中国西南地区妇女孕前体质量指数、孕期增重与妊娠期糖尿病关系的前瞻性队列研究
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摘要
目的分析中国西南地区育龄妇女孕前体质量指数、孕期不同时期体质量增长与妊娠期糖尿病(GDM)的关系。方法采用前瞻性队列研究(GDM组3 593例,对照组15 346例)的方法,选取18 939例于2013～2015年在四川、贵州、云南定期产检的单胎孕妇,测量身高及孕期体质量,于孕24～28周进行GDM筛查。采用多因素logistic回归分析孕前体质量指数(BMI)(暴露水平1)、孕期增重(暴露水平2)与GDM结局的关系。结果孕前超重和肥胖可增加GDM的发生风险[比值比(OR)=2.44,95%可信区间(CI):1.98～2.99;OR=4.98,95%CI:2.52～9.91)。采用美国国家科学院医学研究所(IOM)孕期增重标准,调整了预产年龄及孕前BMI后,与增重适宜组相比,孕早期增重过多或孕中期增重过多均是GDM的危险因素(OR=1.33,95%CI:1.03～1.70;OR=1.48,95%CI:1.26～1.72)。孕早期,高龄组(预产年龄≥35岁)中,与增重适宜者相比,孕期增重过多发生GDM的风险更大[OR和95%CI为1.42(1.02～2.28)],而非高龄组(预产年龄<35岁)中,上述OR值无统计学意义;孕中期,高龄组和非高龄组发生GDM的风险均是增重过多者高于增重适宜者[OR和95%CI分别为1.59(1.14～1.88)和1.49(1.20～1.72)]。结论在中国西南地区的妇女中,孕前超重和肥胖、孕期增重过多均是GDM的危险因素,孕期增重过多的高龄妇女尤应注意。
Objective To determine the associations of pre-pregnancy body mass index(BMI)and gestational weight gain(GWG)with gestational diabetes mellitus(GDM).Methods A prospective cohort of pregnant women were screened for GDM at 24-28 weeks of gestation between 2013 and 2015,resulting in a sample of 3 593 with GDM and 15 346 without GDM.The body mass,plasma glucose,and height data of the participants were collected by the local medical workers.Multivariate logistic regression analyses were performed to determine the associations of pre pregnancy body mass index and weight gain during pregnancy with GDM.Results The participants with pre pregnancy overweight[odds ratio(OR)=2.44,95% cofidence interval(CI)1.98-2.99]and obesity(OR=4.98,95%CI2.52-9.91)were more likely to develop GDM.According to the Institute of Medicine(IOM)criteria,excessive GWG in the first trimester occurred in 8.46% of the women,compared with 55.07% in the second trimester.After adjustment for age at delivery and pre pregnancy BMI,high GWG in the first trimesters in advanced maternal age(age at delivery≥35yr.)group(OR=1.42,95%CI1.02-2.28)was a risk factor for GDM while the OR value of the non-advanced maternal age(age at delivery≤35 yr.)group was not statistically significant.In second trimesters,both advanced maternal age group(OR=1.59,95%CI 1.14-1.88)and nonadvanced maternal age group(OR=1.49,95%CI1.20-1.72)in high GWG were associated with high risk of GDM.Conclusion Pre pregnancy overweight and obesity and excessive GWG during early and second trimesters of pregnancy may increase the risk of GDM in women in Southwestern China.
Objective To determine the associations of pre-pregnancy body mass index(BMI)and gestational weight gain(GWG)with gestational diabetes mellitus(GDM).Methods A prospective cohort of pregnant women were screened for GDM at 24-28 weeks of gestation between 2013 and 2015,resulting in a sample of 3 593 with GDM and 15 346 without GDM.The body mass,plasma glucose,and height data of the participants were collected by the local medical workers.Multivariate logistic regression analyses were performed to determine the associations of pre pregnancy body mass index and weight gain during pregnancy with GDM.Results The participants with pre pregnancy overweight[odds ratio(OR)=2.44,95% cofidence interval(CI)1.98-2.99]and obesity(OR=4.98,95%CI2.52-9.91)were more likely to develop GDM.According to the Institute of Medicine(IOM)criteria,excessive GWG in the first trimester occurred in 8.46% of the women,compared with 55.07% in the second trimester.After adjustment for age at delivery and pre pregnancy BMI,high GWG in the first trimesters in advanced maternal age(age at delivery≥35yr.)group(OR=1.42,95%CI1.02-2.28)was a risk factor for GDM while the OR value of the non-advanced maternal age(age at delivery≤35 yr.)group was not statistically significant.In second trimesters,both advanced maternal age group(OR=1.59,95%CI 1.14-1.88)and nonadvanced maternal age group(OR=1.49,95%CI1.20-1.72)in high GWG were associated with high risk of GDM.Conclusion Pre pregnancy overweight and obesity and excessive GWG during early and second trimesters of pregnancy may increase the risk of GDM in women in Southwestern China.
引文
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[11]American Diabetes Association.Diagnosis and classification of diabetes mellitus.Diabetes Care,2012,35Suppl 1:S64-S71.
[12]XI B,LIANG Y,HE T,et al.Secular trends in the prevalence of general and abdominal obesity among Chinese adults,1993-2009.Obes Rev,2012,13(3):287-296.
[13]PEREIRA MA,KARTASHOV AI,EBBELING CB,et al.Fast-food habits,weight gain,and insulin resistance(the CARDIA study):15-year prospective analysis.Lancet,2015,365(9453):36-42.
[14]HAMMAN RF,WING RR,EDELSTEIN SL,et al.Effect of weight loss with lifestyle intervention on risk of diabetes.Diabetes Care,2006,29(9):2102-2107.
[15]HEDDERSON MM,GUNDERSON EP,FERRARA A.Gestational weight gain and risk of gestational diabetes mellitus.Obstet Gynecol,2010,115(3):597-604.
[16]HERRING SJ,OKEN E,RIFAS-SHIMAN SL,et al.Weight gain in pregnancy and risk of maternal hyperglycemia.Am J Obstet Gynecol,2009,201(1):61.e1-e7[2018-01-03].https://doi.org/10.1016/j.ajog.2009.01.039.
[17]TOVAR A,MUST A,BERMUDEZ OI,et al.The impact of gestational weight gain and diet on abnormal glucose tolerance during pregnancy in Hispanic women.Matern Child Health J,2009,13(4):520-530.
[18]陈燕容,罗交,薛红妹,等.成都市孕妇孕期增重与妊娠期糖尿病、孕中期血脂的关系.现代预防医学,2016,43(14):2568-2576.
[19]GORBER SC,TREMBLAY M,MOHER D,et al.Acomparison of direct vs.self-report measures for assessing height,weight and body mass index:a systematic review.Obes Rev,2007,8(4):307-326.
[2]ZHU WW,YANG HX,WEI YM,et al.Evaluation of the value of fasting plasma glucose in the first prenatal visit to diagnose gestational diabetes mellitus in China.Diabetes Care,2013,36(3):586-590.
[3]HAPO Study Cooperative Research Group,METZGER BE,LOWE LP,et al.Hyperglycemia and adverse pregnancy outcomes.N Engl J Med,2008,358(19):1991-2002.
[4]KIM C,NEWTON KM,KNOPP RH.Gestational diabetes and the incidence of type 2diabetes:a systematic review.Diabetes Care,2002,25(10):1862-1868.
[5]American Diabetes Association.Gestational diabetes mellitus.Diabetes Care,2004,27Suppl 1:S88-S90.
[6]SOLOMON CG,WILLETT WC,CAREY VJ,et al.Aprospective study of pregravid determinants of gestational diabetes mellitus.JAMA,1997,278(13):1078-1083.
[7]KUBO A,FERRARA A,LAURENT CA,et al.Associations between maternal pregravid obesity and gestational diabetes and the timing of pubarche in daughters.Am J Epidemiol,2016,184(1):7-14.
[8]OGONOWSKI J,MIAZGOWSKI T,KUCZY'NSKA M,et al.Pregravid body mass index as a predictor of gestational diabetes mellitus.Diabet Med,2009,26(4):334-338.
[9]CARRENO CA,CLIFTON RG,HAUTH JC,et al.Excessive early gestational weight gain and risk of gestational diabetes mellitus in nulliparous women.Obstet Gynecol,2012,119(6):1227-1233.
[10]RASMUSSEN KM,YAKTINE AL.Weight gain during pregnancy:reexamining the guidelines.Washington,DC:National Academy Press,2009:14-73.
[11]American Diabetes Association.Diagnosis and classification of diabetes mellitus.Diabetes Care,2012,35Suppl 1:S64-S71.
[12]XI B,LIANG Y,HE T,et al.Secular trends in the prevalence of general and abdominal obesity among Chinese adults,1993-2009.Obes Rev,2012,13(3):287-296.
[13]PEREIRA MA,KARTASHOV AI,EBBELING CB,et al.Fast-food habits,weight gain,and insulin resistance(the CARDIA study):15-year prospective analysis.Lancet,2015,365(9453):36-42.
[14]HAMMAN RF,WING RR,EDELSTEIN SL,et al.Effect of weight loss with lifestyle intervention on risk of diabetes.Diabetes Care,2006,29(9):2102-2107.
[15]HEDDERSON MM,GUNDERSON EP,FERRARA A.Gestational weight gain and risk of gestational diabetes mellitus.Obstet Gynecol,2010,115(3):597-604.
[16]HERRING SJ,OKEN E,RIFAS-SHIMAN SL,et al.Weight gain in pregnancy and risk of maternal hyperglycemia.Am J Obstet Gynecol,2009,201(1):61.e1-e7[2018-01-03].https://doi.org/10.1016/j.ajog.2009.01.039.
[17]TOVAR A,MUST A,BERMUDEZ OI,et al.The impact of gestational weight gain and diet on abnormal glucose tolerance during pregnancy in Hispanic women.Matern Child Health J,2009,13(4):520-530.
[18]陈燕容,罗交,薛红妹,等.成都市孕妇孕期增重与妊娠期糖尿病、孕中期血脂的关系.现代预防医学,2016,43(14):2568-2576.
[19]GORBER SC,TREMBLAY M,MOHER D,et al.Acomparison of direct vs.self-report measures for assessing height,weight and body mass index:a systematic review.Obes Rev,2007,8(4):307-326.
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