母亲孕前超重和肥胖与子代先天性心脏病的发生风险:基于江苏省昆山市大样本回顾性队列研究OA北大核心CSTPCD
Associations of maternal pre-pregnancy overweight and obesity with congenital heart disease in offsprings:A large sample retrospective cohort study in Kunshan of Jiangsu Province
目的 探讨孕前母亲体质指数(BMI)与子代先天性心脏病及其亚型的关系.方法 采用回顾性队列研究设计,分析2019年1月至2021年12月在江苏省昆山市产检5次及以上,且在该市分娩并活产新生儿的19 992名孕母临床资料;母亲孕前BMI、产检信息和子代分娩信息均从江苏省妇幼信息系统导出.先天性心脏病结局通过"新生儿先天性心脏病双指标筛查法"及3月龄心脏彩超随访获得,根据中国人群超重和肥胖标准对母亲孕前BMI分组,通过多因素广义线性模型分析母亲孕前BMI与子代先天性心脏病的关系,报告校正的相对危险度(RR)和95％可信区间(CI).结果 研究纳入的19992名孕母中,筛查出280例新生儿患有先天性心脏病,其中复杂先天性心脏病23例.母亲孕前高BMI水平增加子代先天性心脏病发生风险(RR=1.04,95％CI1.01～1.08,P＜0.001),校正协变量后,关联结果仍然有统计学意义(校正的RR=1.05,95％CI1.01～1.09,P＜0.001).与正常体重者相比,母亲孕前肥胖增加子代先天性心脏病发生风险(校正的RR=2.20,95％CI 1.40～3.46,P=0.001).将超重和肥胖两组合并后,亚组分析发现孕前母亲超重或肥胖者子代复杂先天性心脏病的风险是对照组的3.76倍(校正的RR=3.76,95％CI 1.62～8.69,P=0.002).结论 母亲孕前BMI升高其子代先天性心脏病发生风险显著增加,尤其是复杂先天性心脏病的发生风险.临床工作中,应重视对母亲孕前肥胖的干预,以期降低子代先天性心脏病发病风险、提高子代健康水平.
Objective To evaluate the associations of maternal pre-pregnancy body mass index(BMI)with congenital heart disease(CHD)and its sub-types in offsprings.Methods In this retrospective cohort study,we analyzed the maternal data of 19992 women in Kunshan city with more than five-time antenatal examination records in local maternal hospitals and their live newborns from the Maternal and Child Care Information System of Jiangsu Province(from Jan.2019 to Oct.2021).Maternal pre-pregnancy BMI,antenatal examination information and delivery data were all collected via the system.CHD outcomes were obtained by the newborn CHD dual-index screening programs and cardiac ultrasound test at 3 month-old,which were divided into groups concerning maternal BMI before pregnancy according to the definitions for the Chinese population.Multivariate generalized linear models were used to analyze the relationship between maternal BMI befare pregnancy and CHD in offsprings and to estimate adjusted risk ratios(aRRs)and 95％confidence intervals(CIs).Results A total of 280 CHD cases(including 23 complex CHD cases)were screened among 19992 leveraged pregnant women.High maternal BMI before pregnancy increased the risk of CHD in offsprings(unadjusted RR 1.04,95％CI 1.01-1.08;P＜0.001).The associations remained significant even after adjustment for covariates[aRR 1.05,95％CI 1.01-1.09;P＜0.001].Compared with normal weight,maternal obesity before pregnancy increased the risk of CHD in offsprings(aRR 2.20,95％CI 1.40-3.46;P=0.001).Subgroup analysis showed that the maternal overweight or obesity resulted in 3.7-fold higher risk of complex CHD in overweight/obesity group than in control group(aRR 3.76,95％CI 1.62-8.69;P=0.002).Conclusion The increase in maternal BMI before pregnancy increases the risk of offspring CHD,especially the risk of complex CHD.To reduce the risk of CHD and improve the health level of offsprings,more attention should be paid to the intervention of maternal pre-pregnancy obesity in clinical practice.
陈逍天;吴冰;冯佩;张莉;卢平;张译文;马燕;韩霞
复旦大学附属儿科医院,上海 201102昆山市妇幼保健院,江苏苏州 215300
临床医学
母亲肥胖先天性心脏病孕前体质指数
maternal obesitycongenital heart diseasepre-pregnancybody mass index
《中国实用儿科杂志》 2024 (002)
112-118 / 7
苏州市重大疾病、传染病预防和控制关键技术(研究)项目(GWZX201906)
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