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Article(id=1325536116564320424, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325535161890398372, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025352, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1750608000000, receivedDateStr=2025-06-23, revisedDate=1755187200000, revisedDateStr=2025-08-15, acceptedDate=null, acceptedDateStr=null, onlineDate=1793962037458, onlineDateStr=2026-11-06, pubDate=1766592000000, pubDateStr=2025-12-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793962037458, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793962037458, creator=13701087609, updateTime=1793962037458, updator=13701087609, issue=Issue{id=1325535161890398372, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='12', pageStart='1673', pageEnd='1824', issueExtLink='null', onlineDate='null', pubDate='1766592000000', pubDateStr='2025-12-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793961809846, creator='13701087609', updateTime=1793961809846, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1796, endPage=1799, ext={EN=ArticleExt(id=1325536119986872489, articleId=1325536116564320424, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Interactive effects of prenatal and postnatal factors on overweight and obesity in preschool children, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the interactive effects of prenatal and postnatal factors on overweight and obesity in preschool children, so as to provide evidence for subsequent planning of prevention strategies and intervention measures.

Methods

Between October 2020 and June 2021, a convenience cluster sample of 918 preschool children from four kindergartens in Xuzhou urban area underwent questionnaire surveys and physical examinations. The Chi-square test was used to compare intergroup differences in overweight and obesity prevalence. Multivariate Logistic regression analysis was employed to investigate the effects of prenatal and postnatal factors, as well as their interactions, on overweight and obesity in preschool children.

Results

The prevalence of overweight and obesity among preschool children was 30.8%, with boys exhibiting a higher rate (37.0%) than girls (24.8%). Statistically significant differences in overweight and obesity prevalence were observed across age groups, genders, paternal pre-pregnancy body mass index (BMI), paternal educational level, delivery mode, antibiotic use within the six months after birth, and rapid weight gain during infancy (χ2=5.08-17.67, all P < 0.05). After adjusting for confounding factors such as age, gender, the only child, parental educational level and parental average monthly income, interaction analysis revealed that when the father was overweight or obese before conception, children delivered by caesarean section had an increased risk of overweight or obesity (OR=2.05, 95%CI=1.02-3.39), and children with rapid weight gain during infancy also had an increased risk (OR=2.05, 95%CI=1.08-3.88) (both P < 0.05). Gender-stratified analysis revealed that the interaction between paternal pre-pregnancy BMI and mode of delivery on overweight and obesity was more pronounced among girls (OR=4.00, 95%CI=1.51-10.58, P < 0.05). While the interaction between the father's pre-pregnancy BMI and rapid weight gain during infancy was more pronounced in boys (OR=2.85, 95%CI=1.14-7.08, P < 0.05). No significant interactions between prenatal and postnatal factors on overweight and obesity in preschool children were observed (all P>0.05).

Conclusions

Multiple prenatal and postnatal factors influence overweight and obesity in preschool children. Attention should be paid to mode of delivery and infant weight gain, particularly when the father is overweight or obese, to reduce the risk of overweight and obesity in preschool children.

, authors=Pei CHENG1, Xiaoli FAN1, Pei CAO2, Xinyi TIAN2, Jing ZHANG2, Juan ZHANG*, 1, authorsList=Pei CHENG, Xiaoli FAN, Pei CAO, Xinyi TIAN, Jing ZHANG, Juan ZHANG, authorCompany=null, correspAuthors=Juan ZHANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325536128723607724, articleId=1325536116564320424, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=产前产后因素交互作用对学龄前儿童超重肥胖的影响, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

探讨产前产后因素的交互作用对学龄前儿童超重肥胖的影响，为后续规划预防策略和干预措施提供依据。

方法

2020年10月—2021年6月，在徐州市城区方便整群抽取4所幼儿园共918名学龄前儿童进行问卷调查和体格检查。采用χ2检验分析超重肥胖检出率的组间差异，采用多因素Logistic回归分析产前产后因素及其交互作用对学龄前儿童超重肥胖的影响。

结果

学龄前儿童超重肥胖检出率为30.8%，男童的超重肥胖检出率(37.0%)高于女童(24.8%)。不同年龄、性别、孕前父亲体质量指数(BMI)、父亲文化程度、分娩方式、是否6月龄内抗生素使用、是否婴儿期快速增重的学龄前儿童超重肥胖的检出率差异均有统计学意义(χ2=5.08~17.67，P值均 < 0.05)。控制年龄、性别、是否独生子女、父母文化程度、父母人均月收入等混杂因素后，交互作用分析结果表明，孕前父亲超重肥胖时，剖宫产儿童和婴儿期快速增重的学龄前儿童发生超重肥胖的风险均增加(OR=2.05，95%CI=1.02~3.39；OR=2.05，95%CI=1.08~3.88，P值均 < 0.05)。性别分层分析显示，孕前父亲BMI和分娩方式对学龄前儿童超重肥胖的交互作用在女童中更明显(OR=4.00，95%CI=1.51~10.58)，孕前父亲BMI和婴儿期快速增重对学龄前儿童超重肥胖的交互作用在男童中更明显(OR=2.85，95%CI=1.14~7.08)(P值均 < 0.05)。产前和产后因素对学龄前儿童超重肥胖的发生未发现相加交互作用(P值均>0.05)。

结论

多种产前和产后因素是学龄前儿童超重肥胖的影响因素。应关注婴儿分娩方式和婴儿期体重增长状况，尤其是在父亲超重肥胖的情况下，以降低学龄前儿童超重肥胖的发生风险。

, authors=程佩1, 樊晓莉1, 曹培2, 田欣逸2, 张景2, 张娟*, 1, authorsList=程佩, 樊晓莉, 曹培, 田欣逸, 张景, 张娟, authorCompany=null, correspAuthors=张娟, authorNote=

程佩(1995-)，女，江苏徐州人，硕士，主管营养师，主要研究方向为食品营养、学生健康

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张娟，E-mail:
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程佩(1995-)，女，江苏徐州人，硕士，主管营养师，主要研究方向为食品营养、学生健康

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PLoS One, 2022, 17(9): e0273442., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325536186667917543, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, awardId=null, language=CN, fundingSource=徐州市科技局2023年度医药卫生面上项目(KC23226)；江苏省营养学会营养与健康资助项目(JYX202005), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325536135853924525, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, xref=1, ext=[AuthorCompanyExt(id=1325536135895867566, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, companyId=1325536135853924525, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Food Safety and School Health Department, Xuzhou Centre for Disease Control and Prevention, Xuzhou 221000, Jiangsu Province, China), AuthorCompanyExt(id=1325536135912644783, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, companyId=1325536135853924525, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1徐州市疾病预防控制中心食品安全与学校卫生科，江苏 221000)]), AuthorCompany(id=1325536136650842288, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, xref=2, ext=[AuthorCompanyExt(id=1325536136659230897, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, companyId=1325536136650842288, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2徐州市儿童医院临床营养科)])], figs=[ArticleFig(id=1325536176521896160, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, language=EN, label=Tab.1, caption=

Comparison of detection rates of overweight and obesity among preschool children in different groups

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数超重肥胖人数χ2值P值组别选项人数超重肥胖人数χ2值P值
年龄/岁321864(29.4)14.09< 0.01父亲文化程度初中及以下183(16.7)13.30< 0.01
431075(24.2)高中/中专/职高15263(41.4)
5280100(35.7)大专/本科675190(28.1)
611044(40.0)硕士及以上7327(37.0)
性别男451167(37.0)15.99< 0.01父亲月收入/元≤3 0003610(27.8)2.440.49
女467116(24.8)>3 000~6 00014853(35.8)
独生子女是501153(30.5)0.540.82>6 000~9 00029993(31.1)
否417130(31.2)>9 000435127(29.2)
母亲文化程度初中及以下233(13.0)4.390.22孕前母亲BMI非超重肥胖820248(30.2)1.230.27
高中/中专13343(32.3)超重肥胖9835(35.7)
大专/本科711224(31.5)孕前父亲BMI非超重肥胖554152(27.4)7.53< 0.01
硕士及以上5113(25.5)超重肥胖364131(36.0)
母亲月收入/元≤3 00020252(25.7)4.200.24分娩方式自然分娩450120(26.7)7.17< 0.01
>3 000~6 000361115(31.9)剖宫产468163(34.8)
>6 000~9 00022168(30.8)胎龄早产10533(31.4)0.020.89
>9 00013448(35.8)足月813250(30.8)
6月龄内抗生素使用未使用745242(32.5)5.080.02婴儿期快速增重是321127(39.6)17.67< 0.01
已使用17341(23.7)否597156(26.1)
), ArticleFig(id=1325536178191229153, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, language=CN, label=表1, caption=

不同组别学龄前儿童超重肥胖检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数超重肥胖人数χ2值P值组别选项人数超重肥胖人数χ2值P值
年龄/岁321864(29.4)14.09< 0.01父亲文化程度初中及以下183(16.7)13.30< 0.01
431075(24.2)高中/中专/职高15263(41.4)
5280100(35.7)大专/本科675190(28.1)
611044(40.0)硕士及以上7327(37.0)
性别男451167(37.0)15.99< 0.01父亲月收入/元≤3 0003610(27.8)2.440.49
女467116(24.8)>3 000~6 00014853(35.8)
独生子女是501153(30.5)0.540.82>6 000~9 00029993(31.1)
否417130(31.2)>9 000435127(29.2)
母亲文化程度初中及以下233(13.0)4.390.22孕前母亲BMI非超重肥胖820248(30.2)1.230.27
高中/中专13343(32.3)超重肥胖9835(35.7)
大专/本科711224(31.5)孕前父亲BMI非超重肥胖554152(27.4)7.53< 0.01
硕士及以上5113(25.5)超重肥胖364131(36.0)
母亲月收入/元≤3 00020252(25.7)4.200.24分娩方式自然分娩450120(26.7)7.17< 0.01
>3 000~6 000361115(31.9)剖宫产468163(34.8)
>6 000~9 00022168(30.8)胎龄早产10533(31.4)0.020.89
>9 00013448(35.8)足月813250(30.8)
6月龄内抗生素使用未使用745242(32.5)5.080.02婴儿期快速增重是321127(39.6)17.67< 0.01
已使用17341(23.7)否597156(26.1)
), ArticleFig(id=1325536180279992546, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, language=EN, label=Tab.2, caption=

Multiplicative interaction of prenatal and postnatal factors on overweight and obese preschool children[OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
因素总样本(n=918)男童(n=451)女童(n=467)
孕前父亲BMI×胎龄1.73(0.62~4.82)3.33(0.62~17.94)1.16(0.31~4.41)
孕前父亲BMI×分娩方式2.05(1.02~3.39)*1.29(0.55~3.01)4.00(1.51~10.58)*
孕前父亲BMI×6月龄内抗生素使用1.42(0.60~3.38)1.27(0.41~3.94)1.96(0.47~8.12)
孕前父亲BMI×婴儿期快速增重2.05(1.08~3.88)*2.85(1.14~7.08)*1.54(0.61~3.89)
孕前母亲BMI×胎龄0.89(0.25~3.18)0.52(0.04~7.49)0.93(0.20~4.41)
孕前母亲BMI×分娩方式1.43(0.54~3.78)0.57(0.14~2.39)0.91(0.19~4.37)
孕前母亲BMI×6月龄内抗生素使用0.63(0.17~2.37)0.50(0.07~3.33)0.77(0.11~5.20)
孕前母亲BMI×婴儿期快速增重0.95(0.35~2.54)0.42(0.08~2.06)2.22(0.54~8.38)
), ArticleFig(id=1325536181626364132, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, language=CN, label=表2, caption=

产前产后因素对学龄前儿童超重肥胖的相乘交互作用[OR值(95%CI)]

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因素总样本(n=918)男童(n=451)女童(n=467)
孕前父亲BMI×胎龄1.73(0.62~4.82)3.33(0.62~17.94)1.16(0.31~4.41)
孕前父亲BMI×分娩方式2.05(1.02~3.39)*1.29(0.55~3.01)4.00(1.51~10.58)*
孕前父亲BMI×6月龄内抗生素使用1.42(0.60~3.38)1.27(0.41~3.94)1.96(0.47~8.12)
孕前父亲BMI×婴儿期快速增重2.05(1.08~3.88)*2.85(1.14~7.08)*1.54(0.61~3.89)
孕前母亲BMI×胎龄0.89(0.25~3.18)0.52(0.04~7.49)0.93(0.20~4.41)
孕前母亲BMI×分娩方式1.43(0.54~3.78)0.57(0.14~2.39)0.91(0.19~4.37)
孕前母亲BMI×6月龄内抗生素使用0.63(0.17~2.37)0.50(0.07~3.33)0.77(0.11~5.20)
孕前母亲BMI×婴儿期快速增重0.95(0.35~2.54)0.42(0.08~2.06)2.22(0.54~8.38)
), ArticleFig(id=1325536182435864805, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, language=EN, label=Tab.3, caption=

Additive interaction of prenatal and postnatal factors on overweight and obese preschool children(n=918)

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因素RERI值(95%CI)AP值(95%CI)S值(95%CI)
孕前父亲BMI+胎龄0.77(-2.18~3.72)0.35(-0.64~1.33)2.70(0.08~89.08)
孕前父亲BMI+分娩方式-1.07(-4.46~2.32)-0.40(-1.90~1.10)0.61(0.12~3.04)
孕前父亲BMI+6月龄内抗生素使用0.16(-1.66~1.98)0.11(-1.04~1.26)1.53(0.02~143.84)
孕前父亲BMI+婴儿期快速增重2.00(-1.13~5.12)0.54(-0.03~1.05)3.90(0.48~31.66)
孕前母亲BMI+胎龄-0.12(-2.84~2.60)-0.08(-1.92~1.76)0.82(0.01~83.01)
孕前母亲BMI+分娩方式-0.41(-3.72~2.90)-0.23(-2.26~1.91)0.67(0.02~20.03)
孕前母亲BMI+6月龄内抗生素使用-0.58(-2.21~1.04)-0.79(-3.91~2.34)-
孕前母亲BMI+婴儿期快速增重0.29(-3.20~3.78)0.11(-1.10~1.32)1.21(0.13~11.39)
), ArticleFig(id=1325536186177183974, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325536116564320424, language=CN, label=表3, caption=

产前产后因素对学龄前儿童超重肥胖的相加交互作用(n=918)

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因素RERI值(95%CI)AP值(95%CI)S值(95%CI)
孕前父亲BMI+胎龄0.77(-2.18~3.72)0.35(-0.64~1.33)2.70(0.08~89.08)
孕前父亲BMI+分娩方式-1.07(-4.46~2.32)-0.40(-1.90~1.10)0.61(0.12~3.04)
孕前父亲BMI+6月龄内抗生素使用0.16(-1.66~1.98)0.11(-1.04~1.26)1.53(0.02~143.84)
孕前父亲BMI+婴儿期快速增重2.00(-1.13~5.12)0.54(-0.03~1.05)3.90(0.48~31.66)
孕前母亲BMI+胎龄-0.12(-2.84~2.60)-0.08(-1.92~1.76)0.82(0.01~83.01)
孕前母亲BMI+分娩方式-0.41(-3.72~2.90)-0.23(-2.26~1.91)0.67(0.02~20.03)
孕前母亲BMI+6月龄内抗生素使用-0.58(-2.21~1.04)-0.79(-3.91~2.34)-
孕前母亲BMI+婴儿期快速增重0.29(-3.20~3.78)0.11(-1.10~1.32)1.21(0.13~11.39)
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产前产后因素交互作用对学龄前儿童超重肥胖的影响
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程佩 1 , 樊晓莉 1 , 曹培 2 , 田欣逸 2 , 张景 2 , 张娟 *, 1
中国学校卫生 | 疾病控制 2025,46(12): 1796-1799
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中国学校卫生 |疾病控制 2025 , 46 (12) : 1796 -1799
产前产后因素交互作用对学龄前儿童超重肥胖的影响
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程佩1, 樊晓莉1, 曹培2, 田欣逸2, 张景2, 张娟*, 1
作者信息
  • 1徐州市疾病预防控制中心食品安全与学校卫生科，江苏 221000
  • 2徐州市儿童医院临床营养科
通讯作者:
张娟，E-mail:
作者简介:

程佩(1995-)，女，江苏徐州人，硕士，主管营养师，主要研究方向为食品营养、学生健康

Interactive effects of prenatal and postnatal factors on overweight and obesity in preschool children
Pei CHENG1, Xiaoli FAN1, Pei CAO2, Xinyi TIAN2, Jing ZHANG2, Juan ZHANG*, 1
Affiliations
  • 1Food Safety and School Health Department, Xuzhou Centre for Disease Control and Prevention, Xuzhou 221000, Jiangsu Province, China
出版时间: 2025-12-25 doi: 10.16835/j.cnki.1000-9817.2025352
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摘要
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目的

探讨产前产后因素的交互作用对学龄前儿童超重肥胖的影响，为后续规划预防策略和干预措施提供依据。

方法

2020年10月—2021年6月，在徐州市城区方便整群抽取4所幼儿园共918名学龄前儿童进行问卷调查和体格检查。采用χ2检验分析超重肥胖检出率的组间差异，采用多因素Logistic回归分析产前产后因素及其交互作用对学龄前儿童超重肥胖的影响。

结果

学龄前儿童超重肥胖检出率为30.8%，男童的超重肥胖检出率(37.0%)高于女童(24.8%)。不同年龄、性别、孕前父亲体质量指数(BMI)、父亲文化程度、分娩方式、是否6月龄内抗生素使用、是否婴儿期快速增重的学龄前儿童超重肥胖的检出率差异均有统计学意义(χ2=5.08~17.67，P值均 < 0.05)。控制年龄、性别、是否独生子女、父母文化程度、父母人均月收入等混杂因素后，交互作用分析结果表明，孕前父亲超重肥胖时，剖宫产儿童和婴儿期快速增重的学龄前儿童发生超重肥胖的风险均增加(OR=2.05，95%CI=1.02~3.39；OR=2.05，95%CI=1.08~3.88，P值均 < 0.05)。性别分层分析显示，孕前父亲BMI和分娩方式对学龄前儿童超重肥胖的交互作用在女童中更明显(OR=4.00，95%CI=1.51~10.58)，孕前父亲BMI和婴儿期快速增重对学龄前儿童超重肥胖的交互作用在男童中更明显(OR=2.85，95%CI=1.14~7.08)(P值均 < 0.05)。产前和产后因素对学龄前儿童超重肥胖的发生未发现相加交互作用(P值均>0.05)。

结论

多种产前和产后因素是学龄前儿童超重肥胖的影响因素。应关注婴儿分娩方式和婴儿期体重增长状况，尤其是在父亲超重肥胖的情况下，以降低学龄前儿童超重肥胖的发生风险。

妊娠  /  超重  /  肥胖症  /  回归分析  /  儿童，学龄前
Objective

To investigate the interactive effects of prenatal and postnatal factors on overweight and obesity in preschool children, so as to provide evidence for subsequent planning of prevention strategies and intervention measures.

Methods

Between October 2020 and June 2021, a convenience cluster sample of 918 preschool children from four kindergartens in Xuzhou urban area underwent questionnaire surveys and physical examinations. The Chi-square test was used to compare intergroup differences in overweight and obesity prevalence. Multivariate Logistic regression analysis was employed to investigate the effects of prenatal and postnatal factors, as well as their interactions, on overweight and obesity in preschool children.

Results

The prevalence of overweight and obesity among preschool children was 30.8%, with boys exhibiting a higher rate (37.0%) than girls (24.8%). Statistically significant differences in overweight and obesity prevalence were observed across age groups, genders, paternal pre-pregnancy body mass index (BMI), paternal educational level, delivery mode, antibiotic use within the six months after birth, and rapid weight gain during infancy (χ2=5.08-17.67, all P < 0.05). After adjusting for confounding factors such as age, gender, the only child, parental educational level and parental average monthly income, interaction analysis revealed that when the father was overweight or obese before conception, children delivered by caesarean section had an increased risk of overweight or obesity (OR=2.05, 95%CI=1.02-3.39), and children with rapid weight gain during infancy also had an increased risk (OR=2.05, 95%CI=1.08-3.88) (both P < 0.05). Gender-stratified analysis revealed that the interaction between paternal pre-pregnancy BMI and mode of delivery on overweight and obesity was more pronounced among girls (OR=4.00, 95%CI=1.51-10.58, P < 0.05). While the interaction between the father's pre-pregnancy BMI and rapid weight gain during infancy was more pronounced in boys (OR=2.85, 95%CI=1.14-7.08, P < 0.05). No significant interactions between prenatal and postnatal factors on overweight and obesity in preschool children were observed (all P>0.05).

Conclusions

Multiple prenatal and postnatal factors influence overweight and obesity in preschool children. Attention should be paid to mode of delivery and infant weight gain, particularly when the father is overweight or obese, to reduce the risk of overweight and obesity in preschool children.

Pregnancy  /  Overweight  /  Obesity  /  Regression analysis  /  Child, preschool
程佩, 樊晓莉, 曹培, 田欣逸, 张景, 张娟. 产前产后因素交互作用对学龄前儿童超重肥胖的影响. 中国学校卫生, 2025 , 46 (12) : 1796 -1799 . DOI: 10.16835/j.cnki.1000-9817.2025352
Pei CHENG, Xiaoli FAN, Pei CAO, Xinyi TIAN, Jing ZHANG, Juan ZHANG. Interactive effects of prenatal and postnatal factors on overweight and obesity in preschool children[J]. Chinese Journal of School Health, 2025 , 46 (12) : 1796 -1799 . DOI: 10.16835/j.cnki.1000-9817.2025352
正文
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儿童肥胖是全球重大公共卫生问题；截至2022年，约有3 700万5岁以下儿童超重肥胖，占全球该年龄组人口的5.6%[1]。如果不采取干预措施，预计到2035年，将有2 700万儿童患有高血糖，6 800万儿童患有高血压，7 600万儿童因体质量指数(body mass index，BMI)高而出现高密度脂蛋白胆固醇水平偏低[2]。因此，在生命早期识别可改变的危险因素对于有效预防超重肥胖至关重要。
大量证据表明，产前因素(父母孕前BMI高[3])和产后因素(剖宫产[4]、婴儿期体重快速增加[5])是导致儿童超重肥胖的因素。本研究以徐州市学龄前儿童为研究对象，通过相乘和相加交互作用模型评估产前产后因素与超重肥胖的关联，为后续规划预防策略和干预措施提供依据。
1　对象与方法
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1.1　对象
采用方便整群抽样方法，于2020年10月—2021年6月在徐州市城区方便抽取4所幼儿园，调查当日全部在园儿童，共纳入960名儿童。调查问卷由儿童带回交由家长填写，并于第3天回收，剔除儿童体格指标、生命早期因素等主要结果指标缺失的问卷，共纳入918名儿童，年龄3~6岁，有效率为95.6%。其中男童451名(49.1%)，女童467名(50.9%)。调查前已取得家长的知情同意，并得到徐州市儿童医院医学伦理委员会批准(编号：2021-05-03-H03)。
1.2　方法
通过查阅文献[6-7]和专家咨询自行设计问卷，一般人口学特征包括年龄、性别、是否独生子女、父母文化程度(初中及以下、高中/中专/职高、大专/本科、硕士及以上)、父母月收入(≤3 000，>3 000~6 000，>6 000~9 000，>9 000元)等。产前因素包括父母孕前身高和体重；产后因素包括分娩方式、胎龄、6月龄内抗生素使用、婴儿期快速增重等。问卷的Cronbach α系数为0.714。使用经过校正的身高体重秤(无锡衡器厂，型号：TCS-200-RT)获取儿童体重和身高数据，并计算儿童BMI，BMI=体重(kg)/[身高(m)]2[8]。
成人BMI根据世界卫生组织(World Health Organization, WHO)的标准[9](< 25 kg/m2为非超重肥胖，≥25 kg/m2为超重肥胖)进行判定。分娩方式分为自然分娩和剖宫产。胎龄 < 37周的定义为早产儿，≥37周的定义为足月儿[10]。参照WHO儿童生长发育标准，BMI < 同年龄同性别1 s判定为非超重，BMI≥同年龄同性别1 s判定为超重肥胖[8]。儿童体重增加的水平ΔZ-score=Z-score(12月龄)-Z-score(出生时)，采用国际上最常见和广泛接受的婴儿期快速增重标准[11]，将早期体重增加的水平分为婴儿期快速增重(ΔZ-score>0.67)和无快速增重(ΔZ-score≤0.67)[11]。
1.3　质量控制
调查人员在调查前均接受统一培训和考核，问卷填写前向家长说明调查的目的与意义，在填写过程中如有任何问题由调查员及时解答。调查结束后，采用EpiData 3.1软件建立数据库并双人录入数据，核查数据后，剔除主要结果指标缺失的问卷。
1.4　统计学分析
采用SPSS 22.0软件对数据进行分析。其中计数资料用频数、率或构成比表示，组间比较采用χ2检验。调整年龄、性别、是否独生子女、父母文化程度、父母人均月收入等协变量后，采用多因素Logistic回归分析探究产前产后因素及其交互作用对学龄前儿童超重肥胖的影响，其中相乘模型将产前和产后因素二者的乘积项同时纳入多因素Logistic回归模型加以验证，并进一步按性别分层分析；使用Andersson等[12]编制的Excel表计算变量间的相加交互作用，若两因素间存在相加交互作用，则相对超危险度比(relative excess risk due to interaction，RERI)和交互作用的归因比(attributable proportion due to interaction，AP)的可信区间(95%CI)不包含0，交互作用指数(synergy index，S)的95%CI不包含1。检验水准α=0.05。
2　结果
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2.1　学龄前儿童超重肥胖情况
纳入的918名儿童中，超重肥胖检出率为30.8%(283名)。男童超重肥胖检出率(37.0%)高于女童(24.8%)，6岁儿童超重肥胖检出率(40.0%)较高，组间差异均有统计学意义(P值均 < 0.05)。不同孕前父亲BMI、父亲文化程度、分娩方式，是否6月龄内抗生素使用、婴儿期快速增重的学龄前儿童超重肥胖检出率比较，差异均有统计学意义(P值均 < 0.05)。见表1。
2.2　产前产后因素对学龄前儿童超重肥胖的交互作用分析
以儿童是否超重肥胖为因变量(否=0，是=1)，以孕前父亲BMI(非超重肥胖=0，超重肥胖=1)、孕前母亲BMI(非超重肥胖=0，超重肥胖=1)、胎龄(足月=0，早产=1)、分娩方式(自然分娩=0，剖宫产=1)、6月龄内抗生素使用(否=0，是=1)、婴儿期快速增重(否=0，是=1)为自变量，控制年龄、性别、是否独生子女、父母文化程度、父母人均月收入等混杂因素，进行多因素Logistic回归分析。结果显示，孕前父亲BMI和分娩方式、孕前父亲BMI和婴儿期快速增重对学龄前儿童超重肥胖的发生均存在相乘交互作用(P值均 < 0.05)。其中孕前父亲超重肥胖时，剖宫产儿童发生超重肥胖的风险会增加，其相乘交互作用在女童中更为明显；孕前父亲超重肥胖时，婴儿期快速增重的儿童发生超重肥胖的风险增强，其相乘交互作用在男童中更明显(P值均 < 0.05)。见表2。产前和产后因素对超重肥胖的发生未发现相加交互作用(P值均>0.05)。见表3。
3　讨论
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有研究表明，母系因素通过受精卵环境、宫内环境影响后代的健康和疾病易感性，父系因素则通过直接(遗传/表观遗传)和间接(母体子宫环境)效应调节后代发育，通过胎盘成分、端粒长度、精子发生的表观遗传修饰影响后代的整个生命周期[13-14]。本研究发现，孕前父亲超重肥胖会导致儿童超重肥胖的风险增加，且孕前父亲BMI与儿童超重肥胖之间的关联比母亲的更强。可能是因为母亲健康意识提高，从围孕期就开始关注体重和合理饮食[15]。
本研究在控制年龄、性别、是否独生子女、父母文化程度、父母人均月收入等混杂因素后，分析了父母孕前BMI与产后因素对儿童超重肥胖的交互作用。在一项对8 900名学龄前儿童进行的横断面研究中发现，剖宫产分娩的儿童超重风险增加24%，肥胖风险增加29%[16]。本研究结果显示在总体人群中，孕前父亲超重肥胖合并剖宫产的学龄前儿童发生超重肥胖的风险增加，并且该相乘交互作用在女童中更明显；可能因为女童在胎儿期的最后3个月生长较慢，出生后体脂百分比较高、瘦体重较低[17]。有学者论证，父母超重肥胖、剖宫产均可以导致儿童青少年超重肥胖的风险增高[18]，与本研究结果一致。本研究发现孕前父亲超重肥胖合并婴儿期体重快速增加的儿童发生超重肥胖的风险增加，且该相乘交互作用在男童中更明显。有研究发现，婴儿0~6个月的体重快速增加和父母孕前BMI与5岁时的腰高比≥1 s呈正相关，0~6和>6~12月龄的体重快速增加以及母亲孕前BMI与超重肥胖相关[19]，但这些关联背后的潜在机制尚不清楚。本研究未发现父母孕前BMI与其他产后因素对儿童超重肥胖的交互作用，鉴于研究有限，需要进一步调查生命早期因素，尤其是调查父亲在母亲怀孕前的生活方式，与产后相关因素相互作用是否会影响后代的生长发育。
本研究也存在以下局限性：(1)研究基于徐州市部分学龄前儿童的横断面调查，人群代表性有限；(2)问卷由家长自行填写(已告知家长可查找孕期体检记录)，数据可能导致回忆偏倚，父母BMI是使用填写的身高和体重计算获得，自我报告的数据可能会偏离真实的BMI；(3)产前产后因素交互作用与儿童超重肥胖风险增加的原因尚未完全阐明。
基金
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  • 徐州市科技局2023年度医药卫生面上项目(KC23226)；江苏省营养学会营养与健康资助项目(JYX202005)
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2025年第46卷第12期
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doi: 10.16835/j.cnki.1000-9817.2025352
  • 接收时间：2025-06-23
  • 首发时间：2026-11-06
  • 出版时间：2025-12-25
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  • 收稿日期：2025-06-23
  • 修回日期：2025-08-15
基金
徐州市科技局2023年度医药卫生面上项目(KC23226)；江苏省营养学会营养与健康资助项目(JYX202005)
作者信息
    1徐州市疾病预防控制中心食品安全与学校卫生科，江苏 221000
    2徐州市儿童医院临床营养科

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total species (%)		 属
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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