母亲孕前到产后体质指数与3岁儿童的超重或肥胖之间的关系探讨

Trajectories of Maternal Body Mass Index from Pre-Pregnancy through Postpartum and Its Associations with Offspring Overweight or Obesity At 3 Years Old

目的：探讨母亲体质指数(body mass index, BMI)从孕前到产后的变化轨迹及其与儿童超重或肥胖风险的关系。方法：采用整群抽样法，选取2015年1至12月在长沙市开福区三个社区卫生服务中心分娩的产妇及其子代作为研究对象，根据纳入排除标准，最终有688对母子纳入本研究。使用潜类别增长模型(Latent class growth models, LCGM)来确定产妇BMI的轨迹。采用logistic回归模型研究母亲BMI轨迹与子代超重或肥胖之间的关系。结果：确定了三类产妇BMI轨迹。在调整后的模型中，与第3类轨迹相比，第1类轨迹与儿童期超重或肥胖的风险增加密切相关(aOR:2.86, 95%CI:1.48-5.51)。在孕前超重/肥胖亚组分析，与第3类轨迹相比，第1类轨迹(aOR:2.86, 95%CI:1.48-5.51)与儿童期超重或肥胖风险增加相关，在孕期增重过度亚组分析中，与第3类轨迹相比，第1类轨迹( aOR:3.82, 95%CI:1.43-10.20)与儿童期超重或肥胖风险增加相关。在高体重滞留亚组分析中,与第 3 类轨迹相比，第1类轨迹(OR:4.35,95%CI:1.98-9.56)和第2类轨迹(OR:1.78,95% CI:1.01-3.14)均与儿童超重或肥胖的风险增加相关。结论：产妇孕前至产后高BMI可能增加儿童超重或肥胖的风险，而这与孕前BMI、GWG和产后体重滞留有关。

Objective: To explore trajectories of maternal body mass index (BMI) from pre-pregnancy to postpartum and its relationships with the risk of childhood overweight or obesity. Methods: This study analyzed data from 688 mother-offspring pairs in a birth cohort based on Changsha City, Hunan Province, China, which was launched in 2015 at three Community Health Service Centers (CHSCs) in Kaifu District of Changsha City. Latent class growth models (LCGM) were used to identify latent trajectories of maternal BMI. Logistic regression model was used to examine the associations between maternal BMI trajectory group and offspring overweight or obesity.
Results: Three-Class maternal BMI trajectories were identified. In adjusted model, the Class 1 trajectory was strongly related to an increased risk of childhood overweight or obesity compared with the Class 3 trajectory (aOR:2.86, 95%CI:1.48-5.51). In subgroups analysis, the Class 1 trajectory were associated with an increased risk of childhood overweight or obesity compared with the Class 3 trajectory in pre-pregnancy overweight or obese and GWG excessive subgroups, however, in postpartum weight retention < 5kg subgroup, maternal BMI trajectory was associated with offspring overweight or obesity. Conclusions: Maternal high BMI from pre-pregnancy to postpartum might increase the risk of children being overweight or obese, which was effected by pre-pregnancy BMI, GWG and postpartum weight retention.