妊娠期非糖尿病母亲血糖水平与子代5—6岁时体质量指数的相关性

Relationship between blood glucose concentrations of mothers without gestational diabetes mellitns during pregnancy and children＇s body mass index at 5 to 6 years old

目的探讨妊娠期非糖尿病母亲孕期血糖水平与子代5—6岁时体质量指数（BMI）之间的相关性。方法查阅2006年1月至2007年12月在昆明医科大学第一附属医院产科分娩的妊娠期非糖尿病产妇的病历资料，获得其孕期口服葡萄糖耐量试验（OGTT）血糖资料，并对其子代进行随访，获得其子代5～6岁时的身高及体质量资料，计算子代5—6岁时的BMI，采用多元线性回归分析母亲孕期OGTF血糖水平与子代5—6岁时BMI之间的相关性，采用Logistic回归分析预测子代发生超体质量或者肥胖风险。结果共随访5—6岁儿童860例，其中男459例，女401例；BMI为（15．6±2．7）kg／m2，超体质量78例（9．06％），肥胖50例（5．81％）；母亲孕期OGTY0h平均血糖为（3．8±0．6）mmol／L，2h平均血糖为（6．0±0．9）mmol／L；在对孕前BMI、孕期增体质量、性别、出生体质量、年龄及父亲体质量等混杂因素进行校正后，孕期OGTT0h血糖水平≥5．51mmol／L母亲的子代5—6岁时BMI明显高于母亲平均血糖水平低于5．51mmol／L的子代（β=0．45，95％CI：O．15—0．80），且当母亲孕期OGTY0h血糖水平≥5．51mmol／L时，子代发生超体质量风险将增加2倍（OR=2．32，95％CI：1．30—3．96）。结论即使孕前无糖尿病或孕期血糖水平达不到妊娠期糖尿病诊断标准的孕妇，当孕期OGTr空腹血糖大于5．51mmol／L时将可能增加子代5—6岁时超体质量发生的风险。

Objective To investigate the relationship between children＇s body mass index （BMI）at 5 to 6 years old and glucose concentrations of mothers without pre-existing diabetes or a gestational diabetes mellitus （ GDM ） diagnosis during pregnancy. Methods A prospective observational study was performed in offspring whose mother had no pre-existing diabetes or a GDM diagnosis during pregnancy in the First Affiliated Hospital of Kunming Medical Uni- versity from Jan. 2006 to Dee. 2007. The data of maternal glucose concentrations of oral glucose tolerance test（OGTT） were acquired through referring to clinical records. Weight and height at 5 to 6 years old were measured and used to cal- culate BMI. Multivariable linear regression models were used to examine the association between children＇s BMI and maternal glucose concentrations. The influence of maternal glucose concentrations on the risk of overweight of offspring was analyzed by Logistic regression. Results There were 860 cases of children were followed-up, including 459 male cases and 401 female cases. The average BMI of children was（ 15.6± 2.7 ） kg/m2. There were 78 cases of overweight （9.06%） and 50 cases of obesity（5.81% ）. The mean maternal fasting glucose level of the OGTT was（3.8 ± 0.6） mmol/L and 2 h glucose level of the OGTT was （6.0 ± 0.9） mmol/L. After adjusting for progestation BMI, maternal weight gain during pregnancy, sex, birth weight, age and paternal weight, at the 5 to 6 years old, BMI of offspring of mothers whose fasting glucose levd of the OGTT〉5.51 mmol/L were significantly higher than those of mothers whose average blood glucose level 〈 5.51 mmol/L（/3 = 0. 45,95% CI： O. 15 -O. 80）. Maternal fasting glucose level of the OGT＇F i〉 5.51 mmol/L was associated with an greater risk of children＇s overweight （ OR = 2. 32,95 % CI： 1.30 - 3.96）. Conclusions Even though the mother was in the absence of pre-existing diabetes or GDM during pregnancy,fetal ex- posure to high maternal glucose concentration may also promote the development of overweight in the offspring at 5 to 6 years old.