孕早期中度及以上体力活动降低妊娠期糖尿病的发病风险

Moderate-to-vigorous intensity physical activity in early pregnancy reduces risk of gestational diabetes mellitus

目的探讨四川地区女性孕早期中度及以上体力活动(moderate-to-vigorous intensity physical activity, MVPA)时间对妊娠期糖尿病(gestational diabetes mellitus, GDM)的影响。 方法采用病例对照研究,选取2017年2月至7月在四川省妇幼保健院产前门诊建卡的孕8~14周妇女为研究对象。通过问卷调查收集孕妇孕早期基线信息;应用孕期体力活动量表收集孕妇在孕早期的体力活动时间及强度,计算其MVPA时间和评价体力活动活跃程度;测量身高,结合问卷收集到的自报孕前体重计算孕前体重指数;于孕24~28周行75 g口服葡萄糖耐量试验,按照我国"妊娠合并糖尿病诊治指南(2014)"诊断标准将孕妇分为GDM组(561例)和非GDM组(947例)。采用Mann-Whitney U检验、χ^2检验进行统计学分析,采用多因素非条件logistic回归方法分析孕早期MVPA时间对GDM的影响。 结果所有孕妇孕早期MVPA中位时间[M(P25~P75)]为3.00(0.50~3.12) h/周,其中体力活动活跃者(MVPA时间≥3.5 h/周)345例,占22.9%。控制年龄、孕次、产次、孕前体重指数等混杂因素后,多因素非条件logistic回归分析显示:孕早期体力活动活跃孕妇GDM发生风险较体力活动非活跃者(MVPA时间<3.5 h/周)降低26.1%(OR=0.739,95%CI:0.553~0.989,P=0.042)。在初孕和初产妇中,孕早期体力活动活跃孕妇GDM发生风险较非活跃者分别降低47.6%(OR=0.524,95%CI:0.297~0.925,P=0.026)和44.3%(OR=0.557,95%CI:0.357~0.868,P=0.010)。 结论四川地区孕妇孕早期体力活动普遍不足,孕早期MVPA时间≥3.5 h/周可降低GDM的发病风险,以初孕及初产妇明显。

ObjectiveTo investigate the effects of moderate-to-vigorous intensity physical activity (MVPA) in early pregnancy on the onset of gestational diabetes mellitus (GDM) in Sichuan Province. MethodsA case-control study was performed on 1 508 gravidas at 8-14 gestational weeks in Sichuan Provincial Hospital for Women and Children from February to July, 2017. Baseline information during early pregnancy was collected through questionnaires. Information on time and intensity of physical activity were collected through pregnancy physical activity questionnaire. The time spent in MVPA was calculated and was categorized as active (≥3.5 h/week) or inactive MVPA (<3.5 h/week). Based on self-reported pre-pregnancy weights collected by questionnaire as well as the measured heights, body mass index (BMI) before pregnancy was calculated. After a 75 g oral glucose tolerance test (OGTT) at 24-28 gestational weeks, all subjects were divided into GDM (n=561) or non-GDM group (n=947), according to the GDM diagnostic criteria of the Guidelines for the Diagnosis and Treatment of Pregnancy Diabetes in China (2014). Mann-Whitney U test and Chi-square test were used for statistical analysis. Multivariate unconditional logistic regression model was used to analyze the association between the time of MVPA in early pregnancy and GDM incidence. ResultsThe median time spent in MVPA [M(P25-P75)] in early pregnancy was 3.00 (0.50-3.12) h/week, and 345 gravidas (22.9%) were classified as active in MVPA. After the control of confounding factors such as age, gravidity and parity history, and pre-pregnancy BMI, the multivariate unconditional logistic regression analysis showed that compared with the inactive group, the risk of GDM of active MVPA gravidas was reduced by 26.1%(OR=0.739, 95%CI: 0.553-0.989, P=0.042). Among primigravidas and primiparae, the risk of GDM in active MVPA gravidas was decreased by 47.6% and 44.3% than the inactive ones, respectively (primigravidas: OR=0.524, 95%CI: 0.297-0.925, P=0.026;primiparae: OR=0.557, 95%CI: 0.357-0.868, P=0.010). ConclusionsInsufficient physical activity in early pregnancy is common in gravidas in Sichuan, China. The risk of GDM could be reduced if the frequency of MVPA during early pregnancy is no less than 3.5 h/week, especially in primigravidas and primiparae.