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Article(id=1325529995313172515, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325529948685091532, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025236, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1754150400000, receivedDateStr=2025-08-03, revisedDate=1754496000000, revisedDateStr=2025-08-07, acceptedDate=null, acceptedDateStr=null, onlineDate=1793960577941, onlineDateStr=2026-11-06, pubDate=1756051200000, pubDateStr=2025-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793960577941, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793960577941, creator=13701087609, updateTime=1793960577941, updator=13701087609, issue=Issue{id=1325529948685091532, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='8', pageStart='1065', pageEnd='1216', issueExtLink='null', onlineDate='null', pubDate='1756051200000', pubDateStr='2025-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793960566921, creator='13701087609', updateTime=1793960566921, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1065, endPage=1069, ext={EN=ArticleExt(id=1325529995795517476, articleId=1325529995313172515, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Birth cohort study on the impact of adverse maternal factors during pregnancy on children's physical growth and development, columnId=1325500683172065622, journalTitle=Chinese Journal of School Health, columnName=Editorial, runingTitle=null, highlight=null, articleAbstract=

Cohort studies characterized by clear temporal sequencing, rigorous control of confounding factors, and other methodological strengths, has effectively promoted scientific exploration of the effects of pregnancy exposure on children's health. The review focuses on the impacts of adverse maternal factors during pregnancy on children's physical growth and development, sorts out the scientific evidence on the longitudinal association between adverse exposures (such as endocrine and metabolic disorders, environmental pollutants, lifestyle factors, and psychological stressors) and children' s growth trajectories in existing cohort studies, explores the path of transforming high-quality research results into potential public health intervention strategies to promote the in-depth development of health protection for children and adolescents, thereby contributing to enhancing population health and the long-term goal of sustainable societal development.

, authors=Haijun WANG, Jinlang LÜ, authorsList=Haijun WANG, Jinlang LÜ, authorCompany=null, correspAuthors=null, 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=1325529996143644709, articleId=1325529995313172515, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=重视母亲妊娠期不良因素对儿童体格生长发育影响的出生队列研究, columnId=1325500684380025177, journalTitle=中国学校卫生, columnName=述评, runingTitle=null, highlight=null, articleAbstract=

出生队列研究凭借其时序特征清晰、混杂因素控制精细等优势，有效推动了妊娠期暴露对儿童健康影响效应的科学探索。研究围绕母亲妊娠期不良因素对儿童体格生长发育的影响展开述评，梳理现有队列研究中不良暴露(内分泌代谢、环境污染物、生活方式、心理因素等)与儿童生长轨迹纵向关联的科学证据，探讨将高质量研究成果转化为切实可行的公共卫生干预策略的路径，以推动儿童青少年健康保障工作的深入开展，助力提高人口素质和促进社会可持续发展。

, authors=王海俊, 吕瑾莨, authorsList=王海俊, 吕瑾莨, authorCompany=null, correspAuthors=null, authorNote=

王海俊(1973-)，女，河北唐山人，博士，教授，主要研究方向为妇幼人群重大健康问题影响因素与防控技术

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王海俊(1973-)，女，河北唐山人，博士，教授，主要研究方向为妇幼人群重大健康问题影响因素与防控技术

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王海俊(1973-)，女，河北唐山人，博士，教授，主要研究方向为妇幼人群重大健康问题影响因素与防控技术

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重视母亲妊娠期不良因素对儿童体格生长发育影响的出生队列研究
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王海俊 , 吕瑾莨
中国学校卫生 | 述评 2025,46(8): 1065-1069
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中国学校卫生 |述评 2025 , 46 (8) : 1065 -1069
重视母亲妊娠期不良因素对儿童体格生长发育影响的出生队列研究
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王海俊(1973-)，女，河北唐山人，博士，教授，主要研究方向为妇幼人群重大健康问题影响因素与防控技术

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王海俊(1973-)，女，河北唐山人，博士，教授，主要研究方向为妇幼人群重大健康问题影响因素与防控技术

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王海俊, 吕瑾莨
作者信息
  • 北京大学公共卫生学院妇幼卫生学系，北京 100191
作者简介:

王海俊(1973-)，女，河北唐山人，博士，教授，主要研究方向为妇幼人群重大健康问题影响因素与防控技术

Birth cohort study on the impact of adverse maternal factors during pregnancy on children's physical growth and development
Haijun WANG, Jinlang LÜ
Affiliations
  • Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China
出版时间: 2025-08-25 doi: 10.16835/j.cnki.1000-9817.2025236
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摘要
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出生队列研究凭借其时序特征清晰、混杂因素控制精细等优势，有效推动了妊娠期暴露对儿童健康影响效应的科学探索。研究围绕母亲妊娠期不良因素对儿童体格生长发育的影响展开述评，梳理现有队列研究中不良暴露(内分泌代谢、环境污染物、生活方式、心理因素等)与儿童生长轨迹纵向关联的科学证据，探讨将高质量研究成果转化为切实可行的公共卫生干预策略的路径，以推动儿童青少年健康保障工作的深入开展，助力提高人口素质和促进社会可持续发展。

母亲  /  妊娠  /  危险因素  /  儿童  /  生长和发育  /  队列研究

Cohort studies characterized by clear temporal sequencing, rigorous control of confounding factors, and other methodological strengths, has effectively promoted scientific exploration of the effects of pregnancy exposure on children's health. The review focuses on the impacts of adverse maternal factors during pregnancy on children's physical growth and development, sorts out the scientific evidence on the longitudinal association between adverse exposures (such as endocrine and metabolic disorders, environmental pollutants, lifestyle factors, and psychological stressors) and children' s growth trajectories in existing cohort studies, explores the path of transforming high-quality research results into potential public health intervention strategies to promote the in-depth development of health protection for children and adolescents, thereby contributing to enhancing population health and the long-term goal of sustainable societal development.

Mothers  /  Pregnancy  /  Risk factors  /  Child  /  Growth and development  /  Cohort studies
王海俊, 吕瑾莨. 重视母亲妊娠期不良因素对儿童体格生长发育影响的出生队列研究. 中国学校卫生, 2025 , 46 (8) : 1065 -1069 . DOI: 10.16835/j.cnki.1000-9817.2025236
Haijun WANG, Jinlang LÜ. Birth cohort study on the impact of adverse maternal factors during pregnancy on children's physical growth and development[J]. Chinese Journal of School Health, 2025 , 46 (8) : 1065 -1069 . DOI: 10.16835/j.cnki.1000-9817.2025236
正文
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妊娠期是塑造子代长期健康与疾病易感性的关键窗口期，母亲在妊娠期暴露于各种不良因素(如内分泌代谢异常、环境污染物、心理应激等)可能改变胎儿宫内编程，对儿童生长发育产生深远影响[1]。尽管现有研究已开始聚焦于妊娠期不良因素对儿童体格生长发育的潜在危害，但由于研究设计、数据完整性以及分析方法存在局限，仍存在剂量-反应关系未明确[2]、生物学机制未阐明[3]以及儿童动态生长轨迹研究较少[4]等问题。运用出生队列的科学设计，精准识别儿童体格生长发育问题的“生命早期根源”，对于开展儿童肥胖及其他代谢性疾病的早期预防、解决我国代谢性疾病患病率日益增长[5]的问题具有重要意义。
1　出生队列研究推动妊娠期暴露与儿童体格生长发育的科学探索
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出生队列研究旨在追踪一组同一时代出生的个体，并在生命历程的特定年龄阶段收集信息[6]。此类研究通过长期随访固定人群，能够评估健康事件或结局的发生率与分布特征，并揭示生命早期因素与后续结局之间的关联。国际上出生队列研究起步较早，以丹麦国家出生队列(Danish National Birth Cohort)[7]、英国埃文郡亲子纵向研究队列(Avon Longitudinal Study of Parents and Children)[8]、荷兰R世代队列(Generation R Study)[9]等为典型代表。国外队列的建立得益于较为完善的医疗保健和出生登记系统，为数据的长期收集提供了保障。早期的出生队列在出生时招募研究对象，通过回顾性查询医疗电子记录获取妊娠期因素，但部分变量(如营养因素和生活方式)未被系统记录，仅能依赖询问获得，故存在回忆偏倚。此外，由于缺乏妊娠期生物样本，无法开展体内暴露水平研究。因此，后期的队列研究逐渐将招募时间提前到孕早期甚至孕前，实质上已拓展为孕产妇及其子代健康队列[10]。
我国的出生队列研究在近20年取得显著进展，如马鞍山优生优育队列[11]、上海优生儿童队列[12]、广州出生队列[13]、中国国家出生队列[14]、北大-通州出生队列[15]等。以上队列研究设计的暴露变量广泛，涵盖社会人口学特征、内分泌代谢状况、营养因素、环境污染物暴露等多个维度，研究结局涉及不良妊娠结局、子代体格生长发育、心理行为发育等多方面。相比于回顾性队列研究，前瞻性的出生队列研究对于探讨妊娠期不良因素暴露与子代体格生长发育关联具有以下优势：(1)明确的时序特征。从妊娠期或出生起收集暴露信息，通过随访获得结局情况，遵循暴露-结局的时间序列，为因果推断提供重要证据[16]。(2)精细化的混杂控制。从研究初期前瞻性地设计、收集并持续追踪关键协变量，通过标准化问卷、定期访视及医疗记录等方式获取变量信息，降低了回忆偏倚的影响[17]。(3)识别生长发育敏感窗口。针对妊娠期关键时期(如胎儿器官发生期、快速生长期)设计暴露监测，有助于识别特定健康风险形成的敏感时间段[18]。(4)生长轨迹动态建模。依托长期随访采集的儿童身体测量数据，构建反映生长速度、变化趋势及个体差异的动态变化轨迹，定量解析妊娠期暴露对儿童生长轨迹的影响[19]。(5)样本库驱动机制探索。队列建立的生物样本库和高通量组学技术为探究表观遗传调控等分子机制提供了研究平台[20]。综上所述，基于收集的临床保健信息、流行病学调查资料和生物样本，前瞻性的出生队列着眼于关键生长发育阶段，开展系列疾病溯源研究能够为阐明妊娠期不良因素暴露对儿童体格生长发育的影响提供有力的科学证据。
2　妊娠期不良因素暴露对儿童体格生长轨迹影响的研究
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儿童体格生长具有动态且连续变化的特点。已有研究表明，儿童生长轨迹与青少年及成年期发生肥胖[21]和代谢性疾病[22]的风险密切相关。相较于单一时点指标，监测体格生长发育的动态模式可能对后期疾病预防具有更为重要的作用。近年来，利用出生队列的重复测量数据构建儿童生长轨迹的研究日益增多，研究者利用潜类别增长模型[23]、增长混合模型[24]、K均值轨迹聚类[25]等统计学方法识别体格生长发育异常的群体，系统评估了妊娠期多种不良因素暴露对儿童生长轨迹的影响。
2.1　内分泌代谢因素
孕前超重肥胖、孕期增重异常及妊娠期糖尿病已成为重要的内分泌代谢问题。研究发现，以上因素在增加儿童持续高生长轨迹或加速增长轨迹风险方面具有独立和协同作用。如Michael等[26]基于新加坡成长至健康结局队列(Growing Up in Singapore Towards healthy Outcomes，GUSTO)发现，孕前母亲高体质量指数(body mass index, BMI)可增加儿童在出生至6岁期间出现BMI加速增长轨迹的风险，且该轨迹与内脏脂肪蓄积、胰岛素抵抗等病理状态密切相关。另一项在西班牙开展的研究也证实，母亲孕前BMI及孕期增重均与儿童0~4岁的加速生长轨迹存在独立关联[27]。不同因素还具有联合作用，如Deng等[28]发现，孕前超重和妊娠期糖尿病不仅与儿童从出生至青春早期呈现快速增长的肥胖轨迹存在独立关联，且两者共同作用时儿童BMI的增长幅度更高。除传统因素，Hu等[29]通过组学分析发现，孕中期母亲体内类固醇生物合成等代谢通路改变与儿童0~4岁BMI的快速上升轨迹之间存在关联。
2.2　环境污染物
多项队列研究结果表明，妊娠期环境污染物暴露对子代体格生长轨迹产生影响。相关物质主要分为大气污染物、持久性有机污染物和重金属三大类。在大气污染物方面，多项研究聚焦于大气颗粒物(PM10、PM2.5)及其组分。尽管不同地区暴露浓度和组分特征有所不同，但来自美国[30-31]及我国北京[32]、上海[33]、合肥[34]等地的多项研究均显示，妊娠期高浓度环境污染物暴露与儿童加速型生长轨迹呈正相关，此类轨迹以体格指标在早期快速增长后维持在较高水平为主要特征。研究者通过生物样本测定母亲体内暴露水平，发现全氟及多氟烷基物质[35]、邻苯二甲酸盐[36]、多氯联苯[37]、双酚类化合物[38]等有机污染物可以导致儿童年龄别体重标准化评分或者BMI呈现“出生时低随后赶上生长”的特殊变化模式。在重金属领域，有综述总结孕期镉、砷和铅的高暴露与儿童较低的生长轨迹存在关联，且该效应可持续至青春期[39]。
2.3　生活方式
近年来孕期生活方式作为重要的可干预因素受到关注，涵盖膳食模式、身体活动、吸烟等方面。我国马鞍山母婴健康队列研究发现，孕期健康型膳食模式(以奶类及其制品、豆类及其制品、坚果类和蛋类为主要特征)低暴露组的子代在儿童期更倾向于出现低BMI生长轨迹，而孕期饮料型膳食模式(以咖啡、可乐和茶为主要特征)的高暴露则增加了子代儿童期高BMI生长轨迹的风险[40]。美国学者亦发现，含糖饮料为特征的孕期膳食模式引发儿童出现早期快速生长并且增加了肥胖的发病风险[41]。挪威母婴队列研究进一步揭示，孕期极高剂量咖啡因摄入(≥300 mg/d)与儿童自婴幼儿期至8岁期间体重的加速增长存在显著关联[42]。除膳食因素，孕期久坐行为过多[43]和吸烟[44]等不良生活方式同样会导致子代出生后生长速度的增加。值得注意的是，多项研究证实儿童期的加速生长与成年期肥胖及代谢性疾病的发生发展密切相关[21]。
2.4　心理因素
妊娠期不良心理因素可使孕妇长期处于慢性应激状态，近期研究显示其能够影响子代出生后的体格生长发育。Pi等[45]基于江苏出生队列，对4 710名儿童进行了身长别体重标准化评分(weight-for-length Z-score，WLZ)的轨迹拟合及关联分析，结果显示相较于母亲仅有轻度抑郁症状的儿童，母亲抑郁症状更为严重的儿童倾向于呈现持续高位且不断增长的轨迹模式。澳大利亚Raine研究也发现，妊娠早期压力性生活事件的暴露与儿童3~14岁间BMI标准化评分加速生长轨迹之间存在正向关联[46]。
2.5　社会经济因素
社会经济地位也是当前关注的健康决定因素。无论是采用单一维度指标(母亲受教育程度)还是多维综合指标(涵盖教育程度、社会阶层及社会流动性)进行评估，妊娠期较低的社会经济状况均与儿童生长模式偏离正常范围的风险升高密切相关，且可能受到营养状况、居住环境及社会支持等多重因素的影响[47-48]。
2.6　多种因素的复合暴露
孕妇在现实环境中往往同时暴露于多种不良因素，这些因素之间存在复杂的联合或交互作用。环境污染物的复合暴露是一种典型的暴露情景。考虑到污染物间常存在强相关性，研究者开发了加权分位数和回归等分析方法，不仅能定量解析多种污染物联合效应的方向与强度，还可识别单一物质对整体效应的贡献度[49]。上海优生儿童队列采用加权分位数和回归模型，系统评估了孕期7种全氟及多氟烷基物质暴露与儿童生长轨迹的关联，结果显示，混合暴露水平升高可增加儿童出现赶上生长轨迹的风险，全氟己烷磺酸是对该关联贡献较为突出的主要物质[35]。另外，环境暴露与其他不良因素之间也可产生复杂的交互效应。我国另一项研究表明，NO2暴露可以导致儿童BMI标准化评分的加速增长，且该加速效应在孕前超重肥胖(BMI≥25 kg/m2)孕妇的子代群体中更为显著，孕前超重肥胖状态与NO2暴露之间存在交互作用。这些复合暴露效应可能通过全身炎症或氧化应激等共同生物学途径干扰子代发育[44, 50]。因此，未来队列研究应着重构建多因素暴露评估体系，评估真实世界中多种不良因素的联合暴露效应及其生物学机制，为制定针对多种暴露共同作用靶点的综合干预策略提供科学依据。
3　队列研究有待产出高质量证据并转化为公共卫生干预
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本期重点号收录了环境内分泌干扰物、金属、脂代谢异常等妊娠期不良因素暴露与儿童体格生长发育的前沿研究[51-54]，为制定针对高危人群的早期识别和干预提供了科学依据。然而，队列研究产出高质量证据以及转化仍存在挑战，亟须通过以下路径实现从科学发现到公共卫生干预的落地，以切实改善儿童青少年的健康水平。
3.1　强化队列长期随访与高质量纵向数据研究
现有研究多聚焦于儿童早期阶段，针对妊娠期不良暴露对青春期及成年期体格发育的长期效应尚缺乏系统性的科学证据。特别需要探讨的是，由产前不良暴露所导致的儿童体格生长轨迹异常，将如何持续影响青春期生长突增的时相和强度、成年期超重肥胖及代谢性疾病等远端结局[19]？为系统阐明这些问题，亟需开展规范测量和严格质控的长期随访，在关键的生长发育窗口期(婴儿期、学龄前期、学龄期及青春期)采集不同的体格生长数据(身高、体重、皮褶厚度、体成分数据等)。基于这些纵向数据，研究者可构建高精度、连续性的生长轨迹，结合多维度代谢指标，全面解析妊娠期暴露对儿童体格生长发育及代谢健康的动态影响及其机制，为早期开展精准防控提供科学依据。
3.2　多源数据驱动生长轨迹异常的精准预测
前瞻性出生队列研究可以整合多源异构数据，包括结构化临床/问卷数据、环境监测数据、组学生物数据、医学影像数据以及可穿戴设备动态数据等。基于这些多模态数据，已有研究运用不同算法(多层感知机、支持向量机、深度学习以及朴素贝叶斯等)构建预测模型，尝试进行妊娠期糖尿病、子痫前期、新生儿窒息等不良结局的早期预测，充分展现了人工智能技术在围产医学领域的应用潜力[55]。未来研究可应用这些前沿技术，解析妊娠期复合暴露模式与动态变化，构建精准的生长轨迹异常预测模型，为高风险儿童提供个性化的干预措施。
3.3　推动产前保健优化与健康政策转化
妊娠期敏感窗口期指子代对不良环境因素暴露具有较强敏感性的阶段，通常对应于胚胎和胎儿关键生物学过程高度活跃的时间段。例如，依托出生队列所开展的人群研究表明，孕早期和孕晚期是重金属暴露致使儿童生长轨迹发生改变的敏感窗口期[38]。提示在该阶段的常规产前保健需要积极开展降低暴露风险的宣教，以及高危人群的监测。未来队列研究有望发现多种不良因素各异的敏感窗口期，从而基于暴露-窗口期开展精准防控。值得强调的是，现有的研究成果也为修订公共卫生健康标准提供了重要的科学依据[56-58]。
综上所述，队列研究为探索妊娠期不良因素与儿童体格生长发育的关联提供了重要科学证据。未来应进一步关注复合暴露的作用，解析关键生物学机制，开发针对高危人群的个性化干预策略，持续将队列研究的高质量证据转化为切实可行的公共卫生干预措施，共同促进儿童青少年健康成长。
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2025年第46卷第8期
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doi: 10.16835/j.cnki.1000-9817.2025236
  • 接收时间：2025-08-03
  • 首发时间：2026-11-06
  • 出版时间：2025-08-25
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  • 收稿日期：2025-08-03
  • 修回日期：2025-08-07
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国家自然科学基金面上项目(82473640)
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    北京大学公共卫生学院妇幼卫生学系，北京 100191
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
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
栓菌属 Trametes 5 2.39
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