A Study On The Correlation Between The Influencing Factors In Early Life And Infants’ The Growth And Development

Objective:Birth outcomes and early growth and development of infants and young children have a profound impact on long-term health.Adverse birth outcomes and early developmental abnormalities in infants and young children are important predisposing factors for the onset of chronic diseases in adulthood.Systematically exploring the influencing factors of adverse birth outcomes and early growth and development abnormalities in infants and young children,and formulating targeted prevention strategies have important public health significance for promoting child health and preventing chronic diseases in adulthood.Previous studies have found that birth outcomes and infant growth and development are influenced by multiple factors such as maternal intrauterine physiological environmental factors,nutritional environmental factors,and natural environmental exposure during pregnancy.These studies are mostly based on sampled birth cohort studies,with a limited sample size and focus on the health effects of a single factor.Currently,there is a lack of large-scale natural population studies that comprehensively explore the factors affecting early growth and development of infants and young children in China.In view of this,this research plan relies on the three-level network of maternal and child health care in Liaoning Province to carry out a prospective large-scale natural population cohort study,systematically exploring the relationship between various pregnancy risk factors and birth outcomes and early infant development,providing a reference basis for achieving optimal birth and healthy development of children.Method:The research of this topic is based on the three-level monitoring network of maternal and child health in Liaoning.This study was conducted on 1026294 pregnant women and their offspring infants who received maternal and child health care at the maternal and child health clinics of community health service centers in various cities of Liaoning Province from January 2012 to December 2018.Prospective collection of maternal health information,delivery information,child birth defects information,and growth and development indicators.Multiple logistic regression models,linear regression,generalized estimation equations,and other models were used to analyze the correlation between physiological indicators,physical examination indicators,and environmental pollutant exposure concentrations of pregnant women at different stages of pregnancy and adverse birth outcomes,as well as infant growth and development.The details are as follows:1.Part Ⅰ:According to the"Recommended Value Standard for Weight Gain in Pregnant Women"（WS/T801-2022）issued by the National Health Commission,pregnant women’s weight gain during pregnancy（GWG）is divided into insufficient,moderate,and excessive weight gain;Pregnant women were divided into normal blood pressure,pregnancy with chronic hypertension,chronic hypertension with preeclampsia,pregnancy with hypertension,and preeclampsia based on their blood pressure before and during pregnancy;According to the fasting blood glucose status of pregnant women in the early pregnancy,<4.0 mmol/L is defined as low fasting blood glucose,4.0-5.1 mmol/L is normal fasting blood glucose,and>5.1 mmol/L is high fasting blood glucose;Pregnant women with hemoglobin<110g/L were diagnosed as anemia during pregnancy.The definition of a low birth weight infant with a birth weight of<2500g and a birth weight of>4000g is macrosomia;According to the"Evaluation Criteria for Growth of Newborn Children of Different Gestational Ages at Birth"issued by the National Health and Health Commission^[65],newborns are divided into smaller than gestational age infants,suitable for gestational age infants,and larger than gestational age infants;A newborn whose pregnancy reaches 28 weeks but is delivered less than 37 weeks is defined as a premature infant;Neonatal asphyxia was judged according to the Apgar score of the newborn:specifically,the Apgar score≤7 points 1 minute after birth;Or Apgar score>7points at 1 minute after birth,but Apgar score≤7 points at 5 minutes.It is divided into mild asphyxia and severe asphyxia.Mild asphyxia refers to an Apgar score of 1 minute≤7 points,or 5 minutes≤7 points;Severe asphyxia refers to an Apgar score of 1 minute≤3 points,or 5 minutes≤5 points.Multiple logistic regression was used to investigate the effects of prenatal body mass index（BMI）,gestational weight gain（GWG）,hypertensive disorder complicating pregnancy（HDP）,fasting blood glucose,fasting urine glucose,hemoglobin,folic acid supplementation,assisted reproductive conception,exposure to teratogens,and other intrauterine physiological and nutritional environmental factors on macrosomia,low birth weight（LBW）,greater than gestational age（LGA）Association of adverse birth outcomes such as small for gestational age（SGA）,premature delivery（PTB）,and neonatal asphyxia.2.Part Ⅱ:Evaluate the physical development of infants and young children with reference to the World Health Organization（WTO）child growth and development standards issued in 2006.The evaluation indicators include the Weight for age Z-Score（WAZ）,Length for age Z-Score（LAZ）,BMI for age Z-Score（BAZ）,and Weight for Length Z-Score（WLZ）.The evaluation standard for overweight infants is1SD<BMI<2SD,and the evaluation standard for obesity infants is BMI>2SD.A generalized linear regression model was used to analyze the association between intrauterine physiological and nutritional environmental factors such as pre pregnancy body mass index（BMI）,gestational weight gain（GWG）,hypertensive disorder complicating pregnancy（HDP）,fasting blood glucose during early pregnancy,fasting urine glucose during early pregnancy,hemoglobin during early pregnancy,folic acid supplementation during early pregnancy,cesarean section,assisted reproductive pregnancy,and exposure to teratogens during early pregnancy,on the growth and development of infants at 0,1,3,6,12,24 months of age.3.Part Ⅲ:Using NASA meteorological satellite data to match the PM_2.5exposure concentration of pregnant women during pregnancy based on their permanent home address,the exposure concentration was classified into quartiles.Multiple logistic regression models,generalized estimation equations,and other models were used to analyze the correlation between PM_2.5exposure concentration and adverse birth outcomes and infant growth and development.To explore the association of PM_2.5exposure during pregnancy with adverse birth outcomes such as macrosomia,low birth weight（LBW）,greater than gestational age（LGA）,smaller than gestational age（SGA）,premature delivery（PTB）,neonatal asphyxia,and the association of PM_2.5exposure during different pregnancy periods with overweight and obesity in children aged 1 and 2.Result:1.Part Ⅰ:（1）In this study,compared to the control group,pregnant women with low weight before pregnancy,insufficient weight gain during pregnancy（Chinese standard）,insufficient weight gain during pregnancy（IOM standard）,preeclampsia,fasting hypoglycemia during early pregnancy,assisted reproductive conception,and exposure to teratogens during early pregnancy had a higher risk of LBW,with RR values of 1.58（95%CI:1.47-1.70）,1.60（95%CI:1.40-1.82）,1.46（95%CI:1.32-1.62）、3.61（95%CI:3.18-4.10）、1.05（95%CI:0.96-1.15）、2.69（95%CI:2.24-3.22）、1.17（95%CI:1.03-1.32）。（2）Pregnant women who are overweight before pregnancy,obese before pregnancy,overweight during pregnancy（Chinese standard）,overweight during pregnancy（IOM standard）,preeclampsia,fasting hyperglycemia during early pregnancy,and high fasting urine glucose during early pregnancy have a higher risk of delivering macrosomia,with RR values of 1.88（95%CI:1.84-1.92）,2.79（95%CI:2.72-2.85）,2.15（95%CI:2.07-2.23）,2.10（95%CI:2.02-2.17）,1.50（95%CI:1.38-1.64）1.46（95%CI:1.43-1.49）、1.67（95%CI:1.55-1.79）。（3）Pregnant women with low weight before pregnancy,insufficient weight gain during pregnancy（Chinese standard）,insufficient weight gain during pregnancy（IOM）,preeclampsia,fasting hypoglycemia during early pregnancy,and assisted reproduction have a higher risk of delivering SGA newborns,with RR values of 1.68（95%CI:1.62-1.74）,1.40（95%CI:1.29-1.51）,1.44（95%CI:1.36-1.53）,2.07（95%CI:1.87-2.30）,1.16（95%CI:1.10-1.22）1.41（95%CI:1.17-1.69）。（4）Pregnant women who are overweight before pregnancy,obese before pregnancy,overweight during pregnancy（Chinese standard）,overweight during pregnancy（IOM）,preeclampsia,fasting hyperglycemia during early pregnancy,and high fasting urine glucose during early pregnancy have a higher risk of LGA delivery,with RR values of 1.68（95%CI:1.66-1.71）,2.36（95%CI:2.31-2.40）,1.78（95%CI:1.73-1.83）,1.77（95%CI:1.72-1.82）,1.31（95%CI:1.23-1.41）1.34（95%CI:1.32-1.36）、1.51（95%CI:1.42-1.60）。（5）Pregnant women who are overweight before pregnancy,obese before pregnancy,insufficient weight gain during pregnancy（Chinese standard）,insufficient weight gain during pregnancy（IOM）,fasting hyperglycemia during early pregnancy,high fasting urine glucose during early pregnancy,low hemoglobin during early pregnancy,assisted reproductive conception,and exposure to teratogens during early pregnancy have a higher risk of premature delivery,with RR values of 1.29（95%CI:1.25-1.33）,1.72（95%CI:1.66-1.78）,1.74（95%CI:1.61-1.88）1.50（95%CI:1.41-1.59）、2.63（95%CI:2.40-2.88）、1.19（95%CI:1.15-1.22）、1.66（95%CI:1.50-1.82）、1.05（95%CI:1.01-1.10）、3.39（95%CI:3.01-3.83）、1.10（95%CI:1.02-1.19）。（6）Factors such as overweight before pregnancy,obesity before pregnancy,insufficient weight gain during pregnancy（Chinese standard）,preeclampsia,fasting hyperglycemia during early pregnancy,and high urine sugar during early pregnancy are associated with a higher risk of mild asphyxia in newborns delivered by pregnant women,with RR values of 1.17（95%CI:1.07-1.28）,1.46（95%CI:1.32-1.62）,2.09（95%CI:1.61-2.73）,1.10（95%CI:1.0-1.20）,and 1.46（95%CI:1.09-1.97）,respectively;The risk factor for severe neonatal asphyxia is preeclampsia,with a RR value of 2.36（95%CI:1.55-3.61）.2.Part Ⅱ:（1）The risk of overweight and obesity in infants born to low weight mothers before pregnancy is low,while the risk of overweight and obesity in infants born to overweight and obese mothers before pregnancy is high,with RR values of 1.59（95%CI:1.47-1.72）and 2.17（95%CI:1.98-2.38）at 24 months of age,respectively;The RR values of obese infants from overweight and obese mothers before pregnancy at the age of 24months were 1.99（95%CI:1.71-2.32）and 3.40（95%CI:2.89-4.00）,respectively.（2）Infants born to mothers with insufficient weight gain during pregnancy have a lower risk of being overweight and obese,while infants born to mothers with excessive weight gain before pregnancy have a higher risk of being overweight and obese.The RR values for overweight and obesity in infants whose mothers gained excessive weight before pregnancy were 1.44（95%CI:1.26-1.65）and 1.71（95%CI:1.33-2.19）at the age of 24 months.（3）Prevalence of preeclampsia in pregnant women was significantly associated with the risk of obesity in infants at 3 and 6 months of age,with RR values of 1.58（95%CI:1.12-2.22）and 1.60（95%CI:1.11-2.31）,respectively.（4）Fasting hyperglycemia in early pregnancy was significantly associated with the risk of obesity in infants at 3 and 24 months of age,with RR values of 1.28（95%CI:1.16-1.41）and 1.44（95%CI:1.24-1.66）,respectively.（5）High urine sugar in the first trimester of pregnancy was significantly associated with the risk of overweight in 12 month old infants,with a RR value of 0.77（95%CI:0.61,0.98）.（6）Hypohemoglobin was significantly associated with the risk of obesity in 24month old infants,with a RR value of 0.73（95%CI:0.56-0.94）.（7）Cesarean section was significantly associated with the risk of overweight and obesity in infants at various months of age,with the RR values of overweight and obesity in infants at 24 months of age being 1.41（95%CI:1.32-1.51）and 1.76（95%CI:1.54-2.02）,respectively.（8）Exposure to teratogens during early pregnancy was significantly associated with the risk of obesity in 24 month old infants,with a RR value of 1.67（95%CI:1.23-2.28）.3.Part Ⅲ:（1）PM_2.5exposure levels were significantly associated with LBW in the IQR4percentile before pregnancy,early pregnancy,mid pregnancy,and late pregnancy,with RR values of 0.89（95%CI:0.83,0.95）,0.87（95%CI:0.81-0.92）,0.84（95%CI:0.79-0.90）,and 0.90（95%CI:0.84-0.97）,respectively.（2）Exposure to PM_2.5before pregnancy in the IQR4 quantile was significantly associated with macrosomia,with a RR value of 0.96（95%CI:0.93,0.98）.（3）PM_2.5exposure to IQR4 before,during,during,and during pregnancy was significantly associated with LGA,with RR values of 1.05（95%CI:1.03-1.07）,1.05（95%CI:1.03-1.08）,1.05（95%CI:1.03-1.07）,and 1.05（95%CI:1.02-1.07）,respectively.（4）PM_2.5exposure to IQR4 before,during,during,and during pregnancy was significantly associated with preterm birth,with RR values of 0.88（95%CI:0.85-0.92）,0.90（95%CI:0.86-0.93）,0.92（95%CI:0.89-0.96）,and 0.95（95%CI:0.91-0.99）,respectively.（5）PM_2.5exposure to IQR4 before,during,during,and during pregnancy was significantly associated with severe neonatal asphyxia,with RR values of 0.68（95%CI: 0.54-0.86）,0.64（95%CI:0.50-0.81）,0.66（95%CI:0.52-0.85）,and 0.64（95%CI:0.48-0.84）,respectively.（6）PM_2.5exposure to IQR4 before,during,during,and during pregnancy was significantly associated with overweight in 1-year-old children,with RR values of 1.24（95%CI:1.16-1.33）,1.29（95%CI:1.21-1.38）,1.28（95%CI:1.20-1.37）,and 1.27（95%CI:1.18-1.36）,respectively.（7）PM_2.5exposure to IQR4 before,during,during,and during pregnancy was significantly associated with obesity in 2-year-old children,with RR values of 1.32（95%CI:1.18-1.47）,1.29（95%CI:1.06-1.58）,1.39（95%CI:1.15-1.69）,and 1.38（95%CI:1.13-1.68）,respectively.Conclusion:1.Part Ⅰ:Pre pregnancy BMI,gestational weight gain levels,hypertensive disorders during pregnancy,fasting blood glucose,fasting urine glucose,hemoglobin,folic acid supplementation,delivery methods,assisted reproductive conception,and exposure to teratogens in early pregnancy.Various pregnancy risk factors are associated with pregnancy outcomes such as neonatal birth weight,intrauterine growth and development,premature delivery,and neonatal asphyxia.2.Part Ⅱ:Pre pregnancy BMI,gestational weight gain levels,hypertensive disorder during pregnancy,fasting blood glucose,fasting urine glucose,hemoglobin,folic acid supplementation,delivery methods,assisted reproductive conception,exposure to teratogens in early pregnancy,multiple pregnancy risk factors in children aged 0-2 years,including WAZ,LAZ,WLZ,BMI,and overweight,are associated with obesity.3.Part Ⅲ:Exposure to PM_2.5before,during,during,and during pregnancy can affect birth outcomes such as newborn birth weight,intrauterine growth and development,premature delivery,and neonatal asphyxia;Exposure to PM_2.5before,during,during,and during pregnancy is associated with overweight and obesity in children aged 1 and 2.