Association between gestational weight gain and the risk of overweight/obesity in adult offspring: a systematic review and meta-analysis
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摘要:
目的 采用系统综述和Meta分析的方法评估妊娠期体重增加与后代成年超重和肥胖发生风险之间的相关性。 方法 在线检索PubMed、Web of Science、Embase、中国知网(CNKI)、维普及万方等数据库从建库至2021年7月24日前发表的有关妊娠期体重增加与后代成年超重和肥胖发生关联的文献，并人工检索纳入文献的参考文献列表。使用随机效应模型计算合并RR和95% CI值。通过亚组分析和敏感性分析，探索异质性的可能来源，并评估结果的稳健性。 结果 本研究共纳入6项研究，共计31 968人。结果显示：妊娠期体重增加过多会增加后代成年超重和肥胖发生风险(RR=1.37, 95% CI: 1.24~1.52, P < 0.001)，妊娠期体重增加不足与后代成年超重和肥胖发生风险无关(RR=0.93, 95% CI: 0.78~1.11, P=0.430)。 结论 妊娠期体重增加过多会增加后代成年超重和肥胖的发生风险，应注意均衡膳食摄入及适量运动，避免妊娠期体重增加过多。 Abstract:Objective To evaluate the association between gestational weight gain (GWG) and the risk of overweight/obesity in adult offspring by systematically reviewing and Meta analyzing. Methods A systematic literature search was performed in the PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang, and Weipu databases from inception to June 2, 2021, for relevant articles on the association between GWG and the risk of overweight/obesity in adult offspring, complementing with a perusal of bibliographies of retrieved articles. The overall risk ratio (RR) and 95% confidence intervals (CI) were calculated using a random-effects model. Subgroup and sensitivity analyses were performed to explore possible sources of heterogeneity and assess the robustness of the results. Results Six studies with a total of 31 968 individuals were included in this study. Results showed that a statistically significant association was found between excessive GWG and the risk of overweight and obesity in adult offspring (RR=1.37, 95% CI: 1.24-1.52, P < 0.001). No significant association was obtained between inadequate GWG and the risk of overweight and obesity in adult offspring (RR=0.93, 95% CI: 0.78-1.11, P=0.430). Conclusions Excessive GWG will increase the risk of overweight and obesity in adult offspring. Therefore, pregnant women should pay attention to a balanced diet and exercise moderately to avoid excessive weight gain during pregnancy. -
Key words:
- Gestational weight gain /
- Overweight /
- obesity /
- Adult offspring
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图 2 妊娠期体重增加与后代成年超重和肥胖发生风险的森林图
Figure 2. Forest plot of the association between gestational weight gain and the risk of overweight/obesity in adult offspring
表 1 纳入文献的基本特征
Table 1. Characteristics of included studies
第一作者及年份 国家/地区 研究设计 随访时间(年) 妊娠期增重分类标准 超重和肥胖 样本量 子代随访时的年龄(岁) 调整的混杂因素 质量评分 McWhorter 2018 美国 回顾性队列研究 1 2009 IOM孕期增重指南 超重(25≤BMI < 30 kg/m2)肥胖(BMI≥30 kg/m2) 19 20.3±3.3 孕前BMI 7 Houghton 2016 美国 前瞻性队列研究 49 2009 IOM孕期增重指南 超重/肥胖(BMI≥25 kg/m2) 1 035 44.1±1.9 种族、教育程度、分娩年龄、怀孕期间吸烟、孕龄 9 Rooney 2011 美国 前瞻性队列研究 20 1990 IOM孕期增重指南 肥胖(BMI≥30 kg/m2) 453 18~20 产妇婚姻状况、出生时的保险状况、性别 9 Schack-Nielsen 2010 丹麦 前瞻性队列研究 42 增重过多: >16 kg增重不足: < 6 kg 肥胖(BMI≥30 kg/m2) 1 540 42 性别、母亲年龄、孕前BMI、父母社会地位、教育程度、产妇婚姻状况、早产、出生体重、孕期水肿、孕期吸烟 9 Stuebe 2009 美国 双向性队列研究 12 增重过多: >40 lbs增重不足: < 15 lbs 超重(25≤BMI < 30 kg/m2)肥胖(BMI≥30 kg/m2) 26 506 18；36~56 孕期吸烟、孕期呕吐、母亲年龄、产次、妊娠期糖尿病、孕BMI、diabetes and education、产妇婚姻状况 8 Mamun 2009 澳大利亚 前瞻性队列研究 21 1990 IOM孕期增重指南 超重(25≤BMI < 30 kg/m2)肥胖(BMI≥30 kg/m2) 2 415 21 母亲年龄、教育程度、父母的种族、孕期BMI、烟草消费、母乳喂养、出生体重 8 注：IOM，美国医学会。 
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表 2 妊娠期体重增加与成年后代超重/肥胖风险相关性的敏感性分析
Table 2. Sensitivity analyses for the association between gestational weight gain and the risk of overweight/obesity in adult offspring
删除文献 RR值 LCI a UCI b P值 I2 (%) 妊娠期体重增加过多 Mamun 2009 1.43 1.23 1.66 < 0.001 34 Stuebe 2009 1.43 1.24 1.64 < 0.001 29 Schack-Nielsen 2010 1.37 1.22 1.54 < 0.001 43 Rooney 2011 1.35 1.24 1.47 < 0.001 14 Houghton 2016 1.30 1.19 1.44 < 0.001 6 McWhorter 2018 1.36 1.23 1.51 < 0.001 34 妊娠期体重增加不足 Stuebe 2009 0.85 0.67 1.07 0.174 49 Mamun 2009 0.89 0.64 1.24 0.492 78 Schack-Nielsen 2010 1.05 0.078 1.10 0.078 0 Rooney 2011 0.93 0.77 1.12 0.452 80 注：a95% CI下限; b95% CI上限。
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表 3 妊娠期体重增加与成年后代超重/肥胖风险相关性的亚组分析
Table 3. Subgroup analyses for the association between gestational weight gain and the risk of overweight/obesity in adult offspring
亚组 文献数量 RR(95% CI)值 I2(%) 异质性检验(P值) 组间差异性检验 χ2值 P值 I2(%) 妊娠期体重增加过多 妊娠期增重分类标准 0.22 3.31 0.190 40 2009 IOM孕期增重指南 2 1.51(1.31~1.74) 0 1990 IOM孕期增重指南 2 1.54(0.93~2.54) 64 其他 2 1.28(1.13~1.44) 0 超重和肥胖(kg/m2) 0.41 1.86 0.170 46 超重(25≤BMI < 30) 3 1.26(1.09~1.45) 0 肥胖(BMI≥30) 5 1.43(1.28~1.59) 7 平均年龄(年) 0.02 0.04 0.840 0 < 30 4 1.37(1.20~1.57) 27 ≥30 3 1.34(1.11~1.62) 75 妊娠期体重增加不足 妊娠期增重分类标准 0.02 0.13 0.710 0 1990 IOM孕期增重指南 2 0.96(0.82~1.12) 0 其他 2 0.89(0.60~1.31) 89 超重和肥胖(kg/m2) 0.07 0.44 0.510 0 超重(25≤BMI < 30) 2 1.03(0.98~1.07) 0 肥胖(BMI≥30) 4 0.93(0.71~1.23) 63 平均年龄(年) 0.02 0.77 0.380 0 < 30 3 1.05(0.93~1.18) 26 ≥30 2 0.88(0.60~1.28) 88 注：IOM，美国医学会。
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[1] Thaker VV. Genetic and epigenetic causes of obesity[J]. Adolesc Med State Art Rev, 2017, 28(2): 379-405. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6226269/ [2] Jaacks L M, Vandevijvere S, Pan A, et al. The obesity transition: stages of the global epidemic[J]. Lancet Diabetes Endocrinol, 2019, 7(3): 231-240. DOI: 10.1016/S2213-8587(19)30026-9. [3] Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years[J]. N Engl J Med, 2017, 377(1): 13-27. DOI: 10.1056/NEJMoa1614362. [4] James WP. WHO recognition of the global obesity epidemic[J]. Int J Obes (Lond), 2008, 32(7): 120-126. DOI: 10.1038/ijo.2008.247. [5] World Health Organization. Obesity and overweight. fact sheet 2016[EB/OL](2021-06-09)[2021-07-25]. http://www.who.int/mediacentre/factsheets/fs311/en/. [6] GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017[J]. Lancet, 2018, 392(10159): 1923-1994. DOI: 10.1016/S0140-6736(18)32225-6. [7] Martínez-Hortelano JA, Cavero-Redondo I, álvarez-Bueno C, et al. Monitoring gestational weight gain and prepregnancy BMI using the 2009 IOM guidelines in the global population: a systematic review and meta-analysis[J]. BMC Pregnancy Childbirth, 2020, 20(1): 649. DOI: 10.1186/s12884-020-03335-7. [8] Patel N, Pasupathy D, Poston L. Determining the consequences of maternal obesity for offspring health[J]. Exp Physiol, 2015, 100(12): 1421-1428. DOI: 10.1113/EP085132. [9] Stuebe AM, Forman MR, Michels KB. Maternal-recalled gestational weight gain, pre-pregnancy body mass index, and obesity in the daughter[J]. Int J Obes (Lond), 2009, 33(7): 743-752. DOI: 10.1038/ijo.2009.101. [10] Schneider BC, Menezes A, Wehrmeister FC, et al. Gestational weight gain and childhood body mass index across three generations: results from the 1993 Pelotas (Brazil) birth cohort[J]. Pediatr Obes, 2021, 16(6): 12760. DOI: 10.1111/ijpo.12760. [11] Wan N, Cai L, Tan W, et al. Associations of gestational weight gain with offspring thinness and obesity: by prepregnancy body mass index[J]. Reprod Health, 2018, 15(1): 149. DOI: 10.1186/s12978-018-0585-5. [12] Castillo H, Santos IS, Matijasevich A. Relationship between maternal pre-pregnancy body mass index, gestational weight gain and childhood fatness at 6-7 years by air displacement plethysmography[J]. Matern Child Nutr, 2015, 11(4): 606-617. DOI: 10.1111/mcn.12186. [13] Voerman E, Santos S, Patro GB, et al. Maternal body mass index, gestational weight gain, and the risk of overweight and obesity across childhood: an individual participant data meta-analysis[J]. PLoS Med, 2019, 16(2): 1002744. DOI: 10.1371/journal.pmed.1002744. [14] Schack-Nielsen L, Michaelsen KF, Gamborg M, et al. Gestational weight gain in relation to offspring body mass index and obesity from infancy through adulthood[J]. Int J Obes (Lond), 2010, 34(1): 67-74. DOI: 10.1038/ijo.2009.206. [15] Shamseer L, Moher DC, Ghersi D, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation[J]. BMJ, 2015, 354(4086): g7647. DOI: 10.1136/bmj.i4086. [16] Borenstein M, Hedges LV, Higgins JP, et al. A basic introduction to fixed-effect and random-effects models for meta-analysis[J]. Res Synth Methods, 2010, 1(2): 97-111. DOI: 10.1002/jrsm.12. [17] Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses[J]. British Medical Journal, 2003, 327(7414): 557-560. DOI: 10.1136/bmj.327.7414.557. [18] Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis[J]. Statistics in Medicine, 2002, 21(11): 1539-1558. DOI: 10.1002/sim.1186. [19] Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test[J]. BMJ, 1997, 315(7109): 629-634. DOI: 10.1136/bmj.315.7109.629. [20] McWhorter KL, Bowers K, Dolan L, et al. Assessing the impact of excessive gestational weight gain among women with type 1 diabetes on overweight/obesity in their adolescent and young adult offspring: a pilot study[J]. Front Endocrinol (Lausanne), 2018, 9: 713. DOI: 10.3389/fendo.2018.00713. [21] Houghton LC, Ester WA, Lumey LH, et al. Maternal weight gain in excess of pregnancy guidelines is related to daughters being overweight 40 years later[J]. Am J Obstet Gynecol, 2016, 215(2): 241-246. DOI: 10.1016/j.ajog.2016.02.034. [22] Rooney BL, Mathiason MA, Schauberger CW. Predictors of obesity in childhood, adolescence, and adulthood in a birth cohort[J]. Matern Child Health J, 2011, 15(8): 1166-1175. DOI: 10.1007/s10995-010-0689-1. [23] Mamun AA, O'Callaghan M, Callaway L, et al. Associations of gestational weight gain with offspring body mass index and blood pressure at 21 years of age: evidence from a birth cohort study[J]. Circulation, 2009, 119(13): 1720-1727. DOI: 10.1161/CIRCULATIONAHA.108.813436. [24] Mamun AA, Mannan M, Doi SA. Gestational weight gain in relation to offspring obesity over the life course: a systematic review and bias-adjusted meta-analysis[J]. Obes Rev, 2014, 15(4): 338-347. DOI: 10.1111/obr.12132. [25] Fernandez-Twinn DS, Constancia M, Ozanne SE. Intergenerational epigenetic inheritance in models of developmental programming of adult disease[J]. Semin Cell Dev Biol, 2015, 43: 85-95. DOI: 10.1016/j.semcdb.2015.06.006. -
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