母乳喂养对妊娠期糖尿病母亲子代儿童期超重的影响

赵亚玲; 马润玫; 黄永坤; 梁琨; 丁臻博

doi:10.7499/j.issn.1008-8830.2013.01.015

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中国当代儿科杂志 ›› 2013, Vol. 15 ›› Issue (1) : 56-61. DOI: 10.7499/j.issn.1008-8830.2013.01.015

论著·临床研究

母乳喂养对妊娠期糖尿病母亲子代儿童期超重的影响

赵亚玲，马润玫，黄永坤，梁琨，丁臻博

作者信息 +

Effect of breastfeeding on childhood overweight in the offspring of mothers with gestational diabetes mellitus

ZHAO Ya-Ling, MA Run-Mei, HUANG Yong-Kun, LIANG Kun, DING Zheng-Bo

Author information +

文章历史 +

摘要

目的：通过对妊娠期糖尿病（GDM）母亲子代的随访，探讨母乳喂养是否可以降低GDM子代发生超重的风险性。方法：对2003年1月至2009年12月GDM母亲子代1189例进行随访，采用logistic回归分析出生后0～3月母乳喂养方式及母乳喂养持续时间对GDM子代超重发生风险的影响。结果：在对孕前BMI、孕期增重、孕期血糖水平、性别、出生体重、年龄及父亲体重等混杂因素进行校正后，0～3月纯母乳喂养组GDM子代儿童期超重发生风险低于人工喂养组（OR：0.479，95%CI：0.256～0.897）；接受0～3月母乳喂养、4～6月母乳喂养及大于6月母乳喂养GDM子代儿童期超重发生风险均低于人工喂养组（分别OR：0.456，95%CI：0.233～0.827；OR：0.29，95%CI：0.103～0.817；OR：0.534，95%CI：0.280～0.970）；接受4～6月母乳喂养GDM子代儿童期超重发生风险低于0～3月母乳喂养组（OR：0.372，95%CI：0.129～0.874）；而接受母乳喂养时间<6月与接受母乳喂养时间≥6月与GDM子代儿童期超重发生风险无相关性（OR：0.769，95%CI：0.4701～1.258）。结论：出生后0～3月母乳喂养，尤其是纯母乳喂养可以降低GDM子代发生超重的风险，且在出生后6月内，随着母乳喂养时间的增加，GDM子代超重发生风险降低，而出生6月以后，延长母乳喂养时间可能并不能降低超重的发生风险。

Abstract

OBJECTIVE: To investigate whether breastfeeding can reduce the risk of childhood overweight in the offspring of mothers with gestational diabetes mellitus (GDM). METHODS: Follow-up was performed on 1189 offspring of mothers with GDM between January 2003 and December 2009. The influence of the manner and duration of breastfeeding between 0 to 3 months after birth on the risk of childhood overweight in the offspring of mothers with GDM was analyzed by logistic regression. RESULTS: After correcting confounding factors such as pre-pregnancy BMI, gestational weight gain, gestational blood sugar, sex, birth weight, age and farther′s body weight, it was found that the risk of childhood overweight in the offspring who received exclusive breastfeeding during the first 3 months after birth was lower than in the artificial feeding group (OR: 0.479, 95%CI: 0.256-0.897). Offspring who were breastfed for 0 to 3 months, 4 to 6 months and over 6 months had a lower risk of childhood overweight than the artificial feeding group (OR: 0.456, 95%CI: 0.233-0.827; OR: 0.29, 95%CI: 0.103-0.817; OR: 0.534, 95%CI: 0.280-0.970), offspring who were breastfed for 4 to 6 months had a lower risk of childhood overweight than those who were breastfed for 0 to 3 months (OR: 0.372, 95%CI: 0.129-0.874), and offspring who were breastfed for more than 6 months did not show significantly lower risk of overweight than those who were breastfed for less than 6 months (OR: 0.769, 95%CI: 0.470-1.258). CONCLUSIONS: Within 3 months of birth, breastfeeding, especially exclusively, may reduce the risk of childhood overweight in the offspring of mothers with GDM. Within 6 months of birth, the risk of childhood overweight decreases as the duration of breastfeeding increases, but prolonging the duration of breastfeeding cannot necessarily reduce the risk of childhood overweight after postnatal six months.

导出引用

赵亚玲，马润玫，黄永坤，梁琨，丁臻博. 母乳喂养对妊娠期糖尿病母亲子代儿童期超重的影响[J]. 中国当代儿科杂志. 2013, 15(1): 56-61 https://doi.org/10.7499/j.issn.1008-8830.2013.01.015

ZHAO Ya-Ling, MA Run-Mei, HUANG Yong-Kun, LIANG Kun, DING Zheng-Bo. Effect of breastfeeding on childhood overweight in the offspring of mothers with gestational diabetes mellitus[J]. Chinese Journal of Contemporary Pediatrics. 2013, 15(1): 56-61 https://doi.org/10.7499/j.issn.1008-8830.2013.01.015

参考文献

［1］Kokkvoll A, Jeppesen E, Juliusson PB, Flaegstad T, Njolstad I. High prevalence of overweight and obesity among 6-year-old children in Finnmark Country, North Norway［J］. Acta Pediatr, 2012, 101(9): 924-928.

［2］Metzger BE. Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring［J］.Clin Obstet Gynecol, 2007, 50(4): 972-979.

［3］Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence［J］. Pediatrics, 2005, 115(5): 1367-1377.

［4］Schmidt MI, Matos MC, Reichelt AJ, Forti AC, de Lima L, Duncan BB. Prevalence of gestational diabetes mellitus-do the new WHO criteria make a difference? Brazilian Gestational Diabetes Study Group［J］. Diabetes Med, 2000, 17(5): 376-380.

［5］黎海芪.婴幼儿喂养建议［J］.中华儿科杂志，2009,47（7）：504-507.

［6］李辉，季成叶，宗心南，张亚钦. 中国0～18岁儿童、青少年体块指数的生长曲线［J］.中华儿科杂志，2009，47（7）：493-498.

［7］Pedersen J. Diabetes and pregnancy; blood sugar of newborn infants during fasting and glucose administration［J］. Nord Med, 1952, 47(30): 1049.

［8］Freinkel N. Banting Lecture 1980. Of pregnancy and progeny［J］. Diabetes, 1980, 29(12): 1023-1035.

［9］Dabelea D, Pettitt DJ. Intrauterine diabetic environment confers risks for type 2 diabetes mellitus and obesity in the offspring, in addition to genetic susceptibility［J］. J Pediatr Endocrinol Metab, 2001, 14(8): 1085-1091.

［10］Silverman BL, Metzger BE, Cho NH, Loeb CA. Impaired glucose tolerance in adolescent offspring of diabetic mothers: relationship to fetal hyperinsulinism［J］. Diabetes Care, 1995, 18(5): 611-617.

［11］Krishnaveni GV, Veena SR, Hill JC, Kehoe S, Karat SC, Fall CH. Intrauterine exposure to maternal diabetes is associated with higher adiposity and insulin resistance and clustering of cardiovascular risk markers in Indian children［J］. Diabetes Care, 2010, 33(2): 402-404.

［12］Tam WH, Ma RC, Yang X, Li AM, Ko GT, Kong AP, et al. Glucose intolerance and cardiometabolic risk in adolescents exposed to maternal gestational diabetes: a 15-years follow-up study［J］. Diabetes Care, 2010, 33(6): 1382-1384.

［13］Plagemann A, Harder T, Frank K, Kolhoff R. Long-term impact of neonatal breasting-feeding on body weight and glucose tolerance in children of diabetic mothers［J］. Diabetes Care, 2002, 25(1): 16-22.

［14］Mayer-Davis EJ, Rifas-Shiman SL, Zhou L, Hu FB, Colditz GA, Gilman MW. Breast feeding and risk for childhood obesity: does diabetes or obesity status matter?［J］. Diabetes Care, 2006, 29(10): 2231-2237.

［15］Crume TL, Ogden L, Maligie M, Sheffield S, Bischoff KJ, McDuffie R, et al. long-term impact of neonatal breastfeeding on childhood adiposity and fat distribution among children exposed to diabetes in utero［J］. Diabetes Care, 2011, 34(3): 641-645.

［16］Schaefer-Graf UM, Hartmann R, Pawliczak J, Passow D, Abou-Dakn M, Vetter K, et al. Association of breast-feeding and early childhood overweight in children from mothers with gestational diabetes mellitus［J］. Diabetes Care, 2006, 29(5): 1105-1107.

［17］季成叶.从胎儿到青春期肥胖发生和流行的生长发育轨迹［J］. 中国儿童保健杂志，2010，18（6）：445-447.

［18］霍亭竹，杨凡，熊菲，李平，毛萌. 成都市9～15岁儿童出生情况与体格指标流行病学调查［J］. 中国当代儿科杂志，2012,14（4）：289-293.

［19］Pirkola J, Pouta A, Bloigu A, Hartikainen AL, Laitinen J, Jarvelin MR, et al. Risk of overweight and abdominal obesity at age 16 years associated with prenatal exposures to maternal prepregnancy overweight and gestational diabetes mellitus［J］. Diabetes Care, 2010, 33(5): 1115-1121.

［20］梁贞贞，朱鹏，高荣，鲁影，黄文，陶芳标. 孕期增重对婴幼儿体重和肥胖风险影响的随访研究［J］. 中国当代儿科杂志，2011，13（10）：794-798.