目的:母亲肥胖是子代先天性心脏病(CHD)的高危因素。然而,与母亲体重不足相关的后代CHD风险很少被提及.因此,本研究旨在探讨孕前体重过轻对子代冠心病的影响。
方法:2017年11月至2021年8月,在中国进行了一项妊娠早期出生队列研究,纳入了132386名孕妇,并完成随访直至分娩(或流产/终止)。通过产前超声检查在活产和死产中诊断出后代CHD。使用对数二项回归和有限的三次样条来估计与孕前体重指数(BMI)相关的后代冠心病的风险。采用广义加性模型探讨孕龄对孕前BMI与子代冠心病关系的修正效应。
结果:共有129096名孕妇被纳入分析。体重不足的冠心病发病率,正常体重,超重,肥胖人群为117/17313(0.68%),556/85695(0.65%),128/19936(0.64%),47/6152(0.76%),分别。怀孕前体重过轻和肥胖都会略微增加后代冠心病的风险。孕前BMI与后代冠心病之间的关系因母亲年龄而异,在<24岁的女性中,低的孕前BMI与后代冠心病的风险显着升高相关(RR2.32,95%CI:1.07-5.01,17vs21kg/m2)。
结论:孕前体重过轻与年轻孕妇的后代冠心病风险增加相关。因此,体重增加对预防后代冠心病很重要,特别是对于低孕前BMI的年轻女性。
OBJECTIVE: Maternal obesity is a highly suggestive risk factor of offspring congenital heart diseases (CHD). However, the risk of offspring CHD associated with maternal underweight has rarely been mentioned. Therefore, this study aimed to explore the effect of preconception underweight on offspring CHD.
METHODS: From November 2017 to August 2021, 132 386 pregnant women were enrolled in a birth cohort study in China in early pregnancy, and completed follow-up until delivery (or miscarriage/termination). Offspring CHD was diagnosed by prenatal ultrasound examination in both live births and stillbirths. Log-binomial regression and restricted cubic spline were used to estimate the risk of offspring CHD associated with preconception body mass index (BMI). A generalized additive model was used to explore the modification effect of maternal age on the association between preconception BMI and offspring CHD.
RESULTS: A total of 129 096 pregnant women were included in the analysis. The incidence of CHD in the underweight, normal weight, overweight, and obesity groups were 117/17 313 (0.68%), 556/85 695 (0.65%), 128/19 936 (0.64%), 47/6152 (0.76%), respectively. Both underweight and obesity before pregnancy marginally increased the risk of offspring CHD. The association between preconception BMI and offspring CHD varied by maternal age, with low preconception BMI associated with a significantly higher risk of offspring CHD in women <24 years (RR 2.32, 95% CI: 1.07-5.01 for 17 vs 21 kg/m2).
CONCLUSIONS: Preconception underweight was associated with an increased risk of offspring CHD in young pregnant women. Therefore, weight gain is important to prevent offspring CHD, especially for young women with low preconception BMI.