Bouthoorn Selma H, Silva Lindsay M, Murray Sheila E, Steegers Eric A P, Jaddoe Vincent W V, Moll Henriette, Hofman Albert, Mackenbach Johan P, Raat Hein
The Generation R Study Group, Erasmus Medical Center, University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands,
Acta Diabetol. 2015 Jun;52(3):445-52. doi: 10.1007/s00592-014-0668-x. Epub 2014 Oct 26.
To investigate whether maternal educational level is associated with gestational diabetes mellitus (GDM), and to what extent risk factors for GDM mediate the effect of educational level.
We examined data of 7,511 pregnant women participating in a population-based cohort study in Rotterdam, the Netherlands. The highest achieved education was categorized into four levels. Diagnosis of GDM was retrieved from delivery records. Odds ratios (OR) of GDM were calculated for levels of education, adjusting for confounders and potential mediators. Mediators were selected according to Baron and Kenny's causal step approach.
Adjusted for ethnicity, age, family history of diabetes and parity, women in the lowest educational level were three times more likely to develop GDM than women in the highest level (OR 3.07; 95 % CI 1.37, 6.89). Selected mediators were alcohol use and body mass index (BMI). Additional adjustment for alcohol use attenuated the OR to 2.54 (95 % CI 1.11, 5.78). The individual addition of BMI attenuated the OR to 2.35 (95 % CI 1.03, 5.35). All mediators together explained 51 % (95 % CI -122, -25) of the association between low education and GDM.
Low maternal educational level is associated with GDM, which is mainly due to higher rates of overweight and obesity. In order to reduce the higher rates of GDM, and consequently type 2 diabetes among women in low socioeconomic subgroups, prevention and intervention strategies need to be focused on reducing the rates of overweight and obesity before pregnancy.
研究母亲教育水平是否与妊娠期糖尿病（GDM）相关，以及GDM的危险因素在多大程度上介导了教育水平的影响。
我们检查了参与荷兰鹿特丹一项基于人群的队列研究的7511名孕妇的数据。将最高学历分为四个层次。从分娩记录中获取GDM的诊断。计算不同教育水平的GDM优势比（OR），并对混杂因素和潜在中介因素进行校正。中介因素根据Baron和Kenny因果步骤法进行选择。
在对种族、年龄、糖尿病家族史和产次进行校正后，最低教育水平的女性患GDM的可能性是最高教育水平女性的三倍（OR 3.07；95%CI 1.37，6.89）。选定的中介因素为饮酒和体重指数（BMI）。对饮酒进行额外校正后，OR降至2.54（95%CI 1.11，5.78）。单独加入BMI后，OR降至2.35（95%CI 1.03，5.35）。所有中介因素共同解释了低教育水平与GDM之间关联的51%（95%CI -122，-25）。
母亲教育水平低与GDM相关，这主要是由于超重和肥胖率较高。为了降低社会经济地位较低亚组女性中较高的GDM发生率以及随后的2型糖尿病发生率，预防和干预策略应侧重于在怀孕前降低超重和肥胖率。
