背景:母亲肥胖,全世界越来越普遍的健康状况,被认为与后代出生缺陷的高风险有关,而来自中国的基于人群的数据的证据在很大程度上缺乏。此外,妊娠期糖尿病在孕妇肥胖与出生缺陷之间的关系中的作用尚不清楚.我们旨在调查孕妇孕前超重或肥胖与后代中任何和不同类型的出生缺陷的关系,以及孕前超重或肥胖与妊娠期糖尿病之间的相互作用。
方法:我们进行了一项基于人群的队列研究,包括2015年至2021年在龙岗区出生的257107名单身人士,深圳,中国,使用深圳市妇幼保健管理系统的数据。进行泊松回归以估计孕妇孕前超重或肥胖的关联。以及孕前超重或肥胖与妊娠期糖尿病之间的相互作用,有出生缺陷的风险。模型根据分娩时的产妇年龄进行了调整,教育水平,户籍类型,和妊娠。
结果:孕前超重与任何出生缺陷(风险比[RR]1.21,95%置信区间[CI]1.12至1.31)以及先天性循环系统畸形(RR1.26,95%CI1.12至1.41)的风险较高有关。眼睛/耳朵/面部/颈部(RR1.42,95%CI1.04至1.94),和肌肉骨骼系统(RR1.21,95%CI1.01至1.44)。孕前肥胖与任何出生缺陷(RR1.38,95%CI1.18至1.63)和先天性循环系统畸形(RR1.61,95%CI1.30至1.98)的高风险相关。患有妊娠糖尿病的超重或肥胖母亲所生的婴儿比没有妊娠糖尿病的超重或肥胖母亲所生的婴儿患先天性循环系统畸形的风险更高。
结论:孕前超重或肥胖与出生缺陷的风险较高有关。特别是循环系统的先天性畸形,在后代中。妊娠期糖尿病与孕前超重或肥胖在改变循环系统先天性畸形的风险上相互作用。在计划怀孕的超重或肥胖的妇女中,强调了改善体重管理以及评估葡萄糖和代谢功能的重要性。
BACKGROUND: Maternal obesity, a health condition increasingly prevalent worldwide, has been suggested to be associated with a higher risk of birth defects in offspring, whereas evidence from population-based data from China was largely lacking. Additionally, the role of gestational diabetes in the association between maternal obesity and birth defects remains unclear. We aimed to investigate the association of maternal pre-pregnancy overweight or obesity with any and different types of birth defects in offspring and the interaction between pre-pregnancy overweight or obesity and gestational diabetes.
METHODS: We conducted a population-based cohort
study including 257 107 singletons born between 2015 and 2021 in Longgang District, Shenzhen, China, using data from the Shenzhen Maternal and Child Health Management System. Poisson regression was conducted to estimate the associations of maternal pre-pregnancy overweight or obesity, as well as the interaction between pre-pregnancy overweight or obesity and gestational diabetes, with the risk of birth defects. Models were adjusted for maternal age at delivery, educational level, type of household registration, and gravidity.
RESULTS: Maternal pre-pregnancy overweight was associated with a higher risk of any birth defect (risk ratio [RR] 1.21, 95% confidence interval [CI] 1.12 to 1.31) as well as of congenital malformations of the circulatory system (RR 1.26, 95% CI 1.12 to 1.41), eye/ear/face/neck (RR 1.42, 95% CI 1.04 to 1.94), and musculoskeletal system (RR 1.21, 95% CI 1.01 to 1.44). Maternal pre-pregnancy obesity was associated with a higher risk of any birth defect (RR 1.38, 95% CI 1.18 to 1.63) and congenital malformations of the circulatory system (RR 1.61, 95% CI 1.30 to 1.98). Infants born to overweight or obese mothers with gestational diabetes had a higher risk of congenital malformations of the circulatory system than infants born to overweight or obese mothers without gestational diabetes.
CONCLUSIONS: Maternal pre-pregnancy overweight or obesity was associated with a higher risk of birth defects, particularly congenital malformations of the circulatory system, in offspring. Gestational diabetes interacts additively with pre-pregnancy overweight or obesity on modifying the risk of congenital malformations of the circulatory system. The importance of improving weight management and assessment of glucose and metabolic functions was emphasized among women planning for pregnancy who are overweight or obese.