Abstract
Introduction: There are several studies involving the association between Metabolic Syndrome (MS) in pregnancy and unfavorable birth outcomes. However, there is still little data about its impacts on the life cycle.
The aim of this study is to analyze the association between MS in pregnancy and weight excess in the offspring at two years old in two birth cohorts, Ribeirão Preto (RP) and São Luís (SL).
Methods: cohort study started in 2010 during antenatal care (22 - 25 weeks of pregnancy) that involved 1069 mother-newborn couples in RP and 1151 in SL. In antenatal care, mothers were evaluated by questionnaires, blood sampling, anthropometric and blood pressure measurement and were defined whether having or not MS according to an adaptation of the NCEP-ATP III criteria. During the second year of life, the women’s offspring was classified by their BMI (in accordance with WHO’s growth charts) as: severe thinness (Z score < -3), thinness (Z score ≥ -3 and < -2), normal weight (Z score ≥ -2 and ≤ +1), risk of overweight (Z score > +1 and ≤ +2), overweight (Z score > +2 and ≤ +3) and obesity (Z score> +3). Preterm infants were excluded and children classified as at risk of overweight, overweight, and obesity were considered having weight excess. A theoretical model was built using Directed Acyclic Graphs, in which, in addition to MS during pregnancy and BMI in the 2nd year, the following variables were tested: maternal education, socioeconomic level, birth weight and type of delivery. Unadjusted and adjusted logistic regression analyses were applied, with a significance level of 5%.
Results: SL presented higher rates of weight excess at the age of two years than RP (49.59% vs 42.74%; p < 0.001). RP had higher obesity rate (25.43% vs 23.43%; p < 0.001) and SL showed higher risk of overweight (19.83% vs 13.29%; p < 0.001) and overweight (6.5% vs 4.93%; p < 0.001). With respect to maternal pregnancy metabolic variables, RP showed higher rates of obesity (13.6% vs 5.63%; p < 0.001), hypertension (4.01% vs 2.05%; p = 0.002) and fasting glucose ≥ 100mg/dl (16.51% vs 9.98%; p < 0.001); there was no difference concerning HDL-cholesterol. In adjusted analysis, weight excess at two years was associated with macrosomia (RR 1.93; 95% CI 1.16- 3.2) and socioeconomic level class C (RR 1.35; 1.02-1.78) in RP. There was no association with maternal MS, type of delivery or parity. In SL, associations between weight excess at the age of two and macrosomia (RR 1.81; 1.11-2.97) and cesarean section (RR 1.47; 1.62-1.86) was found. There was no association with maternal MS, parity or socioeconomic level.
Conclusions: Weight excess at the age of two years was associated with macrosomia in both cities. In SL, with a higher rate of cesarean section, this mode of delivery was associated with weight excess at two years as well. No correlation between maternal MS and weight excess at two years was found in any of the cities.
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