【作者】 李岩；

【导师】 徐平；

【作者基本信息】 中国医科大学 ， 卫生事业管理， 2023， 博士

【摘要】 目的:出生结局及婴幼儿早期生长发育情况对人的远期健康具有深远的影响,不良出生结局和婴幼儿早期发育异常是成人期慢性病发病的重要诱因。系统的探究不良出生结局和婴幼儿早期生长发育异常的影响因素,制定针对性的预防策略,对于促进儿童健康和预防成人期慢性病具有重要的公共卫生意义。既往研究发现出生结局及婴幼儿生长发育受到母亲妊娠期宫内生理环境因素、营养环境因素及自然环境暴露等多种因素的影响。这些研究多基于抽样样本的出生队列研究,样本量有限且多关注了单一因素的健康效应。目前国内尚缺乏全面探究婴幼儿早期生长发育影响因素的自然人群大样本研究。鉴于此,本研究计划依托辽宁省妇幼保健三级网络,开展前瞻性的大规模自然群人队列研究,系统的探究各类妊娠期风险因素对出生结局和婴幼儿早期发育的关联,为实现儿童的优生优育和健康发育提供参考依据。方法:本课题研究依托辽宁妇幼保健三级监测网络开展。本研究以2012年1月-2018年12月期间在辽宁省各市基层社区卫生服务中心妇保、儿保门诊进行孕期和儿童保健的1026294名孕妇及其子代婴幼儿为研究对象。前瞻性的采集孕妇孕期保健信息、分娩信息、儿童出生缺陷信息、生长发育指标。应用多元Logistic回归模型、线性回归、广义估计方程等模型分析孕妇不同孕期生理指标、体格检查指标和环境污染物暴露浓度与不良出生结局和婴幼儿生长发育情况的关联。具体如下:1.第一部分:依据国家卫健委《妊娠期妇女体重增长推荐值标准》（WS/T801—2022）对孕妇的孕期体重增长（GWG）分为增重不足、增重适宜和过度增重;依据孕妇孕前和孕期血压情况将孕妇分为正常血压、妊娠合并慢性高血压、慢性高血压并发子痫前期、妊娠高血压、子痫前期孕妇;根据孕妇孕早期空腹血糖情况,将<4.0 mmol/L为定义为低空腹血糖,4.0-5.1mmol/L为正常空腹血糖,>5.1mmol/L为高空腹血糖;将孕妇血红蛋白<110g/L则诊断为妊娠期贫血。将出生时体重<2500g定义为低出生体重儿、出生体重>4000g为出生巨大儿;根据国家卫健委发布的《不同胎龄新生儿出生时生长评价标准》[65],将新生儿分为小于胎龄儿、适于胎龄儿及大于胎龄儿;将指妊娠达到28周但不足37周分娩的新生儿定义为早产儿;按照新生儿Apgar评分判定新生儿出生窒息:具体为出生后1分钟Apgar评分≤7分;或出生后1分钟Apgar评分>7分,但5分钟Apgar评分≤7分。分为轻度窒息和重度窒息。轻度窒息是指Apgar评分1分钟≤7分,或者5分钟≤7分;重度窒息是指Apgar评分1分钟≤3分,或者5分钟≤5分。采用多元Logistic回归探究孕前体重指数（BMI）、孕期体重增长（GWG）、妊娠期高血压疾病（HDP）、孕早期空腹血糖、孕早期空腹尿糖、孕早期血红蛋白、孕早期增补叶酸、辅助生殖受孕、孕早期致畸物暴露等宫内生理和营养环境因素对出生巨大儿、低出生体重（LBW）、大于胎龄儿（LGA）、小于胎龄儿（SGA）、早产（PTB）、新生儿窒息等不良出生结局的关联。2.第二部分:参照世界卫生组织（WTO）2006年发布的儿童生长发育标准对婴幼儿的体格发育进行评价。评价指标包含年龄别体重Z评分（Weight-for-age Z-Score,WAZ）、年龄别身长Z评分（Length--for-age Z-Score,LAZ）、年龄别体重指数Z评分（BMI--for-age Z-Score,BAZ）、身长别体重指数（Weight-for-Length Z-Score,WLZ）。婴幼儿超重的评价标准为1SD<BMIZ<2SD,婴儿肥胖的评价标准为BMIZ>2SD。采用广义线性回归模型分析孕前体重指数（BMI）、孕期体重增长（GWG）、妊娠期高血压疾病（HDP）、孕早期空腹血糖、孕早期空腹尿糖、孕早期血红蛋白、孕早期增补叶酸、剖宫产、辅助生殖受孕、孕早期致畸物暴露等宫内生理和营养环境因素对婴幼儿0,1,3,6,12,24月龄时生长发育之间的关联。3.第三部分:应用美国NASA气象卫星数据根据孕妇常住家庭住址,匹配孕妇孕期PM_2.5暴露浓度,将暴露浓度进行四分位分类,应用多元Logistic回归模型、广义估计方程等模型分析PM_2.5暴露浓度与不良出生结局和婴幼儿生长发育情况的关联。探究孕期PM_2.5暴露与出生巨大儿、低出生体重（LBW）、大于胎龄儿（LGA）、小于胎龄儿（SGA）、早产（PTB）、新生儿窒息等不良出生解决的关联以及不同孕期PM_2.5暴露与儿童1周岁、2周岁超重与肥胖的关联。结果:1.第一部分:（1）本研究中,相比于对照组孕妇,孕前低体重、妊娠期增重不足（中国标准）、妊娠期增重不足（IOM标准）、子痫前期、孕早期空腹低血糖、采用辅助生殖受孕、孕早期致畸物暴露的孕妇具有更高的LBW风险,RR值分别为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）孕前超重、孕前肥胖、妊娠期增重过度（中国标准）、妊娠期增重过度（IOM标准）、子痫前期、孕早期空腹高血糖、孕早期空腹尿糖高的孕妇具有更高的分娩巨大儿的风险,RR值分别为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）孕前低体重、妊娠期增重不足（中国标准）、妊娠期增重不足（IOM）、子痫前期、孕早期空腹低血糖、采用辅助生殖受孕的孕妇具有更高的分娩SGA新生儿的风险,RR值分别为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）孕前超重、孕前肥胖、妊娠期增重过度（中国标准）、妊娠期增重过度（IOM）、子痫前期、孕早期空腹高血糖、孕早期空腹尿糖高的孕妇具有更高的分娩LGA新生儿风险、,RR值分别为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）孕前超重、孕前肥胖、妊娠期增重不足（中国标准）、妊娠期增重不足（IOM）、孕早期空腹高血糖、孕早期空腹尿糖高、孕早期血红蛋白过低、采用辅助生殖受孕、孕早期致畸物暴露的孕妇具有更高的早产风险,RR值分别为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）孕前超重、孕前肥胖、妊娠期增重不足（中国标准）、子痫前期、孕早期空腹高血糖、孕早期尿糖高的孕妇分娩新生儿具有更高的轻度窒息的危险,RR值分别为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:1.00-1.20）、1.46（95%CI:1.09-1.97）;新生儿重度窒息的危险因素有子痫前期,RR值为2.36（95%CI:1.55-3.61）。2.第二部分:（1）孕前低体重母亲分娩的各月龄的婴幼儿超重、肥胖的风险较低,孕前超重、肥胖的母亲分娩的各月龄的婴幼儿超重、肥胖的风险高,在24月龄超重的RR值分别为1.59（95%CI:1.47-1.72）、2.17（95%CI:1.98-2.38）;孕前超重、肥胖母亲的婴幼儿在24月龄肥胖的RR值分别为1.99（95%CI:1.71-2.32）、3.40（95%CI:2.89-4.00）。（2）孕期增重不足母亲分娩的各月龄的婴幼儿超重、肥胖的风险较低,孕前增重过度的母亲分娩的各月龄的婴幼儿超重、肥胖的风险高。母亲孕前增重过度的婴幼儿在24月龄超重、肥胖的RR值分别为1.44（95%CI:1.26-1.65）、1.71（95%CI:1.33-2.19）。（3）孕妇发生子痫前期与3、6月龄婴幼儿肥胖发生风险显著相关,RR值分别为1.58（95%CI:1.12-2.22）、1.60（95%CI:1.11-2.31）。（4）孕早期空腹高血糖与3、24月龄婴幼儿肥胖的发生风险显著相关,RR值分别为1.28（95%CI:1.16-1.41）、1.44（95%CI:1.24-1.66）。（5）孕早期尿糖高与12月龄的婴儿超重的发生风险显著相关,RR值为0.77（95%CI:0.61,0.98）。（6）血红蛋白过低与24月龄的婴儿肥胖的发生风险显著相关,RR值为0.73（95%CI:0.56-0.94）。（7）剖宫产与各个月龄婴幼儿超重、肥胖的发病风险显著相关,其中24月龄婴儿超重与肥胖的RR值分别为1.41（95%CI:1.32-1.51）、1.76（95%CI:1.54-2.02）。（8）孕早期致畸物暴露与24月龄婴儿肥胖的发病风险显著相关,RR值为1.67（95%CI:1.23-2.28）。3.第三部分:（1）孕前、孕早期、孕中期、孕晚期PM_2.5暴露暴露水平在IQR4分位均与LBW发生显著相关,RR值分别为0.89（95%CI:0.83,0.95）、0.87（95%CI:0.81-0.92）、0.84（95%CI:0.79-0.90）、0.90（95%CI:0.84-0.97）。（2）孕前PM_2.5暴露在IQR4分位与巨大儿显著相关,RR值为0.96（95%CI:0.93,0.98）。（3）孕前、孕早期、孕中期、孕晚期PM_2.5暴露在IQR4与LGA显著相关,RR值分别为1.05（95%CI:1.03-1.07）、1.05（95%CI:1.03-1.08）、1.05（95%CI:1.03-1.07）、1.05（95%CI:1.02-1.07）。（4）孕前、孕早期、孕中期、孕晚期PM_2.5暴露在IQR4与早产显著相关,,RR值分别为0.88（95%CI:0.85-0.92）、0.90（95%CI:0.86-0.93）、0.92（95%CI:0.89-0.96）0.95（95%CI:0.91-0.99）。（5）孕前、孕早期、孕中期、孕晚期PM_2.5暴露在IQR4与新生儿重度窒息显著相关,RR值分别为0.68（95%CI:0.54-0.86）、0.64（95%CI:0.50-0.81）、0.66（95%CI:0.52-0.85）、0.64（95%CI:0.48-0.84）。（6）孕前、孕早期、孕中期、孕晚期PM_2.5暴露在IQR4与1岁儿童超重显著相关,RR值分别为1.24（95%CI:1.16-1.33）、1.29（95%CI:1.21-1.38）、1.28（95%CI:1.20-1.37）、1.27（95%CI:1.18-1.36）。（7）孕前、孕早期、孕中期、孕晚期PM_2.5暴露在IQR4与2岁儿童肥胖显著相关,RR值分别为1.32（95%CI:1.18-1.47）、1.29（95%CI:1.06-1.58）、1.39（95%CI:1.15-1.69）、1.38（95%CI:1.13-1.68）。结论:1.第一部分:孕前BMI、孕期增重水平、妊娠期高血压疾病、孕早期空腹血糖、孕早期空腹尿糖、孕早期血红蛋白、补充叶酸情况、分娩方式、采用辅助生殖受孕、孕早期致畸物暴露多种妊娠期风险因素均与新生儿出生体重、新生儿宫内生长发育、早产以及新生儿窒息等妊娠结局相关。2.第二部分:孕前BMI、孕期增重水平、妊娠期高血压疾病、孕早期空腹血糖、孕早期空腹尿糖、孕早期血红蛋白、补充叶酸情况、分娩方式、采用辅助生殖受孕、孕早期致畸物暴露多种妊娠期风险因素会与0-2岁儿童WAZ、LAZ、WLZ、BMIZ及超重与肥胖发病相关。3.第三部分:孕前、孕早期、孕中期、孕晚期的PM_2.5的暴露会影响新生儿出生体重、新生儿宫内生长发育、早产以及新生儿窒息等出生结局;孕前、孕早期、孕中期、孕晚期的PM_2.5的暴露与儿童1周岁、2周岁的超重与肥胖相关。更多还原

【Abstract】 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.更多还原