妊娠早期内脏脂肪厚度与妊娠期糖尿病发生风险的关联性研究

The association between visceral adipose thickness and gestational diabetes mellitus in the first trimester

目的研究我国女性妊娠早期内脏脂肪(VAT)厚度与妊娠期糖尿病(GDM)发生风险的关联。方法基于青岛妇女儿童健康队列,选取2019年5月至2022年10月间妊娠早期(妊娠11~13^(+6)周)建档的孕妇为研究对象。VAT测量于妊娠11~13^(+6)周,采用多功能彩超测量从腹直肌内缘到大动脉前壁的距离。随访妊娠 24~28 周 75 g 口服葡萄糖耐量试验(OGTT)的结果,根据 75 g OGTT 试验的结果将研究对象分为 GDM 组和非 GDM 组。根据妊娠早期VAT的四分位数将研究对象分为4组,用多因素log-binomial 回归模型和多重线性回归模型分别分析VAT与GDM、血糖浓度之间的关联。结果 3 686例研究对象年龄为(30.56±4.05)岁,其中722例诊断为GDM,发病率为19.6%。多因素log-binomial 回归模型分析结果显示,与VAT厚度Q1(VAT<14.70 mm)者相比,VAT厚度Q3(21.65≤VAT≤29.69 mm)者GDM发病风险增加34%[RR(95%CI):1.34(1.08~1.67)],VAT厚度Q4(VAT≥29.70 mm)者GDM的发病风险增加61%[RR(95%CI):1.61(1.30~2.00)]。亚组分析结果显示,在妊娠年龄<35岁女性中,与VAT厚度Q1者相比,VAT厚度Q3和Q4者GDM发病风险分别增加42%[RR(95%CI):1.42(1.22~1.65)]和70%[RR(95%CI):1.70(1.46~1.98)],而在妊娠年龄≥35岁女性中未发现该关联(P>0.05);在孕前BMI<24.0 kg/m^(2)的女性中,与VAT厚度Q1者相比,VAT厚度Q3和Q4者GDM发病风险分别增加57%[RR(95%CI):1.57(1.22~2.04)]和65%[RR(95%CI):1.65(1.24~2.19)]。多重线性回归结果显示,VAT与空腹血糖、75 g OGTT 1 h后血糖及75 g OGTT 2 h后血糖均呈现正向关联(P趋势<0.001)。结论妊娠早期高内脏脂肪厚度与GDM发生有关联,随着脂肪厚度的增加,GDM发病风险随之升高。

Objective To investigate the association between visceral adipose tissue(VAT)thickness in early pregnancy and the risk of gestational diabetes mellitus(GDM).Methods Based on the Qingdao Women and Children Health Cohort,pregnant women in the first trimester(11-13^(+6) weeks of gestation)were enrolled in this cohort study between May 2019 and October 2022.The VAT was measured in first trimester and determined as the distance from the inner margin of the rectus abdominis muscle to the anterior wall of the great artery using multi-functional color ultrasound.The 75 g oral glucose tolerance test(OGTT)results were followed up at 24-28 weeks and the participants were divided into GDM group and non-GDM group.The pregnant women were divided into 4 groups according to the VAT quartile.Log-binomial model and linear regression model were used to analyze the association between VAT and GDM/blood glucose.Results A total of 3686 pregnant women were included in this study,the mean age of participants was(30.56±4.05)years and 722 were diagnosed with GDM,with an incidence of 19.6%.The log-binomial regression model results showed that compared with VAT thickness Q1(VAT<14.70 mm),the GDM risk in Q3(21.65≤VAT≤29.69 mm)and Q4(VAT≥29.70 mm)increased by 34%[RR(95%CI):1.34(1.08-1.67)],and 61%[RR(95%CI):1.61(1.30-2.00)],respectively.Among women with gestational age<35 years old,compared with VAT thickness Q1,the risk of GDM increased by 42%in Q3[RR(95%CI):1.42(1.22-1.65)]and 70%[RR(95%CI):1.70(1.46-1.98)]in Q4,whereas no associations were found in women with gestational age≥35 years old(P>0.05).The association between VAT and GDM risk was only found in pregnant women with pre-pregnancy BMI<24.0 kg/m^(2),and the GDM risk increased by 57%[RR(95%CI):1.57(1.22-2.04)]in Q3 and 65%[RR(95%CI):1.65(1.24-2.19)]in Q4 compare with Q1.The results of multiple linear regression analysis showed that VAT was positively correlated with fasting blood glucose,1-hour blood glucose after 75 g OGTT and 2-hours blood glucose after 75 g OGTT(all Pfor trend<0.001).Conclusion High VAT thickness in early pregnancy is an independent risk factor for GDM,and the GDM risk increases with the raising of VAT depth.