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

Associations of Pre-pregnancy Body Mass Index and Gestational Weight Gain with Gestational Diabetes Mellitus:a Cohort Study in Southwest China

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.