不同妊娠季节与孕妇妊娠空腹血糖水平的相关性研究

Gestation season can affect pregnant women′s fasting blood glucose levels during pregnancy

目的研究不同妊娠季节与孕妇妊娠三期空腹血糖水平(FBG)的相关性。方法选取2018年1月至2019年9月在中国医科大学附属第一医院和2018年7月至2019年7月在北部战区总医院和平院区产科门诊就诊的孕妇542名,按妊娠时(末次月经时间)的季节,将孕妇分为春季妊娠组85名、夏季妊娠组55名、秋季妊娠组203名和冬季妊娠组199名。分别于孕早期(孕周<14周)、孕中期(17~22周)、孕晚期(28~32周)检测FBG。采用χ^2检验、Mann-Whitney U检验、Kruskal-Wallis检验和配对Friedman非参数检验比较各组FBG水平及血糖异常的出现比率。以冬季组为参考,分别以FBG≥5.1 mmol/L和FBG≥4.4 mmol/L为切点值,通过二元logistic回归分析评价妊娠季节是否对妊娠期血糖异常存在独立影响。结果与夏季妊娠组相比,其他三组妊娠三期FBG水平均较低(P均<0.05);与春季组相比,冬季组妊娠三期FBG水平均明显更低,秋季组孕中和晚期也明显低于春季组相应水平(P<0.05)。与夏季妊娠组相比,秋季组和冬季组妊娠三期FBG≥5.1 mmol/L者的比率均明显更低(P均<0.05);与春季组和夏季组相比,秋季组和冬季组孕中期<4.4 mmol/L者的比例均明显更高(P均<0.05)。与冬季妊娠相比,夏季妊娠是孕中期和孕晚期FBG水平≥5.1 mmol/L的独立危险因素;与冬季妊娠相比,春季和夏季妊娠是孕中期FBG水平≥4.4 mmol/L的独立危险因素,而秋季妊娠不是孕中、晚期FBG升高的危险因素。结论在既往健康的孕妇中,与春季、夏季妊娠者相比,秋季和冬季妊娠者妊娠三期FBG水平更低;春季和夏季妊娠者发生GDM风险较高,秋季和冬季妊娠者发生GDM的风险可能更小。

Objective To explore the correlation between different gestational seasons and blood fasting blood glucose(FBG)levels in the three trimesters during pregnancy.Methods Five hundred and fourty two healthy women in early pregnancy were included from the First Affiliated Hospital of China Medical University and General Hospital of Northern Theater Command.Participants were divided into spring group(n=85),summer group(n=55),autumn group(n=203)and winter group(n=199)according to the last menstrual period.FBG level was prospectively monitored during the three trimesters of pregnancy.Statistical analysis was performed by chi-square test,Mann-Whitney U test,Kruskal-Wallis test,paired Friedman nonparametric test and binary logistic regression.Results FBG levels in the whole three trimesters of pregnancy were highest in the summer group,followed by spring group,and FBG levels in the autumn and winter groups were significantly lower than the former two groups(P<0.05).Also,among the autumn and winter groups,the percentage of women with FBG≥5.1 mmol/L were significantly lower,and the percentage of women with FBG<4.4 mmol/L were also markedly higher than the former two groups(P<0.05).Binary logistic regression analysis showed that as compared with those who got pregnant in winter,pregnancy in summer was an independent risk factor for FBG levels≥5.1 mmol/L in the second and third trimesters;and that in both spring and summer were also independent risk factors for FBG level≥4.4 mmol/L(indicating high risk of developing GDM)while pregnancy in autumn wasn′t an independent risk factor for increasing FBG level in the second trimester.Conclusions Among the healthy women before pregnancy,those who get pregnant in the autumn and winter may have lower FBG levels during the three trimesters than in the spring and summer.The former women may have a decreased risk of developing GDM.