目的 探讨宫内暴露于妊娠期糖尿病是否增加儿童3岁内发生超重肥胖的风险,为预防儿童肥胖提供科学依据。方法 采用前瞻性队列研究,自2014年9月—2015年8月从北京市16个社区入组符合标准的儿童2 275名,从新生儿期随访至3岁。结果 宫内暴露于妊娠期糖尿病的儿童在1、2、3岁时的BMI均高于非暴露组,但差异无统计学意义(P>0.05)。出生时为巨大儿(OR=2.01,95%CI:1.40~2.89)、母亲孕前体重指数较高(OR=1.09,95%CI:1.06~1.13)、母亲孕期体重增加过多(OR=1.01,95%CI:0.99~1.03)是儿童1岁内超重肥胖的危险因素(P<0.05);家庭人均收入较高(OR=0.83,95%CI:0.71~0.98)是儿童1岁内超重肥胖的保护因素(P<0.05)。出生时为巨大儿(OR=1.66,95%CI:1.07~2.58)、母亲孕前体重指数较高(OR=1.14,95%CI:1.09-1.18)、母亲孕期体重增加过多(OR=1.02,95%CI:1.00~1.04)是儿童2岁内超重肥胖的危险因素(P<0.05);家庭人均收入较高(OR=0.61,95%CI:0.49~0.75)和纯母乳喂养持续6个月(OR=0.61,95%CI:0.45~0.84)是儿童2岁内超重肥胖的保护因素(P<0.05)。出生时为巨大儿(OR=1.89,95%CI:1.23~2.91)、母亲孕前体重指数较高(OR=1.14,95%CI:1.09~1.18)也是儿童3岁内超重肥胖的危险因素(P<0.05);家庭人均收入较高(OR=0.66,95%CI:0.54~0.81)和纯母乳喂养持续6个月(OR=0.55,95%CI:0.40~0.75)是儿童3岁时超重肥胖的保护因素(P<0.05)。辅食添加时间与3岁内儿童超重肥胖无相关性。结论 为了减少儿童在3岁内发生超重肥胖,应严格控制孕妇孕前和孕期的体重,尽可能地坚持纯母乳喂养6个月。
Abstract
Objective To investigate the risk of overweight/obesity during 3 years old in children exposed to gestational diabetes mellitus (GDM), in order to provide scientific basis for prevention of childhood obesity. Methods Totally 2 275 eligible children were enrolled in this prospective cohort study from September 2014 to August 2015 in 16 communities of Beijing, and were followed up to 3 years old. Their height and weight were measured at each regular physical examination. Results The body mass index(BMI) of children exposed to GDM was higher than that in the non-exposure group at 1, 2 and 3 years old, but the differences were not significant (P>0.05). The factors that increased the risk of children being overweight and obese within 1 year old included macrosomia (OR=2.01, 95%CI:1.40—2.89), mother with high BMI before pregnancy (OR=1.09, 95%CI:1.06—1.13) and excessive weight gain during pregnancy (OR=1.01, 95%CI:0.99—1.03), while high family income was a protective factor(OR=0.83, 95%CI:0.71—0.98). The factors increasing the risk of children being overweight and obese within 2 years old were macrosomia (OR=1.66, 95%CI:1.07—2.58), mother with high BMI before pregnancy(OR=1.14, 95%CI:1.09—1.18) and excessive weight gain during pregnancy(OR=1.02, 95%CI:1.00—1.04), while factors decreased the risk included higher level of family incomes (OR=0.61, 95%CI:0.49—0.75) and exclusive breastfeeding for 6 months (OR=0.61, 95%CI:0.45—0.84). Factors increasing the risk of children being overweight and obese within 3 years old were macrosomia (OR=1.89, 95%CI:1.23—2.91) and mother with high BMI before pregnancy (OR=1.14, 95%CI:1.09—1.18),while high family incomes (OR=0.66, 95%CI: 0.54—0.81) and exclusive breastfeeding for 6 months (OR=0.55, 95%CI:0.40—0.75) were protective factors for overweight and obese within 3 years old. Conclusion In order to reduce the overweight and obesity of children within 3 years old, the weight of pregnant women before and during pregnancy should be strictly controlled, and exclusive breastfeeding should be adhered to 6 months old as much as possible.
关键词
儿童肥胖 /
妊娠期糖尿病 /
纯母乳喂养
Key words
childhood obesity /
gestational diabetes mellitus /
exclusive breastfeeding
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. state-level prevalence of adult obesity and severe obesity[J]. N Engl J Med,2019,381(25):2440-2450..
[2] Yardim MS, Özcebe LH, Araz OM, et al. Prevalence of childhood obesity and related parental factors across socioeconomic strata in Ankara, Turkey[J]. East Mediterr Health J, 2019,25(6):374-384.
[3] Adair LS. Child and adolescent obesity: epidemiology and developmental perspectives[J]. Physiol Behav,2008,94(1):8-16.
[4] Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013[J]. Lancet, 2014,384(9945):766-781.
[5] Kohut T, Robbins J, Panganiban J. Update on childhood/adolescent obesity and its sequela[J]. Curr Opin Pediatr, 2019, 31(5):645-653.
[6] Gibson-Smith D, Halldorsson TI, Bot M, et al. Childhood overweight and obesity and the risk of depression across the lifespan[J]. BMC Pediatr, 2020,20(1):25-32.
[7] Yang Y, Wang ZP, Mo MJ, et al. The association of gestational diabetes mellitus with fetal birth weight[J]. J Diabetes Complicat,2018,32(7): 635-642.
[8] Chen L, Mayo R, Chatry A, et al. Gestational diabetes mellitus: its epidemiology and implication beyond pregnancy[J]. Curr Epidemiol Rep,2016,3(1):1-11.
[9] Badakhsh M, Daneshi F, Abavisani M, et al. Prevalence of gestational diabetes mellitus in Eastern Mediterranean region: a systematic review and meta-analysis[J]. Endocrine, 2019, 65(3):505-514.
[10] Aris IM, Soh SE, Tint MT, et al. Associations of infant milk feed type on early postnatal growth of offspring exposed and unexposed to gestational diabetes in utero[J]. Eur J Nutr, 2017, 56(1):55-64.
[11] Bider-Canfield Z, Martinez MP, Wang X, et al. Maternal obesity, gestational diabetes, breast- feeding and childhood overweight at age 2 years[J]. Pediatr Obes,2017,12(2): 171-178.
[12] Vandyousefi S, Whaley SE, Widen EM, et al. Association of breastfeeding and early exposure to sugar-sweetened beverages with obesity prevalence in offspring born to mothers with and without gestational diabetes mellitus[J]. Pediatr Obes, 2019, 14(12): e12569.
[13] Mannan H. Early infant feeding of formula or solid foods and risk of childhood overweight or obesity in a socioeconomically disadvantaged region of australia: A longitudinal cohort analysis[J]. Int J Environ Res Public Health, 2018, 15(8):1685-1692.
[14] Papoutsou S, Savva SC, Hunsberger M, et al. Timing of solid food introduction and association with later childhood overweight and obesity: The IDEFICS study[J]. Matern Child Nutr, 2018, 14(1): e12471.
[15] Hillier TA, Pedula KL, Vesco KK, et al. Impact of Maternal glucose and gestational weight gain on child obesity over the first decade of life in normal birth weight infants[J]. Matern Child Health J,2016,20(8):1559-1568.
[16] 邵婷, 陶慧慧, 倪玲玲,等. 母亲孕前BMI和孕期增重对学龄前儿童超重肥胖的影响[J]. 中华预防医学杂志, 2016,50(2):123-128.
[17] 梁晶晶,胡艳,邢艳菲,等.母亲孕前体质指数及孕期增重与学龄前儿童超重肥胖的关系研究[J].中华流行病学杂志, 2019,40(8):976-981.
基金
首都卫生发展科研专项资助(首发2020-2-2111);中国疾病预防控制中心妇幼保健中心“母婴营养与健康研究项目”(2019FYH001)
PDF(417 KB)
