两次妊娠间体重变化对妊娠期糖尿病再发的影响分析

Association of Interpregnancy Weight Change with Recurrence of Gestational Diabetes Mellitus

目的探讨连续两次妊娠间体重变化与妊娠期糖尿病(gestational diabetes mellitus,GDM)再发之间的关联。方法基于广东省妇幼保健院信息系统,选取2017年1月~2022年7月有2次分娩记录且第1次妊娠患有GDM的女性为研究对象。两次妊娠间体重变化定义为第2次妊娠孕前体质量指数(body mass index,BMI)减去前1次妊娠孕前BMI,并将其分为4组(<-1、-1~、1~、≥3 kg/m^(2)),将-1~kg/m^(2)组(体重稳定组)作为参照。采用Logistic回归模型分析连续两次妊娠间体重变化与GDM再发及两次妊娠糖耐量试验血糖值变化的关联。结果在703名研究对象中,有326人(46.4%)再次发生了GDM。与妊娠间BMI变化-1~kg/m^(2)组相比,BMI变化1~kg/m^(2)和≥3 kg/m^(2)组再发GDM的风险增加,比值比(odds ratio,OR)[95%置信区间(confidence interval,CI)]分别为2.16(1.52~3.08)和2.56(1.44~4.56),GDM再发风险随着妊娠间BMI增加而增加(P-trend<0.01)。然而BMI变化<-1 kg/m^(2)组与GDM再发无显著关联,OR(95%CI)为0.95(0.57~1.57)。妊娠间BMI每增加1 kg/m^(2),空腹血糖升高、服糖后1 h血糖升高的风险增加,OR(95%CI)分别为1.15(1.05~1.26)和1.21(1.10~1.33)。结论有GDM史的妇女是GDM再发的高危人群,连续两次妊娠间体重增加可显著增加GDM再发的风险。该研究结果提示,应对有GDM患病史并有再次生育意愿的妇女加强健康教育,提高其对体重管理重要性的认识,减少GDM的再发生,保障母婴健康。

Objective To explore the association between interpregnancy weight change and the recurrence of gestational diabetes mellitus(GDM).Methods This study included women who had two delivery records and a history of GDM during their previous pregnancy at the Guangdong Women and Children Hospital between January 2017 and July 2022.Interpregnancy weight change was defined as the difference between the prepregnancy BMIs of two consecutive pregnancies.Interpregnancy weight change was categorized into four groups(<-1,-1 to<1,1 to<3,≥3 kg/m~2),with the-1 to<1 kg/m^(2)group serving as the reference.Logistic regression analyses were used to assess the associations of interpregnancy weight changes with GDM recurrence and changes in glucose values during two consecutive pregnancies.Results Among 703 participants,326 individuals(46.4%)experienced GDM recurrence.Compared with the groups with an interpregnancy BMI change of-1 to<1 kg/m~2,the groups with a BMI change of 1 to<3 or≥3 presented an increased risk of GDM recurrence,with odds ratio(OR)[95%confidence intervals(CI)]of 2.16(1.52-3.08)and 2.56(1.44-4.56),respectively.The risk of GDM recurrence significantly increased with increasing interpregnancy weight gain(P for trend<0.01).However,there was no significant association between a BMI change<-1 kg/m~2 and GDM recurrence,with an OR(95%CI)of 0.95(0.57-1.57).An increase of 1 kg/m~2 in the interpregnancy BMI was associated with a higher risk of elevated fasting blood glucose and 1 h plasma glucose,with OR(95%CI)of 1.15(1.05-1.26)and 1.21(1.10-1.33),respectively.Conclusion Women with a history of GDM are at a high risk of GDM recurrence,and interpregnancy weight gain is associated with an increased risk of GDM recurrence.These findings underscore the importance of health education among women with a history of GDM who plan to conceive again and emphasize the importance of weight management in reducing the recurrence of GDM.