孕妇饮食模式及其与妊娠结局关联的队列研究
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摘要
背景孕期营养对胎儿生长发育至关重要,但目前国内有关孕妇饮食模式对胎儿生长发育影响的队列研究却很少。
目的本研究拟描述孕妇饮食模式的类型,分析与饮食模式有关的社会人口统计学等变量,分析孕妇饮食模式与妊娠结局尤其是小于胎龄儿的关联。
方法本研究资料来自于一项正在进行中的以人群为基础的安徽出生缺陷及儿童发育前瞻性队列研究,该队列研究拟于2010年底招募2万名孕妇。本研究以在安徽省合肥市和马鞍山市共7个妇幼保健机构建卡并且孕周在28周以内的孕妇为研究对象,由经过专门培训的调查员指导孕妇进行自填式问卷调查,收集孕期饮食行为情况。从2008年10月-2009年9月,共招募7 122名孕妇,最终收集有效问卷6 905份,其中2 387名孕妇有活产出生结局。采用主成分分析方法判断孕期饮食模式;然后分析潜在的社会人口统计学等变量对每种饮食模式的影响;最后用非条件logistic回归分析模型,分别分析每种饮食模与出生结局的关联。
结果孕期饮食模式共分为5种类型。分别为“动物蛋白”型饮食、“健康”型饮食、“传统”型饮食、“咖啡因”型饮食和“加工”型饮食。“动物蛋白”型饮食以禽肉、牛羊肉和鱼虾等为主;“健康”型饮食以奶类、蛋类和坚果类为主;“传统”型饮食中因子负荷所占比重较大的是米及其制品、蔬菜和水果;“咖啡因”型饮食以可乐、咖啡和茶类所占比重最大;“加工”型饮食主要包括腌制食品和油炸食品。每一种饮食模式均与不同的社会人口统计学特征、生活方式和医学特征变量存在较强的关联。文化程度越高、年龄越大和有准备妊娠的孕妇越倾向于高“健康”型饮食模式,而有抑郁症状和孕早期呕吐的孕妇更倾向于低“健康”型饮食;年龄大、有准备的妊娠和城市户籍的孕妇在“咖啡因”型饮食模式上得分较低,而有抑郁症状者在“咖啡因”型饮食模式上得分较高;有焦虑症状的孕妇更倾向于高“加工”型饮食模式。
调整孕妇年龄、身高和婴儿性别等混杂因素的影响后,倾向于高“咖啡因”型饮食模式的孕妇小于胎龄儿发生风险增加(OR=2.24,95%CI:1.26～3.98),倾向于高“传统”型饮食模式的孕妇小于胎龄儿发生风险是中“传统”型饮食模式的2.23倍(95%CI:1.25～3.95)。
结论孕期饮食可分为5种主要类型,不同饮食模式有不同的影响因素。“咖啡因”型和“传统”型饮食模式可增加小于胎龄儿发生的风险,其潜在的宏量或微量营养素对出生结局的影响还有待进一步研究。膳食平衡和生活方式指导应纳入孕前健康咨询中。
Backbround Maternal nutritional status during pregnancy is important for the growth and development of the fetus. However, there is little information about the effect of maternal diet patterns during pregnancy on the fetus growth in China.
Objectives To describe dietary patterns of a cohort of women during pregnancy, investigate whether the dietary patterns are associated with sociodemographic factors, and assess the effect of these dietary patterns on the pregnancy outcomes, especially the risk of delivering a small-for-gestational-age (SGA) infant.
Methods This study drew on resources from the Anhui Birth Defects and Child Development Cohort Study (ABC cohort study), which is an ongoing, population-based, long-term prospective cohort study that aims to recruit 20 000 pregnant women by the end of 2010. Subjects were women seeking routine antenatal health care for the first time with gestational age of no more than 28 weeks and booking into the Maternal and Child Healthcare Centers in two areas: Hefei city (including three centers) and Ma’anshan city (including four centers) of Anhui province. Pregnant women entering the cohort from October 2008 to September 2009 were retrospectively asked to complete a food-frequency questionnaire concerning their diet during pregnancy by the trained researcher. A total of 7 122 women were recruited and 6 905 completed questionaires were obtained. Finally 2 387 women delivered live babies. Principal-components analysis was used to derive dietary patterns from 19 food groups. Then dietary patterns were related to social and demographic characteristics and lifestyle factors. The association between maternal dietary patterns and fetal growth (in terms of SGA) was investigated by logistic regression analysis.
Results Five dietary patterns were established and labelled to best describe the types of diet being consumed in pregnancy. The“animal protein”component loaded highly on poultry, mutton and fish. The“healthy”component described a diet based on milk, egg and nuts. The“traditional”component loaded highly on rice, fruit and vegetables. The“caffeine”component was characterized by coffee, tea and cola and the final“processed”component was associated with pickled food and fried food. There were strong associations between various socio-demographic variables and all dietary components; in particular, a“healthy”diet was positively associated with increasing education and age, and planned pregnancy. There was a negative association with depressive women and those who vomited in the first trimester of pregnancy. A“caffeine”diet was negatively associated with increasing age, planned pregnancy and living in urban place. There was a positive association with depressive symptom. A“processed”diet was negatively associated with education and positively associated with anxious symptom.
The“caffeinee”dietary pattern was associated with a higher risk of a SGA baby (OR=2.24; 95%CI: 1.26～3.98). This risk remained significant after adjustment for potential confounders, such as maternal age and height, and gender of the babies. The odds ratio of having a SGA infant was 2.23 (95%CI: 1.25～3.95) for women in the high“traditional”class compared with women in the moderate“traditional”class. The analyses were adjusted for age and height of the women, and gender of the babies.
Conclusions Principal components analysis produced five dietary patterns. There were strong associations between various socio-demographic variables and various dietary patterns. Our results indicated that a diet in pregnancy, based on“caffeinee”and“traditional”diet, was associated with increased risk for SGA. Further studies are required to identify potential macro-, or micronutrients that may be underlying these associations. Therefore, dietary and lifestyle profiles should be included in periconception screening programs.
目的本研究拟描述孕妇饮食模式的类型,分析与饮食模式有关的社会人口统计学等变量,分析孕妇饮食模式与妊娠结局尤其是小于胎龄儿的关联。
方法本研究资料来自于一项正在进行中的以人群为基础的安徽出生缺陷及儿童发育前瞻性队列研究,该队列研究拟于2010年底招募2万名孕妇。本研究以在安徽省合肥市和马鞍山市共7个妇幼保健机构建卡并且孕周在28周以内的孕妇为研究对象,由经过专门培训的调查员指导孕妇进行自填式问卷调查,收集孕期饮食行为情况。从2008年10月-2009年9月,共招募7 122名孕妇,最终收集有效问卷6 905份,其中2 387名孕妇有活产出生结局。采用主成分分析方法判断孕期饮食模式;然后分析潜在的社会人口统计学等变量对每种饮食模式的影响;最后用非条件logistic回归分析模型,分别分析每种饮食模与出生结局的关联。
结果孕期饮食模式共分为5种类型。分别为“动物蛋白”型饮食、“健康”型饮食、“传统”型饮食、“咖啡因”型饮食和“加工”型饮食。“动物蛋白”型饮食以禽肉、牛羊肉和鱼虾等为主;“健康”型饮食以奶类、蛋类和坚果类为主;“传统”型饮食中因子负荷所占比重较大的是米及其制品、蔬菜和水果;“咖啡因”型饮食以可乐、咖啡和茶类所占比重最大;“加工”型饮食主要包括腌制食品和油炸食品。每一种饮食模式均与不同的社会人口统计学特征、生活方式和医学特征变量存在较强的关联。文化程度越高、年龄越大和有准备妊娠的孕妇越倾向于高“健康”型饮食模式,而有抑郁症状和孕早期呕吐的孕妇更倾向于低“健康”型饮食;年龄大、有准备的妊娠和城市户籍的孕妇在“咖啡因”型饮食模式上得分较低,而有抑郁症状者在“咖啡因”型饮食模式上得分较高;有焦虑症状的孕妇更倾向于高“加工”型饮食模式。
调整孕妇年龄、身高和婴儿性别等混杂因素的影响后,倾向于高“咖啡因”型饮食模式的孕妇小于胎龄儿发生风险增加(OR=2.24,95%CI:1.26～3.98),倾向于高“传统”型饮食模式的孕妇小于胎龄儿发生风险是中“传统”型饮食模式的2.23倍(95%CI:1.25～3.95)。
结论孕期饮食可分为5种主要类型,不同饮食模式有不同的影响因素。“咖啡因”型和“传统”型饮食模式可增加小于胎龄儿发生的风险,其潜在的宏量或微量营养素对出生结局的影响还有待进一步研究。膳食平衡和生活方式指导应纳入孕前健康咨询中。
Backbround Maternal nutritional status during pregnancy is important for the growth and development of the fetus. However, there is little information about the effect of maternal diet patterns during pregnancy on the fetus growth in China.
Objectives To describe dietary patterns of a cohort of women during pregnancy, investigate whether the dietary patterns are associated with sociodemographic factors, and assess the effect of these dietary patterns on the pregnancy outcomes, especially the risk of delivering a small-for-gestational-age (SGA) infant.
Methods This study drew on resources from the Anhui Birth Defects and Child Development Cohort Study (ABC cohort study), which is an ongoing, population-based, long-term prospective cohort study that aims to recruit 20 000 pregnant women by the end of 2010. Subjects were women seeking routine antenatal health care for the first time with gestational age of no more than 28 weeks and booking into the Maternal and Child Healthcare Centers in two areas: Hefei city (including three centers) and Ma’anshan city (including four centers) of Anhui province. Pregnant women entering the cohort from October 2008 to September 2009 were retrospectively asked to complete a food-frequency questionnaire concerning their diet during pregnancy by the trained researcher. A total of 7 122 women were recruited and 6 905 completed questionaires were obtained. Finally 2 387 women delivered live babies. Principal-components analysis was used to derive dietary patterns from 19 food groups. Then dietary patterns were related to social and demographic characteristics and lifestyle factors. The association between maternal dietary patterns and fetal growth (in terms of SGA) was investigated by logistic regression analysis.
Results Five dietary patterns were established and labelled to best describe the types of diet being consumed in pregnancy. The“animal protein”component loaded highly on poultry, mutton and fish. The“healthy”component described a diet based on milk, egg and nuts. The“traditional”component loaded highly on rice, fruit and vegetables. The“caffeine”component was characterized by coffee, tea and cola and the final“processed”component was associated with pickled food and fried food. There were strong associations between various socio-demographic variables and all dietary components; in particular, a“healthy”diet was positively associated with increasing education and age, and planned pregnancy. There was a negative association with depressive women and those who vomited in the first trimester of pregnancy. A“caffeine”diet was negatively associated with increasing age, planned pregnancy and living in urban place. There was a positive association with depressive symptom. A“processed”diet was negatively associated with education and positively associated with anxious symptom.
The“caffeinee”dietary pattern was associated with a higher risk of a SGA baby (OR=2.24; 95%CI: 1.26～3.98). This risk remained significant after adjustment for potential confounders, such as maternal age and height, and gender of the babies. The odds ratio of having a SGA infant was 2.23 (95%CI: 1.25～3.95) for women in the high“traditional”class compared with women in the moderate“traditional”class. The analyses were adjusted for age and height of the women, and gender of the babies.
Conclusions Principal components analysis produced five dietary patterns. There were strong associations between various socio-demographic variables and various dietary patterns. Our results indicated that a diet in pregnancy, based on“caffeinee”and“traditional”diet, was associated with increased risk for SGA. Further studies are required to identify potential macro-, or micronutrients that may be underlying these associations. Therefore, dietary and lifestyle profiles should be included in periconception screening programs.
引文
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7. Crozier SR, Robinson SM, Godfrey KM, et al. Women's dietary patterns change little from before to during pregnancy. J Nutr, 2009, 139(10): 1956-1563.
8. Thompson JM, Wall C, Becroft DM, et al. Maternal dietary patterns in pregnancy and the association with small-for-gestational-age infants. Br J Nutr, 2010, 9: 1-9.
9. Robinson SM, Crozier S, Borland SE, et al. Inskip HM. Impact of educational attainment on the quality of young women’s diets. Eur J Clin Nutr, 2004, 58(8): 1174-1180.
10. Northstone K, Emmett P, Rogers I, et al. Dietary patterns in pregnancy and associations with sociodemographic and lifestyle factors. Eur J Clin Nutr, 2008, 62(4): 471-479.
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