背景:关于妊娠期母体代谢综合征的分类如何影响儿童的发育结局以及这种关联的可能中介因素的证据有限。本研究使用来自英国出生在布拉德福德研究的12,644至13,832对母子对的队列样本,以脐带血标记物作为候选介质,检查母亲代谢综合征分类(MetS)与5岁时儿童发育结果之间的关联。
方法:母体心脏代谢标志物包括糖尿病,肥胖,甘油三酯,高密度脂蛋白胆固醇,血压,高血压,和怀孕期间的空腹血糖。高密度脂蛋白胆固醇的脐带血标志物,低密度脂蛋白胆固醇,甘油三酯,瘦素,和脂联素被用作儿童介质。儿童结果包括两个起始学校变量:英国图片词汇量表(BPVS)和字母识别评估(LID),和来自英国国家框架的五个发展里程碑领域:(1)通信和语言(COM);(2)个人,社会,和情感(PSE);(3)身体发育(PHY);(4)识字(LIT);(5)数学(MAT)。中介模型用于检查母体代谢综合征的分类与儿童发育里程碑之间的关联。针对潜在的产妇调整了模型,社会经济,和儿童混杂因素,如母亲教育,剥夺,和胎龄。
结果:在中介模型中,发现MetS与5岁时LIT领域儿童发育相关的总效应显著。在调整和未调整的模型中,MetS预测了较低HDL和瘦素水平升高的单个脐带血介质。MetS对儿童COM和PSE域的总间接影响(所有介体组合的影响)是显著的,通过所有的LDL的儿童脐带血介质,HDL,甘油三酯,脂联素,和瘦素用于调整模型。
结论:结果支持以下假设:妊娠期母体代谢综合征分类与5岁时某些儿童发育结局相关。在调整了产妇之后,孩子,和环境协变量,通过母体代谢健康的直接影响和脐带血标志物的间接影响(总影响),妊娠期母体代谢综合征分类与儿童LIT领域相关,以及COM和PSE域仅通过儿童脐带血标志物的变化(总间接效应)。
There is limited evidence on how the classification of maternal metabolic syndrome during pregnancy affects children\'s developmental outcomes and the possible mediators of this association. This study uses a cohort sample of 12,644 to 13,832 mother-child pairs from the UK Born in Bradford Study to examine the associations between maternal metabolic syndrome classification (MetS) and child development outcomes at age 5, using cord blood markers as candidate mediators.
Maternal cardiometabolic markers included diabetes, obesity, triglycerides, high-density lipoprotein cholesterol, blood pressure, hypertension, and fasting glucose during pregnancy. Cord blood markers of high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, leptin, and adiponectin were used as child mediators. Child outcomes included two starting school variables: British Picture Vocabulary Scale (BPVS) and the Letter Identification Assessment (LID), and five developmental milestone domains from a national UK framework: (1) communication and language (COM); (2) personal, social, and emotional (PSE); (3) physical development (PHY); (4) literacy (LIT); and (5) mathematics (MAT). Mediation models were used to examine the associations between the classification of maternal metabolic syndrome and child developmental milestones. Models were adjusted for potential maternal, socioeconomic, and child confounders such as maternal education, deprivation, and gestational age.
In mediation models, significant total effects were found for MetS associations with children\'s development in the LIT domain at age 5. MetS predicted individual cord blood mediators of lower HDL and increased leptin levels in both adjusted and unadjusted models. Total indirect effects (effects of all mediators combined) for MetS on a child\'s COM and PSE domain were significant, through all child cord blood mediators of LDL, HDL, triglycerides, adiponectin, and leptin for adjusted models.
The results support the hypothesis that maternal metabolic syndrome classification during pregnancy is associated with some child developmental outcomes at age 5. After adjusting for maternal, child, and environmental covariates, maternal metabolic syndrome classification during pregnancy was associated with children\'s LIT domain through direct effects of maternal metabolic health and indirect effects of cord blood markers (total effects), and COM and PSE domains via changes only in a child\'s cord blood markers (total indirect effects).