Do Gestational Obesity and Gestational Diabetes Have an Independent Effect on Neonatal Adiposity? Results of Mediation Analysis from a Cohort Study in South India
Do Gestational Obesity and Gestational Diabetes Have an Independent Effect on Neonatal Adiposity? Results of Mediation Analysis from a Cohort Study in South India
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DOI：
10.2147/clep.s222726
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发表时间：
2019-01-01
影响因子：
3.9
通讯作者：
Murthy, G. V. S.
中科院分区：
文献类型：
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作者：
Babu, Giridhara R.;Deepa, R.;Murthy, G. V. S.
目的：患有肥胖症或妊娠期糖尿病（GDM）的母亲所生的新生儿在以后的生活中患各种代谢紊乱的机会增加。在印度，还不清楚母亲肥胖或GDM是否与后代肥胖有关。我们的目的是了解孕产妇肥胖和GDM对新生儿肥胖的独立影响，以及GDM是否在孕产妇肥胖和新生儿肥胖之间具有中介作用。方法：我们招募了一个由1120名女性组成的队列（2016年4月至2019年2月期间）来自印度班加罗尔的公立医院，她们自愿同意参与并提供书面知情同意书。主要结果是新生儿肥胖，定义为皮褶厚度之和>第85百分位数。暴露包括母亲肥胖，定义为皮褶厚度>第90百分位数。采用口服葡萄糖耐量试验，按照世界卫生组织的标准对GDM进行分类。应用二元逻辑回归检验母亲肥胖和GDM对新生儿肥胖的影响，并校正潜在的混杂因素。结果：母亲肥胖（OR =2.16，95% CI 1.46，3.18）和GDM（OR=2.21，95% CI 1.38，3.52）对新生儿肥胖有独立影响。妊娠期糖尿病在母亲肥胖和新生儿肥胖之间的总效应中占25.2%，（自然直接效应OR = 1.16 95% CI 1.04，1.30），母亲肥胖具有显著的直接效应（自然直接效应OR = 1.90 95% CI 1.16，3.10）和显著总效应OR=2.20 95% CI 1.35，3.58。此外，GDM介导了母亲肥胖与儿童肥胖的关联。干预措施侧重于预防妇女肥胖，有效筛查和管理GDM可能有助于减少印度儿童肥胖。
Purpose: Neonates born to mothers with obesity or gestational diabetes mellitus (GDM) have an increased chance of various metabolic disorders later in life. In India, it is unclear whether maternal obesity or GDM is related to offspring adiposity. We aimed to understand the independent effect of maternal obesity and GDM with neonatal adiposity and whether GDM has a mediating effect between maternal obesity and neonatal adiposity.Methods: We recruited a cohort of 1120 women (between April 2016 and February 2019) from the public hospitals in Bangalore, India, who voluntarily agreed to participate and provided written informed consent. The primary outcome was neonatal adiposity, defined as the sum of skinfold thickness >85th percentile. Exposure included maternal obesity, defined as >90th percentile of skinfold thickness. GDM, the potential mediator, was classified using the World Health Organization criteria by oral glucose tolerance test. Binary logistic regression was applied to test the effect of maternal obesity and GDM on neonatal adiposity, adjusting for potential confounders. We used Paramed command in STATA version 14 for analyzing mediating effects.Results: We found that maternal obesity (odds ratio (OR)=2.16, 95% CI 1.46, 3.18) and GDM (OR=2.21, 95% CI1.38, 3.52) have an independent effect on neonatal adiposity. GDM significantly mediates 25.2% of the total effect between maternal obesity and neonatal adiposity, (natural direct effect OR = 1.16 95% CI 1.04, 1.30) with significant direct effect of maternal obesity (natural direct effect OR = 1.90 95% CI 1.16, 3.10) and significant total effect (OR=2.20 95% CI 1.35, 3.58).Conclusion: We showed that maternal obesity and GDM are independently associated with offspring adiposity. Also, GDM mediates the association of maternal obesity on adiposity in children. Interventions focused on obesity prevention in women, and effective screening and management of GDM may contribute to reducing childhood obesity in India.