女性成年早期体重变化轨迹对妊娠结局影响的网络模型构建及评价

The problem of overweight and obesity in women of childbearing age is becoming increasingly prominent. Our previous study showed that women's weight gain rate can reach 0.3-2.1 kg/year after their 18. We also found that pre-pregnancy overweight or obesity was associated with increased risks of adverse pregnancy outcomes. With the delay of women’s reproductive age, the average pre-pregnancy weight as well as the rate of overweight or obese pregnancy is increasing. Although women's sustained weight gain before pregnancy has become an important public health problem affecting the offspring, this issue has not drawn enough attention. The effect of maternal weight change in early adulthood on reproductive functions, metabolism and pregnancy outcomes is still unclear. This study is based on the Born in Guangzhou Cohort Study. We will collect the data on body weight in both the pre-pregnancy period (from 18 years to the time of gestation) and pregnancy, as well as other related factors such as environmental factors and behavioral factors, and measure related metabolic indicators (blood sugar, insulin, blood lipids). We will use Bayesian network models to explore the interaction between maternal weight change trajectories in early adulthood and other related exposures, and its relationship with pregnancy outcomes. We will also assess the validity of the model in the population. This study will provide important evidence and theoretical basis for improving pregnancy outcomes, and provide clues for establishing reasonable weight management guidance for women.

育龄期女性超重肥胖问题日渐突出，申请者前期研究发现，成年后女性体重增长速率可达0.3-2.1公斤/年；同时发现孕前超重或肥胖显著增加妊娠期糖尿病等不良妊娠结局的发生。随着女性生育年龄的推迟，平均孕前体重呈上升趋势，超重或肥胖妊娠随之增加。女性孕前体重持续增长已成为影响出生人口素质的重要公共卫生问题，但未得到重视。而成年早期体重变化对女性生殖功能、机体代谢水平及妊娠结局的影响及作用路径尚不清楚。本研究基于已建成的大型出生队列，利用女性18岁至孕前多时点体重、环境暴露及不良行为等暴露组数据，孕前及孕期糖脂代谢指标和母儿妊娠结局，构建基于网络视角的贝叶斯网络模型，分析多暴露间的相互关系，综合探索成年早期体重变化轨迹对母胎健康多结局的影响及可能路径，并对模型的人群应用进行效度评价。研究成果将为改善妊娠结局措施前移提供重要的人群证据及理论依据，为指导女性成年后的体重管理提供科学支撑。

育龄期女性超重肥胖问题日渐突出，而孕前超重或肥胖显著增加妊娠期糖尿病等不良妊娠结局的发生。随着女性生育年龄的推迟，平均孕前体重呈上升趋势，超重或肥胖妊娠随之增加。成年早期体重变化对女性生殖功能、机体代谢水平及妊娠结局的影响及作用路径尚不清楚。 基于大型出生队列，本课题纳入了15236对母子，进行了以下研究：（1）利用已收集的孕前体重数据，分析成年早期体重变化轨迹，结果发现，在18岁消瘦的人群中，有38.7%在孕前依然消瘦，58.1%体重正常，0.3%超重或肥胖；在18岁体重正常的人群里，9.4%在孕期消瘦，75.9%保持体重正常，14.7%超重或肥胖；在18岁超重或肥胖的人群中，有45.4%孕前为正常体重，54.6%依然超重或肥胖。成年早期体重增重（MAWG）为4.2kg。（2）项目进一步采用收集的孕期环境暴露信息及母儿结局等数据，分析成年早期体重变化与妊娠结局的关联，结果发现：对比于18岁及孕前体重均正常的妈妈，18岁消瘦而孕前超重或肥胖的妈妈分娩LGA的风险较高。此外，18岁时BMI>18.5kg/m2的妈妈，任何量级的MAWG均可降低SGA的发生及增加LGA及早产的发生风险。而18岁时消瘦的妈妈，MAWG<8kg有利于妊娠结局的发展。（3）进一步采用收集或检测的糖脂代谢指标，分析成年早期体重变化与糖脂代谢异常的关系，发现18岁消瘦而孕前超重或肥胖的妈妈出现空腹血糖异常的效应值最强；18岁时超重或肥胖的妈妈，任意量级的MAWG均增加孕期血糖及甘油三脂异常发生的风险；这个情况同样出现在18岁体重正常而MAWG>4kg的妈妈中。（4）综合阐明成年早期体重变化轨迹、母体糖脂代谢指标与妊娠结局的作用，结果发现，血糖是成年早期体重变化影响妊娠结局的关键作用因子。本研究成果为改善妊娠结局措施前移提供重要的人群证据及理论依据，为指导女性成年后的体重管理提供科学支撑。