妊娠期糖尿病患者孕前体质量指数和孕期增重对0~12月龄婴儿生长轨迹的影响

Effects of pre-pregnancy body mass index and gestational weight gain on growth trajectories of infants aged 0 to 12 months born to mothers with gestational diabetes mellitus

摘要

目的 分析妊娠期糖尿病患者孕前体质量指数(BMI)、孕期增重及其联合作用对0~12月龄婴儿体重、身长、身长别体重Z评分(WLZ)、BMI的Z评分(BAZ)等轨迹的影响,为高危婴儿的早期生长监测策略提供参考。方法 采用前瞻性队列研究,于2023年12月—2024年10月在扬州妇幼保健院招募孕早期孕妇,收集孕期及新生儿出生时相关资料,并于婴儿出生后42 d、3、6、8和12月龄随访时收集其人体测量数据。采用局部加权回归(LOWESS)绘制不同组婴儿的平滑生长轨迹;采用广义估计方程(GEE)分析孕前BMI、孕期增重及其联合分组对0~12月龄婴儿生长轨迹的影响;采用多因素logistic回归分析孕前BMI与孕期增重联合分组对12月龄婴儿超重/肥胖的影响。结果 与孕前非超重/肥胖且孕期增重适宜组相比,孕前超重/肥胖且孕期增重过度组婴儿体重(β=0.263,95%CI:0.116~0.411)、头围(β=0.366,95%CI:0.122~0.609)、WLZ(β=0.349,95%CI:0.156~0.543)、BMI(β=0.629,95%CI:0.354~0.903)和BAZ(β=0.432,95%CI:0.247~0.616)增长更多(P<0.05)。该组婴儿12月龄发生超重/肥胖的风险为非超重/肥胖且增重适宜组的2.742倍(95%CI:1.015~7.048,P<0.05)。结论 与孕前非超重/肥胖且孕期增重适宜的母亲相比,孕前超重/肥胖且孕期增重过度的母亲其子代在0~12月龄体重、头围、WLZ、BMI和BAZ增长更快,12月龄发生超重/肥胖的风险更高。控制孕前BMI和孕期增重可能有助于降低妊娠期糖尿病患者子代早期超重/肥胖风险。

Abstract

Objective To examine the effects of maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and their joint associations on trajectories of infant weight, length, weight-for-length Z score (WLZ), and BMI-for-age Z score (BAZ) from birth to 12 months among women with gestational diabetes mellitus (GDM), so as to provide evidence for early growth-monitoring strategies for high-risk infants. Methods This prospective cohort study recruited women in early pregnancy from Yangzhou Maternal and Child Health Care Hospital between December 2023 and October 2024. Maternal pregnancy-related data and neonatal birth data were collected. Infant anthropometric measurements were obtained at 42 days and at 3, 6, 8, and 12 months of age. Locally weighted scatterplot smoothing (LOWESS) was used to plot smoothed growth trajectories across groups. Generalized estimating equations (GEEs) were used to assess the effects of prepregnancy BMI, GWG, and their combined categories on infant growth trajectories from 0 to 12 months. Multivariable logistic regression was used to evaluate the association between combined prepregnancy BMI-GWG categories and overweight/obesity at 12 months. Results Compared with infants born to mothers with non-overweight/obesity before pregnancy and adequate GWG, infants born to mothers with prepregnancy overweight/obesity and excessive GWG showed more rapid increases in weight (β=0.263, 95%CI: 0.116-0.411),head circumference (β=0.366, 95%CI:0.122 -0.609),WLZ (β=0.349, 95%CI: 0.156-0.543), BMI (β=0.629, 95%CI: 0.354-0.903), and BAZ (β=0.432, 95%CI: 0.247-0.616) (P<0.05). At 12 months, the risk of overweight/obesity was 2.742 times higher in these infants than in the reference group (95%CI: 1.015-7.048, P<0.05). Conclusions Among mothers with GDM, pre-pregnancy overweight/obesity combined with excessive GWG is associated with more rapid increases in offspring weight, head circumference, WLZ, BMI and BAZ during the first 12 months of life, as well as a higher risk of overweight/obesity at 12 months. Optimizing pre-pregnancy BMI and GWG may help reduce the risk of early-life overweight/obesity among offspring of women with GDM.

关键词

妊娠期糖尿病 / 生长轨迹 / 孕前体质量指数 / 孕期增重 / 队列研究

Key words

gestational diabetes / growth trajectory / pre-pregnancy body mass index / gestational weight gain / cohort study

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基金资助

扬州市基础研究计划(联合专项)卫生健康类项目(2024-3-25);扬州市科技局社会发展项目(YZ2024081)