Prenatal Factors for Childhood Blood Pressure Mediated by Intrauterine and/or Childhood Growth?
Prenatal Factors for Childhood Blood Pressure Mediated by Intrauterine and/or Childhood Growth?
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DOI：
10.1542/peds.2010-2000
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发表时间：
2011-03
期刊：
影响因子：
8
通讯作者：
X. Wen;E. Triche;J. Hogan;E. Shenassa;S. Buka
中科院分区：
文献类型：
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作者：
X. Wen;E. Triche;J. Hogan;E. Shenassa;S. Buka
目的：一些产前因素可能会导致后代的血压，但现有的证据是不确定的，机制仍然不清楚。我们研究了宫内和儿童期生长在儿童期收缩压（SBP）和5个潜在的产前可改变因素之间的关联中的中介作用：母亲在怀孕期间吸烟;孕前BMI;妊娠体重增加;慢性高血压;先兆子痫-子痫。方法：样本包含30 461对母婴对围产期合作项目。产前数据从产科表格中提取，并在7岁时测量儿童的收缩压。潜在的调解宫内生长受限（IUGR）和儿童生长进行了检查的因果步骤的方法。研究结果：母亲在怀孕期间大量吸烟与后代较高的SBP显著相关（与不吸烟者相比，调整后的平均差异为0.73 mmHg [95%置信区间（CI）：0.32-1.14]），在调整出生至7岁的BMI变化后，其衰减为零（0.13 [95% CI：-0.27-0.54]）。孕前超重-肥胖与后代较高的SBP显著相关（与正常体重相比：0.89 mm Hg [95% CI：0.52-1.26]），在校正儿童BMI轨迹后，SBP也衰减为零（-0.04 mm Hg [95% CI：-0.40-0.31]）。调整BMI轨迹增强了母体妊娠体重增加与后代SBP之间的关联。对童年体重轨迹的调整同样改变了这些关联。然而，所有这些协会是独立的IUGR。结论：儿童期BMI和体重轨迹，而不是IUGR，可能在很大程度上介导了母亲怀孕期间吸烟和孕前BMI与后代SBP的关联。
OBJECTIVE: Some prenatal factors may program an offspring's blood pressure, but existing evidence is inconclusive and mechanisms remain unclear. We examined the mediating roles of intrauterine and childhood growth in the associations between childhood systolic blood pressure (SBP) and 5 potentially modifiable prenatal factors: maternal smoking during pregnancy; prepregnancy BMI; pregnancy weight gain; chronic hypertension; and preeclampsia-eclampsia. METHODS: The sample contained 30 461 mother-child pairs in the Collaborative Perinatal Project. Prenatal data were extracted from obstetric forms, and children's SBP was measured at 7 years of age. Potential mediation by intrauterine growth restriction (IUGR) and childhood growth was examined by the causal step method. RESULTS: Heavy maternal smoking during pregnancy was significantly associated with higher offspring SBP (adjusted mean difference versus nonsmoking: 0.73 mm Hg [95% confidence interval (CI): 0.32–1.14]), which attenuated to null (0.13 [95% CI: −0.27–0.54]) after adjustment for changes in BMI from birth to 7 years of age. Prepregnancy overweight-obesity was significantly associated with higher offspring SBP (versus normal weight: 0.89 mm Hg [95% CI: 0.52–1.26]), which also attenuated to null (−0.04 mm Hg [95% CI: −0.40–0.31]) after adjustment for childhood BMI trajectory. Adjustment for BMI trajectory augmented the association between maternal pregnancy weight gain and offspring SBP. Adjustment for childhood weight trajectory similarly changed these associations. However, all these associations were independent of IUGR. CONCLUSIONS: Childhood BMI and weight trajectory, but not IUGR, may largely mediate the associations of maternal smoking during pregnancy and prepregnancy BMI with an offspring's SBP.