHONIS G. The effect of maternal overweight and obesity pre-pregnancy and during childhood in the development of obesity in children and adolescents: a systematic literature review[J]. Nutrients, 2022, 14(23): 5125. doi: 10.3390/nu14235125
[3]	JANJUA N Z, MAHMOOD B, ISLAM M A, et al. Maternal and early childhood risk factors for overweight and obesity among low-income predominantly black children at age five years: a prospective cohort study[J]. J Obes, 2012, 2012: 457173.
[4]	OOSTVOGELS A J, STRONKS K, ROSEBOOM T J, et al. Maternal prepregnancy BMI, offspring's early postnatal growth, and metabolic profile at age 5-6 years: the ABCD study[J]. J Clin Endocrinol Metab, 2014, 99(10): 3845-3854. doi: 10.1210/jc.2014-1561
[5]	MARTIN C L, VLADUTIU C J, ZIKRY T M, et al. Maternal lipid levels during pregnancy and child weight status at 3 years of age[J]. Pediatr Obes, 2019, 14(4): e12485. doi: 10.1111/ijpo.12485
[6]	YUAN S, LI L, PU T, et al. The relationship between NLR, LDL-C/HDL-C, NHR and coronary artery disease[J]. PLoS One, 2024, 19(7): e0290805. doi: 10.1371/journal.pone.0290805
[7]	YUGE H, OKADA H, HAMAGUCHI M, et al. Triglycerides/HDL cholesterol ratio and type 2 diabetes incidence: Panasonic Cohort Study 10[J]. Cardiovasc Diabetol, 2023, 22(1): 308. doi: 10.1186/s12933-023-02046-5
[8]	王超, 张萍. 血脂比值预测心血管疾病的临床研究进展[J]. 山东医药, 2015, 55(36): 99-102. WANG C, ZHANG P. Clinical research progress of lipid ratio in predicting cardiovascular diseases[J]. Shandong Med, 2015, 55(36): 99-102. (in Chinese)
[9]	JIN C, LIN L, HAN N, et al. Effects of dynamic change in fetuin: a levels from the first to the second trimester on insulin resistance and gestational diabetes mellitus: a nested case-control study[J]. BMJ Open Diabetes Res Care, 2020, 8(1): e000802. doi: 10.1136/bmjdrc-2019-000802
[10]	中华人民共和国国家卫生和计划生育委员会. 成人体重判定: WS/T 428—2013[S]. 北京: 中国标准出版社, 2013. National Health and Family Planning Commission of the PRC. Criteria of weight for adults : WS/T 428-2013[S]. Beijing: China Standards Press, 2013. (in Chinese)
[11]	BRÄMER G R. International statistical classification of diseases and related health problems. Tenth revision[J]. World Health Stat Q, 1988, 41(1): 32-36.
[12]	World Health Organization. Child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development[EB/OL]. (2006-11-11)[2025-02-01]. https://www.who.int/publications/i/item/924154693X.
[13]	TINGLEY D, YAMAMOTO T, HIROSE K, et al. Mediation: R package for causal mediation analysis[J]. J Stat Softw, 2014, 59(5): 1-38.
[14]	BAAS R E, HUTTEN B A, HENRICHS J, et al. Associations between maternal lipid blood levels at the 13th week of pregnancy and offspring's adiposity at age 11-12 years[J]. J Clin Endocrinol Metab, 2022, 107(10): e4048-e4057. doi: 10.1210/clinem/dgac442
[15]	GARCÍA A I, NIÑO-SILVA L A, GONZÁLEZ-RUÍZ K, et al. Body adiposity index as marker of obesity and cardiovascular risk in adults from Bogotá, Colombia[J]. Endocrinol Nutr, 2015, 62(3): 130-137. doi: 10.1016/j.endonu.2014.11.007
[16]	WEINSTEIN S, MAOR E, KAPLAN A, et al. Non-interventional weight changes are associated with alterations in lipid profiles and in the triglyceride-to-HDL cholesterol ratio[J]. Nutrients, 2024, 16(4): 486. doi: 10.3390/nu16040486
[17]	XU X, LUO S, LIN J, et al. Association between maternal lipid profiles and lipid ratios in early to middle pregnancy as well as their dynamic changes and gestational diabetes mellitus[J]. BMC Preg Childbirth, 2024, 24(1): 510. doi: 10.1186/s12884-024-06692-9
[18]	ZENG S, LIU Q, WU Y, et al. Reduced low-density lipoprotein cholesterol levels are associated with increased risk of gestational diabetes mellitus in Chinese women[J]. Sci Rep, 2025, 15(1): 6435. doi: 10.1038/s41598-025-91258-8
[19]	MOON J H, JANG H C. Gestational diabetes mellitus: diagnostic approaches and maternal-offspring complications[J]. Diabetes Metab J, 2022, 46(1): 3-14. doi: 10.4093/dmj.2021.0335
[20]	WAHAB R J, JADDOE V W V, VOERMAN E, et al. Maternal body mass index, early-pregnancy metabolite profile, and birthweight[J]. J Clin Endocrinol Metab, 2022, 107(1): e315-e327. doi: 10.1210/clinem/dgab596
[21]	DESOYE G, HERRERA E. Adipose tissue development and lipid metabolism in the human fetus: the 2020 perspective focusing on maternal diabetes and obesity[J]. Prog Lipid Res, 2021, 81: 101082. doi: 10.1016/j.plipres.2020.101082
[22]	周玉博, 李宏田, 刘建蒙. 孕前肥胖、孕期增重过度与子代健康[J]. 中国生育健康杂志, 2022, 33(4): 386-390. ZHOU Y B, LI H T, LIU J M. Pre-pregnancy obesity, excessive weight gain during pregnancy and offspring health[J]. Chin J Reprod Health, 2022, 33(4): 386-390. (in Chinese)
[23]	MULDER J W C M, KUSTERS D M, ROETERS VAN LENNEP J E, et al. Lipid metabolism during pregnancy: consequences for mother and child[J]. Curr Opin Lipidol, 2024, 35(3): 133-140. doi: 10.1097/MOL.0000000000000927
[24]	GUAY S P, HOUDE A A, BRETON E, et al. DNA methylation at LRP1 gene locus mediates the association between maternal total cholesterol changes in pregnancy and cord blood leptin levels[J]. J Dev Orig Health Dis, 2020, 11(4): 369-378. doi: 10.1017/S204017441900076X
[25]	ACHARI A E, JAIN S K. Adiponectin, a therapeutic target for obesity, diabetes, and endothelial dysfunction[J]. Int J Mol Sci, 2017, 18(6): 1321. doi: 10.3390/ijms18061321