MEDLINE/PubMed Journal Browser Search

Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

Title: [Periconceptional maternal homocysteine and birth weight outcomes in offspring: a prospective cohort study].
Author: Zhang Y, Chen XT, Yao QY, Chen HY, Li MR, Wang DM, Dou YL, Peng YZ, Gu XY, Yan WL, Huang GY.
Journal: Zhonghua Er Ke Za Zhi; 2024 Feb 02; 62(2):120-128. PubMed ID: 38264811.
Abstract:
Objective: To quantify the associations between periconceptional maternal homocysteine (HCY) and offspring's birth weight and risk of small for gestational age (SGA) infant. Methods: The 19 984 mother-child pairs in this prospective cohort study were recruited from the Shanghai preconception cohort; the infants were delivered from 1^st September 2016 to 11^th November 2022. A standardized questionnaire was used to collect the mothers' demographic information, medical history, dietary supplement use, and maternal complications during pregnancy, and their serum samples were collected. Serum HCY, folate, and vitamin B₁₂ were measured using chemiluminescent microparticle immunoassay based on serum sample drawn at enrollment. Birth weight data were obtained from medical records. Multiple imputation methods were applied to handle missing data in key variables. Multivariable linear regression and Poisson regression models were used to analyze the relationship between maternal HCY concentration during the periconceptional period and the birth weight and SGA risk of the offspring. Results: A total of 9 452 pairs were enrolled preconceptionally and the remaining 10 532 pairs were enrolled in early pregnancy. The proportion of mothers whose pregnancy age was greater than 35 years was 9.2% (1 832/19 984), the proportion of primiparous women was 76.5% (15 283/19 984), the proportion of pre-pregnancy overweight and obesity was 14.0% (2 804/19 984), the proportion of using folic acid supplements before pregnancy was 21.4% (4 272/19 984), and the proportion of those who supplemented with folic acid during early pregnancy was 85.2% (8 976/10 532); gestational diabetes mellitus was in 6.2% (1 245/19 984), gestational hypertensive syndrome in 3.6% (711/19 984). The birth weight of the offspring was (3 297±468) g, and there were 1 962 SGA children (9.8%). The HCY concentration in the overall population in appropriate for gestational age during the periconceptional period was (7.9±3.2) μmol/L, with (8.3±3.7) μmol/L in the preconception subgroup and (7.3±2.4) μmol/L in the early pregnancy subgroup. After adjustment for the covariates of perinatal demographic information, adverse pregnancy outcomes, serum folate and vitamin B₁₂, increased maternal periconceptional HCY was significantly associated with lower offspring birth weight (β=-2.30, 95%CI -4.43--0.16, P=0.035). Only the early pregnancy subgroup was significantly associated with lower offspring birth weight (β=-7.39, 95%CI-11.50--3.21, P<0.001). No association was found between peripregnancy HCY and offspring SGA risk. However, elevated HCY in early pregnancy was associated with an increased risk of SGA in the offspring (RR=1.05, 95%CI 1.01-1.08, P=0.002). Periconceptional vitamin B₁₂ was a mediator of the association between HCY and offspring birth weight, accounting for 16.5%, 41.2% and 5.4% of its total effect in the overall periconceptional population, the pre-pregnancy subgroup and the early pregnancy subgroup, respectively. Conclusions: Maternal periconceptional HCY level is associated with lower birth weight in offspring, but not with the risk of SGA. Elevated maternal HCY in early pregnancy subgroup may be associated with increased risk of SGA in offspring. 目的： 分析围孕期母亲同型半胱氨酸（HCY）与子代出生体重结局的关系。 方法： 前瞻性队列研究。上海市围孕期亲子队列（SPCC）中在2016年9月1日至2022年11月11日完成分娩的母子对19 984组为研究对象。研究对象分为孕前、孕早期纳入两个亚组。纳入时收集血样并采用统一问卷收集一般人口学信息、膳食补充剂使用、孕期不良并发症等信息。血清HCY、叶酸和维生素B₁₂的测量采用化学发光微粒子免疫法，出生体重从医疗记录获取，采用多重填补法处理缺失数据。采用多因素线性回归和Poisson回归模型分析围孕期母亲HCY与子代出生体重和小于胎龄（SGA）的关系。 结果： 本研究孕前纳入9 452组，孕早期纳入10 532组。怀孕年龄≥35岁的产妇占比为9.2%（1 832/19 984），初产妇占比为76.5%（15 283/19 984），孕前超重和肥胖占比为14.0%（2 804/19 984），孕前期使用叶酸补充剂的占比为21.4%（4 272/19 984），孕早期补充叶酸的占比为85.2%（8 976/10 532），妊娠期糖尿病患者占比为6.2%（1 245/19 984），妊娠期高血压综合征患者占比为3.6%（711/19 984），子代出生体重为（3 297±468）g，SGA儿1 962例（9.8%）。围孕期总人群适于胎龄组母亲HCY浓度为（7.9±3.2）μmol/L，其中孕前亚组为（8.3±3.7）μmol/L，孕早期亚组为（7.3±2.4）μmol/L。调整围孕期人口学信息、妊娠不良结局、血清叶酸和维生素B₁₂等协变量后，围孕期母亲HCY升高与子代出生体重下降有显著关联（β=-2.30，95%CI -4.43~-0.16，P=0.035），亚组人群中仅有孕早期亚组与子代出生体重下降有显著关联（β=-7.39，95%CI -11.50~-3.21，P<0.001）。未发现围孕期总人群母亲HCY与子代SGA风险有关联。但孕早期母亲HCY升高与子代SGA风险升高有关（RR=1.05，95%CI 1.01~1.08，P=0.002）。围孕期维生素B₁₂在HCY升高与子代出生体重降低的关联中存在部分中介效应，围孕期总人群、孕前期、孕早期中介效应分别占其总效应的16.5%、41.2%和5.4%。 结论： 围孕期母亲HCY与子代出生体重下降有关，未发现与SGA存在关联。孕早期亚组母亲HCY升高可能与子代SGA风险增加有关。.

[Abstract] [Full Text] [Related] [New Search]