孕期增重及总增重与妊娠期糖尿病关系的队列研究

Association between gestational weight gain per trimester/total gestational weight gain and gestational diabetes mellitus

目的 探讨孕期增重及其总增重与妊娠期糖尿病（GDM）的关系。方法 采用前瞻性队列研究，于2013年3-9月选取成都市妇幼医疗机构产前门诊829名单胎健康孕妇作为基线调查对象，通过问卷调查于首次纳入时收集孕妇孕前等基线资料，于孕第（12±1）、（28±1）、（36±1）周及分娩前分别收集孕妇锻炼习惯、膳食摄入情况等信息和测量孕妇体重，分娩后收集分娩孕周等分娩信息。GDM诊断按中国妊娠合并糖尿病防治指南（2014），采用多因素logistic回归分析孕早、中、晚期增重和孕期总增重与GDM的关系。结果 共682名孕妇纳入数据分析。控制生育年龄、孕前BMI、糖尿病家族史、高血压家族史、孕早期锻炼、产次、文化程度、家庭人均月收入及膳食能量等混杂因素后，多因素logistic回归分析显示：与孕早期增重适宜组相比，孕早期增重不足组和增重过多组GDM发生风险均增加（分别为OR=1.23，95% CI：0.63-2.38和OR=2.20，95% CI：1.12-4.35）；与孕中期增重适宜组相比，孕中期增重不足组和过多组GDM发生风险均降低（OR=0.47，95% CI：0.18-1.19和OR=0.78，95% CI：0.43-1.42）；与孕晚期增重适宜组相比，孕晚期增重不足组GDM发生风险增加（OR=1.48，95% CI：0.77-2.84），增重过多组GDM发生风险降低（OR=0.53，95% CI：0.28-0.99）；与孕期总增重适宜组相比，总增重不足组GDM发生风险增加（OR=2.16，95% CI：1.04-4.46），总增重过多组GDM发生风险降低（OR=0.74，95% CI：0.38-1.46）。结论 孕早期增重不足和过多均可能增加GDM发生风险，孕早期可能是影响GDM发生的关键时期，孕中晚期增重对GDM的影响还有待进一步论证。

Objective To understand the association between gestational weight gain （GWG） per trimester/total （GWG） and gestational diabetes mellitus （GDM）. Methods A prospective cohort study was conducted among 829 healthy pregnant women from Chengdu who delivered a singleton during March-September 2013. Basic information about pre-pregnancy was collected at the first time, exercise information per trimester, dietary intake information per trimester and gestational age at delivery were obtained by questionnaire. Weight at the （12±1）th, （28±1）th, （36±1）th and last week before delivery were measured. GDM was diagnosed according to the National Diabetes and Pregnancy Prevention Guidelines （2014）. At last, a total of 682 pregnant women were analyzed. After controlling the potential confounders, multiple logistic regression models were used to test the associations between GWG per trimester/total GWG and GDM. Results After adjusting for age at delivery, pre-pregnancy body mass index, family histories of type 2 diabetes and hypertension, exercise in the first trimester, parity and energy intake in trimester and other potential confounders. Compared with adequate GWG in the first trimester, insufficient and excessive GWG in the first trimester were associated with increased risk of GDM （OR=1.23, 95%CI：0.63-2.38, and OR=2.20, 95%CI：1.12-4.35）. Compared with adequate GWG in the second trimester, insufficient and excessive GWG in the second trimester were associated with decreased risk of GDM （OR=0.47, 95%CI：0.18-1.19, and OR=0.78, 95%CI：0.43-1.42）. Compared with adequate GWG in the third trimester, insufficient GWG in the third trimester was associated with increased risk of GDM （OR=1.48, 95%CI：0.77-2.84）, excessive GWG in the third trimester was associated with decreased risk of GDM （OR=0.53, 95%CI：0.28-0.99）. Compared with adequate total GWG in pregnancy, insufficient GWG in pregnancy was associated with increased risk of GDM （OR=2.16, 95%CI：1.04-4.46）, excessive GWG in pregnancy was associated with decreased risk of GDM （OR=0.74, 95%CI：0.38-1.46）.Conclusions Insufficient and excessive GWG in the first trimester were associated with increased risk of GDM, the first trimester may represent a critical period for risk of GDM. The effects of GWG in the second and third trimester on GDM need further study.