生命历程流行病学视角下的童年期不良经历和围孕期压力性生活事件对妊娠期糖尿病的影响

Effects of adverse childhood experiences and stressful life events on gestational diabetes mellitus:a life course epidemiological perspective

目的基于生命历程流行病学视角,探讨童年期不良经历(ACE)和围孕期压力性生活事件(SLE)对妊娠期糖尿病(GDM)发生风险的影响及作用方式。方法本研究为回顾性研究,选取2019年5至9月在马鞍山市妇幼保健院产检的孕早期孕妇作为研究对象。收集孕妇在过去1年是否经历过SLE、SLE的类型和SLE累积事件数,以及其否经历过ACE、ACE的类型和ACE的累计得分,在其妊娠24~28周时进行75 g口服葡萄糖耐量试验以诊断GDM。采用logistic回归模型分析ACE和SLE对GDM发生风险的独立影响;采用交互作用分析判断ACE和SLE对GDM的发生是否存在相加或相乘交互作用,进一步采用分层分析判断ACE对SLE是否存在调节作用。结果共纳入研究对象1001例,ACE检出率为19.1%(191/1001),SLE检出率为38.5%(385/1001)。logistic回归分析结果表明,是否经历过ACE、ACE的类型及ACE的累计得分,以及是否经历过SLE、SLE的类型及SLE累积事件数,对GDM发生风险的影响均无统计学意义(均P>0.05)。分层分析结果表明,在有ACE的孕妇中,与无SLE者相比,SLE数量≥2的孕妇GDM发生风险增加1.64倍(OR=2.64,95%CI 1.08~6.47,异质性检验P值=0.036)。结论ACE和SLE单独对GDM的发生均无影响,但ACE对SLE和GDM间的关系具有调节作用,只有在经历了ACE的孕妇中,围孕期SLE才会增加GDM的发生风险。

Objective Based on the perspective of life course epidemiology,to explore the effects of adverse childhood experiences(ACE)and perinatal stressful life events(SLE)on the risk of gestational diabetes mellitus(GDM)and their modes of action.Methods This study was a retrospective study.Pregnant women in the first trimester who were examined in Ma′anshan Maternal and Child Health Hospital from May to September 2019 were enrolled.The history of SLE,type of SLE and cumulative number of SLE events,as well as the history of ACE,type of ACE and cumulative score of ACE in the past 1 year were collected.At gestational 24-28 weeks,75 g oral glucose tolerance test(OGTT)was performed to diagnose GDM.Logistic regression model was used to analyze the independent effects of ACE and SLE on the risk of GDM.Additive or multiplicative interaction between ACE and SLE were analyzed through interaction analysis.Stratified analysis was used to determine whether ACE had a modifying effect on SLE.Results A total of 1001 participants were included.The reporting rates of ACE and SLE were 19.1%(191/1001)and 38.5%(385/1001),respectively.The results of logistic regression model showed that experienced ACE or not,the type of ACE and the cumulative score of ACE,experienced SLE or not,the type of SLE and the cumulative number of SLE had no statistical significance on the risk of GDM(all P>0.05).Stratified analysis showed that among pregnant women with ACE,those with SLE≥2 and had a 1.64-fold increased the risk of GDM compared with those without SLE(OR=2.64,95%CI 1.08-6.47,Pheterogeneity=0.036).Conclusions The occurrence of GDM is unaffected by ACE or SLE alone,but ACE has a significant moderating effect on the association between SLE and GDM.Perinatal SLE increases the risk of GDM only in pregnant women who have had an ACE.