Association Between Maternal Body Mass Index in Early Pregnancy and Incidence of Cerebral Palsy
Association Between Maternal Body Mass Index in Early Pregnancy and Incidence of Cerebral Palsy
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DOI：
10.1001/jama.2017.0945
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发表时间：
2017-03-07
影响因子：
120.7
通讯作者：
Cnattingius, Sven
中科院分区：
文献类型：
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作者：
Villamor, Eduardo;Tedroff, Kristina;Cnattingius, Sven
重要性孕产妇超重和肥胖与早产、窒息相关新生儿并发症和先天性畸形的风险增加有关，而这些又与脑瘫的风险增加有关。目前还不确定胎儿脑性瘫痪的风险是否随着母亲超重和肥胖的严重程度而增加，以及可能的机制是什么。目的研究早孕体重指数（BMI）与胎龄脑性瘫痪发生率之间的关系，并确定这些关系的潜在介质。和参与者基于人口的回顾性队列研究，研究对象为1997年至2011年在瑞典出生的独生子女妇女。使用国家登记处，儿童被随访到2012年的脑瘫诊断。暴露早孕BMI。主要结果和指标脑瘫的发病率和风险比（HR）及95% CI，经母亲年龄、原籍国、教育水平、与伴侣同居、身高、怀孕期间吸烟、结果1423929名儿童中，有1200名为新生儿，其中1000名为新生儿，有1000名为新生儿（平均胎龄，39.8周[SD，1.8]; 51.4%为男性），3029例在中位7.8年的随访中被诊断为脑瘫（风险，每1 000名活产2.13;比率，每10 000儿童年2.63）。BMI小于18.5的母亲比例为2.4体重指数在18.5至24.9时，（正常体重），24.8%，BMI为25至29.9在BMI为30 - 34.9（肥胖1级）时，肥胖率为7.8%;在BMI为35 - 39.9（肥胖2级）时，肥胖率为2.4%;在BMI为40或更高（肥胖3级）时，肥胖率为0.8%。每个BMI类别的脑瘫病例数分别为64、1487、728、239、88和38;每10000儿童年的发病率分别为2.58、2.35、2.92、3.15、4.00和5.19。与正常体重母亲的儿童相比，脑瘫儿童的校正HR为1.22（95% CI，1.11-1.33）超重，1.28（95%CI，1.11-1.47），2级肥胖为1.54（95%CI，1.24，1.93），3级肥胖为2.02（95%CI，1.46-2.79）。结果对于足月出生的儿童具有统计学意义，占所有脑瘫儿童的71%，但对于早产儿则无统计学意义。估计有45%的产妇体重指数和脑瘫率之间的关联在足月儿介导的窒息相关的新生儿morbidity.CONCLUSIONS和RELEVANCE在Swedishwomen与独生子女，产妇超重和肥胖与脑瘫率显着相关。这种关联仅限于足月出生的儿童，部分通过窒息相关的新生儿并发症介导。
IMPORTANCE Maternal overweight and obesity are associated with increased risks of preterm delivery, asphyxia-related neonatal complications, and congenital malformations, which in turn are associated with increased risks of cerebral palsy. It is uncertain whether risk of cerebral palsy in offspring increases with maternal overweight and obesity severity and what could be possible mechanisms.OBJECTIVE To study the associations between early pregnancy body mass index (BMI) and rates of cerebral palsy by gestational age and to identify potential mediators of these associations.DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study of women with singleton children born in Sweden from 1997 through 2011. Using national registries, children were followed for a cerebral palsy diagnosis through 2012.EXPOSURES Early pregnancy BMI.MAIN OUTCOMES AND MEASURES Incidence rates of cerebral palsy and hazard ratios (HRs) with 95% CIs, adjusted for maternal age, country of origin, education level, cohabitation with a partner, height, smoking during pregnancy, and year of delivery.RESULTS Of 1 423 929 children included (mean gestational age, 39.8 weeks [SD, 1.8]; 51.4% male), 3029 were diagnosed with cerebral palsy over a median 7.8 years of follow-up (risk, 2.13 per 1000 live births; rate, 2.63/10 000 child-years). The percentages of mothers in BMI categories were 2.4% at BMI less than 18.5 (underweight), 61.8% at BMI of 18.5 to 24.9 (normal weight), 24.8% at BMI of 25 to 29.9 (overweight), 7.8% at BMI of 30 to 34.9 (obesity grade 1), 2.4% at BMI of 35 to 39.9 (obesity grade 2), and 0.8% at BMI 40 or greater (obesity grade 3). The number of cerebral palsy cases in each BMI category was 64, 1487, 728, 239, 88, and 38; and the rates per 10 000 child-years were 2.58, 2.35, 2.92, 3.15, 4.00, and 5.19, respectively. Compared with children of normal-weight mothers, adjusted HR of cerebral palsy were 1.22 (95% CI, 1.11-1.33) for overweight, 1.28 (95% CI, 1.11-1.47) for obesity grade 1, 1.54 (95% CI, 1.24, 1.93) for obesity grade 2, and 2.02 (95% CI, 1.46-2.79) for obesity grade 3. Results were statistically significant for children born at full term, who comprised 71% of all children with cerebral palsy, but not for preterm infants. An estimated 45% of the association between maternal BMI and rates of cerebral palsy in full-term children was mediated through asphyxia-related neonatal morbidity.CONCLUSIONS AND RELEVANCE Among Swedishwomen with singleton children, maternal overweight and obesity were significantly associated with the rate of cerebral palsy. The association was limited to children born at full term and was partly mediated through asphyxia-related neonatal complications.