目的 分析0～3岁儿童年龄别体质指数Z评分(body mass index for age Z score，BAZ)的轨迹，并探讨孕期体重增长水平与儿童BAZ轨迹的关联。方法 基于前瞻性队列研究，于2013年至2017年在江苏太仓地区招募孕早期孕妇作为研究对象，追踪其孕期体重变化，采用中国标准计算和评价孕期体重增长(孕期体重增长适宜、不足或过多)。测量儿童出生、1、3、6、8、12、18、24、30和36月龄时的身高/身长和体重，并计算各年龄的BAZ分值。采用基于组的轨迹模型拟合儿童BAZ轨迹。运用多水平Logistic回归分析孕期体重增长水平与BAZ轨迹之间的关联，并调整相关影响因素对结果的影响。结果 1864对母婴数据被纳入分析，其中0～3岁儿童的BAZ可拟合为3组轨迹:生长较缓组(34。07％)、生长适宜组(48。23％)和生长快速组(17。70％)。单因素分析显示，以孕期体重增长适宜的母亲为对照组，孕期体重增长不足会增加子代生长较缓的风险(OR=1。95，95％CI 1。28～2。96)，孕期体重增长过多可增加子代生长快速的风险(OR=1。57，95％CI 1。19～2。07);多因素分析中调整了母亲孕前体质指数、产次、儿童性别及出生体重后，孕期体重增长不足的母亲其子代生长较缓的风险更高(OR=1。84，95％CI1。19～2。84);而孕期体重增长过多与儿童早期生长轨迹间关联无统计学意义(OR=1。26，95％CI 0。94～1。68)。结论 0～3岁儿童BAZ轨迹可分为生长较缓组、生长适宜组及生长快速组;母亲孕期体重增长不足可增加0～3岁儿童生长较缓的风险。
Effect of gestational weight gain on growth trajectory in children aged 0 to 3 years
OBJECTIVE To describe the growth trajectory of body mass index for age Z score(BAZ)in children aged 0 to 3 years and to explore the association between gestational weight gain and BAZ growth trajectory.METHODS Based on a prospective cohort study,we recruited pregnant women in their early pregnancy into this study from 2013 to 2017 in Taicang of Jiangsu Province,tracked their weight changes until they gave birth,and calculated and evaluated their gestational weight gain(GWG)as appropriate,inadequate or excessive GWG based on Chinese GWG standard.Children's height/length and weight were measured at birth,1,3,6,8,12,18,24,30 and 36 months of age,and their BAZ scores were calculated.Group-based trajectory modeling(GBTM)was used for fitting BAZ trajectories.Multilevel Logistic regression was used to analyze the association between the level of GWG and BAZ growth trajectories.RESULTS There were 1864 mother-child pairs in the study,and three groups of BAZ trajectories were fitted including slow growth trajectory(34.07％),appropriate growth trajectory(48.23％),and fast growth trajectory(17.70％).In univariate analysis,compared with children whose mothers had appropriate GWG,the children whose mothers had inadequate GWG were more likely in the group of slow growth trajectory(OR=1.95,95％CI 1.28-2.96),and the children whose mothers had excessive GWG were more likely in the group of fast growth trajectory(OR=1.57,95％CI1.19-2.07).After adjusting for maternal pre-pregnancy body mass index(BMI)and parity,and the child's gender and birth weight,the children whose mothers gained in adequate GWG were more likely in the group of slow growth trajectory(OR=1.84,95％CI 1.19-2.84),while the association between excessive GWG and fast growth trajectory was not statistically significant(OR=1.26,95％CI 0.94-1.68).CONCLUSION The BAZ trajectories of children aged 0-3 years can be categorized into slow,appropriate,and fast growth groups,and children's slow growth was associated with maternal inadequate GWG.
growth trajectorygestational weight gaininfantbody mass index for age Z score
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