孕早期脂蛋白a水平与妊娠期糖尿病的前瞻性队列研究

Association of lipoprotein a in early pregnancy with gestational diabetes mellitus:a prospective cohort study

目的:探讨孕早期脂蛋白a(Lpa)水平与妊娠期糖尿病(GDM)的关系。方法:以“母体关键营养素与子代特应性皮炎”队列中的445名孕12~14周孕妇为研究对象,通过问卷调查收集一般人口学特征,检测孕早期空腹糖脂代谢指标,随访孕24~28周口服糖耐量试验(OGTT)结果。应用多因素logistic回归分析Lpa水平与GDM的关系,计算OR值及其95%CI。结果:孕中期GDM发病人数为78人(17.5%)。GDM孕妇孕早期Lpa水平[105.5(92.0,122.0)mg/L]高于非GDM孕妇[97.0(87.0,109.0)mg/L],差异有统计学意义(P<0.05)。Lpa每升高10 mg/L,GDM发生风险增加21%,OR值(95%CI)为1.21(1.08~1.36),P<0.05;校正年龄、孕周等协变量后,关联仍有统计学意义,校正OR值(95%CI)为1.14(1.01~1.30),P=0.03。结论:孕早期Lpa水平升高可能是GDM发生的危险因素之一,维持正常Lpa水平可能有助于GDM早期预防、提高子代健康水平。

Objective To investigate the association of lipoprotein a(Lpa)in early pregnancy with gestational diabetes mellitus(GDM)risk.Methods A total of 445 pregnant women in 12-14 gestational weeks from"Maternal Key Nutritional Factors and Offspring's Atopic Dermatitis"cohort were included in this study.The demographic characteristics of participants were collected by using questionnaires,and the fasting glucose and lipids levels in early pregnancy were measured.The results of oral glucose tolerance test(OGTT)between 24-28 gestational weeks were recorded.Multivariate logistic regression model was applied to analyze the association of Lpa with GDM by calculating the OR and 95%CI after adjustment for covariates.Results The incidence number of GDM was 78(17.5%).The Lpa level in pregnant women with GDM was significantly higher than that in pregnant women without GDM[105.5(92.0,122.0)vs.97.0(87.0,109.0)mg/L],P<0.05.Lpa was significantly associated with GDM risk[OR(95%CI)=1.21(1.08-1.36)per 10 mg/L],P<0.05.The association was still significant after adjustment for covariates including age,gestational weeks et al,the adjusted OR was 1.14(95%CI:1.01-1.30),P=0.03.Conclusions The elevation of Lpa in early pregnancy is one of risk factor for GDM.Maintaining normal Lpa level during early pregnancy can benefit early prevention of GDM and offspring health.