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孕早中期增重速率与妊娠期糖尿病风险的队列研究 被引量:1

Weight gain rate in the first and second trimesters and risk of gestational diabetes:a prospective cohort study
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摘要 目的探讨孕早中期增重速率与妊娠期糖尿病(gestational diabetes mellitus,GDM)的关系。方法2019年5—9月首次在马鞍山市妇幼保健院产检并建立孕产妇保健手册时(≤14周+6)进行基线纳入合计1189人。共968名孕产妇纳入最终分析,其中GDM病例289例。通过问卷调查收集孕妇社会人口学特征、既往史、生活方式等信息;孕妇24~28周进行口服葡萄糖耐量试验筛查GDM;运用多因素Logistic回归分析孕早期和中期增重速率与GDM的关系。结果调整孕前体质指数、年龄、职业、产次、孕次、受孕季节、受孕方式、城乡、糖尿病家族史后,与增重速率适宜相比,孕早期体重增速过快发生GDM的风险增加(过快组:aOR=1.92,95%CI 1.20~3.07);孕中期体重增重速率过快或缓慢未发现与GDM的风险相关(过快组:aOR=0.89,95%CI 0.47~1.70)(缓慢组:aOR=1.57,95%CI 0.85~2.90)。进一步以孕前体质指数分层,孕前BMI<24且孕早期增重速率过快是GDM的危险因素(过快组;aOR=1.98,95%CI 1.16~3.38),孕前BMI≥24的孕妇在孕早期增重速率未观察到显著关联(缓慢组:aOR=0.79,95%CI 0.29~2.12;过快组:aOR=1.61,95%CI 0.60~4.30)。相乘模型显示,孕前BMI和孕早期增重速率对于GDM无交互作用。结论孕早期增重速率过快会影响GDM发生风险。 OBJECTIVE To investigate the relationship between the rate of weight gain in the first and second trimesters and gestational diabetes mellitus(GDM).METHODS A total of 1189 maternal cases were included at baseline from May to September 2019 when they first came to the Maternal and Child Health Hospital in Ma'anshan for delivery and establishment of maternal health handbook(≤14 weeks+6).A total of 968 maternal cases were included in the final analysis,including 289 cases of GDM.Information on maternal socio-demographic characteristics,past history and lifestyle was collected through questionnaires.Oral glucose tolerance test was performed to screen for GDM at 24-28 weeks of pregnancy.Multi-factor logistic regression was used to analyze the relationship between the rate of weight gain in the first and second trimesters and GDM.RESULTS After adjusting for pre-pregnancy BMI,age,occupation,number of births,number of pregnancies,type of residence,family history of diabetes,season of conception and mode of conception,an increased risk of GDM was found for rapid weight gain in early pregnancy compared with appropriate rate of gain(rapid group:aOR=1.92,95%CI 1.20-3.07).No risk of GDM was found for rapid or slow weight gain in mid-pregnancy(rapid group:aOR=0.89,95%CI 0.47-1.70)(slow group:aOR=1.57,95%CI 0.85-2.90).Further stratified by pre-pregnancy BMI,pre-pregnancy BMI 24-overly rapid growth rate in early pregnancy was a risk factor for GDM(rapid group;aOR=1.98,95%CI 1.16-3.38)and no significant association was observed in pregnant women with pre-pregnancy BMI≥24(slow group:aOR=0.79,95%CI 0.29-2.12;rapid group:aOR=1.61,95%CI 0.60-4.30).A multiplicative model showing no interaction between pre-pregnancy BMI and early pregnancy weight gain rate for GDM.CONCLUSION Excessive growth rate in the first pregnancy can affect the risk of GDM.
作者 宫可心 李海滟 余夏妍 古悦 曹译丹 朱贝贝 陶芳标 Gong Kexin;Li Haiyan;Yu Xiayan;Gu Yue;Cao Yidan;Zhu Beibei;Tao Fangbiao(School of Public Health,Anhui Medical University,Hefei 230032,China;Key Laboratory of Population Health Across Life Cycle,Ministry of Education,Hefei 230032,China;Anhui Provincial Key Laboratory of Population Health&Aristogenics,Hefei i230032,China;Key Laboratory of Study on Abnormal Gametes and Reproductive Tract,National Health Commission,Hefei 230032,China)
出处 《卫生研究》 CAS CSCD 北大核心 2023年第5期726-731,748,共7页 Journal of Hygiene Research
基金 国家自然科学基金(No.82073564,81761128034) 安徽省重点研究与开发计划项目(No.202104j07020034)。
关键词 增重速率 孕早期 妊娠期糖尿病 前瞻性 weight gain rate first trimester gestational diabetes prospective
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