Overall gestational weight gain mediates the relationship between maternal and child obesity
Overall gestational weight gain mediates the relationship between maternal and child obesity
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总体孕期体重增加介导了母亲肥胖与儿童肥胖之间的关系。
DOI：
10.1186/s12889-019-7349-1
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发表时间：
2019-08-07
影响因子：
4.5
通讯作者：
Williams-DeVane, ClarLynda
中科院分区：
文献类型：
--
作者：
Josey, Michele J.;McCullough, Lauren E.;Williams-DeVane, ClarLynda
在美国，大约17%的儿童肥胖。超重或肥胖的儿童成年后也更有可能肥胖，并患有各种慢性疾病和过早死亡。母亲肥胖可以通过宫内机制影响其后代的体重状况，如过度妊娠体重增加（GWG）。目前的文献显示母亲体重状况与GWG对儿童肥胖的正相关，但直接和间接的影响尚未被分解或量化。本研究的目的是评估母亲肥胖对儿童肥胖的影响，介导的GWG，这是一个可修改的危险因素。方法研究参与者是2005年至2009年在北卡罗来纳州达勒姆的杜克/达勒姆地区卫生保健系统接受产前护理的妇女的后代的出生队列。在每次自愿访问医疗机构期间，通过电子病历（EMR）收集拟人化数据。关注的暴露是母亲肥胖，通过孕前体重指数测量，中介是GWG，根据母亲产前BMI分为过度和不过度，结局是4岁时的儿童肥胖，通过最后记录的身高和体重的BMI z评分测量。基于反事实理论的产品方法分析估计了GWG的介导效应，调整了母亲的种族，社会经济地位和吸烟状况。结果在766名儿童中，25%的儿童超重或肥胖，在所有母亲中，超重和肥胖分别为25%和31%。母亲BMI与后代Z评分总体增加0.04相关。母亲肥胖对4岁儿童肥胖的影响由GWG介导的比例为8.1%。结论GWG部分介导了母亲BMI与儿童期肥胖的关系。即使当调解人是固定的，孩子们在一个更高的BMI的风险增加，如果母亲是肥胖的。这些发现强调了一个重要的公共卫生教育机会，强调孕前体重和过量GWG对所有母亲儿童肥胖风险的影响。
Background Approximately 17% of children in the U.S. are obese. Children that are overweight or obese are also more likely to be obese as adults and suffer from various chronic diseases and premature death. Maternal obesity can affect the weight status of her offspring through intrauterine mechanisms like excessive gestational weight gain (GWG). Current literature shows a positive association between maternal weight status and GWG on child obesity, yet the direct and indirect effects have not been decomposed or quantified. The purpose of this study was to estimate the effect of maternal obesity on child obesity, mediated by GWG, which is a modifiable risk factor. Methods The study participants were a birth cohort of offspring from women who received prenatal care in the Duke/Durham Regional health care system in Durham, NC between 2005 and 2009. Anthropomorphic data was collected via electronic medical records (EMRs) during each voluntary visit to a health care facility. The exposure of interest was maternal obesity, measured by pre-pregnancy body mass index, the mediator was GWG, dichotomized into excessive and not excessive based on maternal prenatal BMI, and the outcome was child obesity at age 4, measured as BMI z-scores from the last recorded height and weight. A counterfactual theory-based product method analysis estimated the mediated effects of GWG, adjusted for maternal race, socioeconomic status, and smoking status. Results Of the 766 children, 25% were overweight or obese, and among all mothers, 25 and 31% were overweight and obese, respectively. Maternal BMI was associated with an overall increase of 0.04 in offspring z-score. The proportion of the effect of maternal obesity on child age 4 obesity mediated by GWG was 8.1%. Conclusion GWG, in part, mediated the relationship between maternal BMI and childhood adiposity. Even when the mediator is fixed, children are at an increased risk of a higher BMI if the mother is obese. These findings highlight an important public health education opportunity to stress the impact of a pre-pregnancy weight and excessive GWG on the risk of child obesity for all mothers.