School of Nursing and Midwifery, Division of Health Sciences, University of South Australia, City East Campus North Terrace (P5-21), GPO Box 2471, Adelaide, SA 5001, Australia.
Matern Child Health J. 2012 Aug;16(6):1284-92. doi: 10.1007/s10995-011-0889-3.
To identify pre-pregnancy risk factors for diabetes in pregnancy among a cohort of Australian Indigenous women. Data on 1,009 Indigenous women of childbearing age who participated in a 1998-2000 health screening program in far north Queensland were linked to Queensland hospitalisations data. Women who attended hospital after their health check for a pregnancy-related condition were identified. The data on women who were hospitalised for birth were also linked to Queensland perinatal data. Of 220 women who gave birth, 23 had diabetes in the pregnancy following their health check. A strong predictor of having a subsequent pregnancy affected by diabetes was suboptimal glucose control before conception. The presence of the metabolic syndrome predicted over a threefold increase in risk among non-diabetic women after adjustment for age and ethnicity (PR, 3.50; 95% CI, 1.54-8.00). For each 1-cm increase in waist circumference, there was an age-adjusted increase in risk of 4% for diabetes in pregnancy (1.04; 1.01-1.06). For each 1-mmHg increase in blood pressure (systolic and diastolic), there was an age-adjusted increase in risk of 3% (1.03; 1.01-1.05 and 1.03; 1.00-1.07, respectively). Associations between hypercholesterolaemia and dyslipidaemia and diabetes in the subsequent pregnancy were diminished after adjustment for age and ethnicity. The risk for women with "hyper-triglyceridaemic waist" phenotype before pregnancy was diminished by adjustment for age, ethnicity and baseline fasting glucose. Alcohol intake, smoking, level of physical activity and red cell folate showed little effect. Identification of women at particularly high risk for future diabetes in pregnancy, given their pre-pregnancy health, is important so that they can manage their risks and where overweight or obesity is a factor, interventions aimed at weight management should be implemented.
确定澳大利亚原住民妇女队列中妊娠糖尿病的孕前危险因素。
将参加 1998-2000 年远北昆士兰健康筛查项目的 1009 名育龄期原住民妇女的数据与昆士兰医院数据相关联。在健康检查后因妊娠相关疾病住院的妇女被确定为住院妇女。因分娩住院的妇女的数据也与昆士兰围产期数据相关联。在 220 名分娩的妇女中，有 23 名在健康检查后的妊娠中患有糖尿病。受孕前血糖控制不佳是随后妊娠发生糖尿病的强烈预测因素。代谢综合征的存在预测在调整年龄和种族后，非糖尿病妇女的风险增加三倍以上（PR，3.50；95%CI，1.54-8.00）。对于腰围每增加 1cm，年龄调整后的妊娠糖尿病风险增加 4%（1.04；1.01-1.06）。对于收缩压和舒张压每增加 1mmHg，年龄调整后的风险增加 3%（1.03；1.01-1.05 和 1.03；1.00-1.07）。在调整年龄和种族后，高胆固醇血症和血脂异常与随后妊娠中的糖尿病之间的关联减弱。在调整年龄、种族和基线空腹血糖后，“高甘油三酯腰围”表型的妇女在妊娠前的风险降低。饮酒、吸烟、身体活动水平和红细胞叶酸的影响较小。鉴于孕前健康状况，识别未来妊娠糖尿病风险特别高的妇女非常重要，以便她们能够管理风险，并且如果超重或肥胖是一个因素，应实施针对体重管理的干预措施。
