孕早期体质指数和血红蛋白水平与孕中期血糖水平的关联

Correlation of body mass index and hemoglobin level during first trimester to gestational blood glucose level

目的探讨孕早期体质指数(BMI)和血红蛋白(Hb)水平对孕中期血糖的影响,为妊娠期糖尿病的防治提供科学依据。方法通过天津市妇幼卫生信息系统,收集2009-2010年在天津市和平区第1次产检(孕13周之前)的1 819名单胎妊娠孕妇的孕期基本信息、检查结果(Hb水平和BMI)和孕中期(孕24~28周)口服50 g葡萄糖负荷试验(GCT)检测结果。采用SPSS 22.0软件进行t检验和χ^2检检。孕中期血糖水平的影响因素采用多因素logistic回归分析。结果 1 819名孕妇孕早期Hb平均水平为(132.0±11.0)g/L,Hb>150 g/L者占4.5%,超重和肥胖者分别占18.0%和5.8%,孕中期高血糖,即GCT≥7.8 mmol/L者占16.7%。多因素logistic分析显示,孕早期Hb>150 g/L者发生孕中期高血糖的风险是孕早期Hb≤150 g/L者的1.977倍(OR=1.977,95%CI:1.181~3.310)。孕早期超重、肥胖者发生孕中期高血糖的风险分别是BMI正常者的1.794倍(OR=1.794,95%CI:1.316~2.446)、3.220倍(OR=3.220,95%CI:2.033~5.099)。与孕早期非肥胖且Hb≤150g/L者相比,孕早期Hb>150 g/L使肥胖增加高血糖的风险由2.460倍(95%CI:1.520~3.982)升高到11.414倍(95%CI:3.279~39.764),交互作用归因比(AP)为0.737(95%CI:0.415~1.059),交互作用指数(S)为5.188(95%CI:1.293~20.817),均有统计学意义,二者对于高血糖的发生具有相加交互作用。结论孕早期超重、肥胖和高水平Hb是孕中期高血糖的独立危险因素,且升高的Hb会加重肥胖引发孕中期高血糖风险的效应。

Objective To explore the effects of body mass index(BMI) and hemoglobin(Hb) during first trimester on gestational blood glucose level during the second trimester, and to provide the basis for preventing and treating of gestational diabetes mellitus(GDM). Methods The basic information, test results of Hb level and BMI at the first production inspection(before 13 weeks of gestation) and test results of oral glucose 50 g challenge test(GCT) in the second trimester(24-28 weeks of pregnancy) of 1 819 single pregnancy pregnant women in Heping district of Tianjin city between 2009 and 2010 were collected by Tianjin Maternal and Child Health Information System. The t test and χ^2 test were used to analyze the data, the multivariate logistic regression was used to analyze the influencing factors of blood glucose in the second trimester. The used software was SPSS 22.0. Results The average Hb level of 1 819 pregnant women in early pregnancy was(132.0 ±11.0) g/L,4.5% of the women had the Hb >150 g/L;the proportions of overweight and obesity were 18.0% and 5.8%, respectively;16.7% of the women had the GCT≥7.8 mmol/L in the second trimester. The results of multivariate logistic regression analysis demonstrated that the risk of high blood glucose during the second trimester in women with Hb >150 g/L during the first trimester was 1.977 folds, compared with the women with Hb ≤ 150 g/L during the first trimester(OR=1.977, 95%CI: 1.181-3.310);the risk of high blood glucose during the second trimester in women with overweight and obesity during the first trimester was 1.794 folds(OR=1.794, 95%CI: 1.316-2.446) and 3.220 folds(OR=3.220, 95%CI: 2.033-5.099), compared with the women with normal BMI during the first trimester. Compared with the non obesity women with Hb ≤ 150 g/L during the first trimester,the risk of high blood glucose during the second trimester in women with Hb ≤ 150 g/L plus obesity during the first trimester was 2.460 folds(95%CI: 1.520-3.982), the risk in women with Hb > 150 g/L plus obesity during the first trimester increased to 11.414 folds(95% CI: 3.279-39.764). The attributable proportion of interaction(AP) was 0.737(95%CI: 0.415-1.059), and the synergy index(S) was 5.188(95%CI: 1.293-20.817), there was statistical significance. There were the interaction effects of Hb and obesity on high blood glucose. Conclusion Overweight,obesity and high level of Hb during first trimester are independent risk factors for high blood glucose during second trimester, and high level Hb can promote the risk effect of high blood glucose caused by obesity.