First trimester fetal growth restriction and cardiovascular risk factors in school age children: population based cohort study.
First trimester fetal growth restriction and cardiovascular risk factors in school age children: population based cohort study.
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DOI：
10.1136/bmj.g14
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发表时间：
2014-01-23
期刊：
影响因子：
--
通讯作者：
Gaillard R
中科院分区：
文献类型：
--
作者：
Jaddoe VW;de Jonge LL;Hofman A;Franco OH;Steegers EA;Gaillard R
目的探讨早期妊娠胎儿生长受限与儿童心血管疾病预后的关系。设计基于人群的前瞻性队列研究。背景城市鹿特丹，荷兰。研究对象为1184名孕早期胎儿头臀长测量的儿童，其母亲有可靠的末次月经第一天和规律的月经周期。主要结果测量中位年龄6.0岁（90%范围5.7-6.8）时的体重指数、总脂肪和腹部脂肪分布、血压和胆固醇、甘油三酯、胰岛素和C肽的血液浓度。心血管危险因素的聚集被定义为具有以下三个或更多：高android脂肪质量;高收缩压或舒张压;低高密度脂蛋白胆固醇或高甘油三酯浓度;和高胰岛素浓度。结果一个标准差评分较大的头三个月胎儿冠臀长度与较低的总脂肪量有关（− 0.30%，95%置信区间−0.57%至−0.03%），Android脂肪量（− 0.07%，−0.12%至−0.02%），男性/女性脂肪质量比（−0.53，−0.89至−0.17），舒张压（−0.43，−0.84至−0.01，mm Hg），总胆固醇（−0.05，−0.10至0，mmol/L），低密度脂蛋白胆固醇（−0.04，−0.09至0，mmol/L），以及儿童期心血管危险因素聚集的风险（相对风险0.81，0.66至1.00）。胎龄和出生体重的额外调整仅轻微改变了这些效应估计值。儿童期体重指数能充分解释早期胎儿头臀长与儿童期总脂肪量的关系。孕早期胎儿生长与其他心血管结局无关。纵向生长分析表明，与学龄儿童相比，没有聚集的心血管危险因素，那些聚集有一个较小的头三个月的胎儿冠臀长度和较低的中期和晚期估计胎儿体重，但较高的体重增长从6个月的年龄开始。结论：早期妊娠胎儿发育不良与学龄儿童心血管疾病的危险因素有关。胎儿早期可能是日后心血管健康的关键时期。
Objective To examine whether first trimester fetal growth restriction correlates with cardiovascular outcomes in childhood. Design Population based prospective cohort study. Setting City of Rotterdam, the Netherlands. Participants 1184 children with first trimester fetal crown to rump length measurements, whose mothers had a reliable first day of their last menstrual period and a regular menstrual cycle. Main outcomes measures Body mass index, total and abdominal fat distribution, blood pressure, and blood concentrations of cholesterol, triglycerides, insulin, and C peptide at the median age of 6.0 (90% range 5.7-6.8) years. Clustering of cardiovascular risk factors was defined as having three or more of: high android fat mass; high systolic or diastolic blood pressure; low high density lipoprotein cholesterol or high triglycerides concentrations; and high insulin concentrations. Results One standard deviation score greater first trimester fetal crown to rump length was associated with a lower total fat mass (−0.30%, 95% confidence interval −0.57% to −0.03%), android fat mass (−0.07%, −0.12% to −0.02%), android/gynoid fat mass ratio (−0.53, −0.89 to −0.17), diastolic blood pressure (−0.43, −0.84 to −0.01, mm Hg), total cholesterol (−0.05, −0.10 to 0, mmol/L), low density lipoprotein cholesterol (−0.04, −0.09 to 0, mmol/L), and risk of clustering of cardiovascular risk factors (relative risk 0.81, 0.66 to 1.00) in childhood. Additional adjustment for gestational age and weight at birth changed these effect estimates only slightly. Childhood body mass index fully explained the associations of first trimester fetal crown to rump length with childhood total fat mass. First trimester fetal growth was not associated with other cardiovascular outcomes. Longitudinal growth analyses showed that compared with school age children without clustering of cardiovascular risk factors, those with clustering had a smaller first trimester fetal crown to rump length and lower second and third trimester estimated fetal weight but higher weight growth from the age of 6 months onwards. Conclusions Impaired first trimester fetal growth is associated with an adverse cardiovascular risk profile in school age children. Early fetal life might be a critical period for cardiovascular health in later life.
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DOI：
10.1136/bmj.b2393
发表时间：
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期刊：
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影响因子：
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