Huang T, Brown F M, Curran A, James-Todd T
Division of Women's Health, Department of Medicine, Connors Center for Women's Health and Gender Biology, Brigham and Women's Hospital and Harvard Medical School; Department of Epidemiology, Harvard School of Public Health.
Diabet Med. 2015 Feb;32(2):181-8. doi: 10.1111/dme.12617. Epub 2014 Nov 19.
To examine the association of pre-pregnancy BMI and postpartum weight retention with postpartum HbA(1c) levels in women with Type 1 diabetes.
We longitudinally evaluated 136 women with Type 1 diabetes who received prenatal, pregnancy, and postpartum care through Joslin Diabetes Center's Diabetes and Pregnancy Program between 2004 and 2009. Weight, BMI and HbA(1c) concentrations were assessed before the index pregnancy and repeatedly monitored after delivery until 12 months postpartum. We used linear mixed models to assess the association of postpartum HbA(1c) with pre-pregnancy BMI and postpartum weight retention.
The mean HbA(1c) concentration increased from 49 mmol/mol (6.6%) at 6 weeks postpartum to 58 mmol/mol (7.5%) by 10 months postpartum, a level similar to the mean pre-pregnancy HbA(1c) concentration. Postpartum weight retention showed a linearly decreasing trend of 0.06 kg/week (P < 0.0001), with -0.1 kg average postpartum weight retention by 1 year postpartum. Compared with women with a pre-pregnancy BMI ≥ 25 kg/m², women with a lower pre-pregnancy BMI maintained a 3.4 mmol/mol (0.31%) lower HbA(1c) concentration, after adjusting for several sociodemographic, reproductive and diabetes-related factors (P = 0.03). There was a suggestion of a time-varying positive association between HbA1c and postpartum weight retention, with the most significant difference of 3.7 mmol/mol (0.34%; P = 0.05) at 30 weeks postpartum among women with postpartum weight retention ≥ 5 kg vs those with postpartum weight retention < 5 kg.
Pre-pregnancy BMI and postpartum weight retention were positively associated with HbA(1c) during the first postpartum year in women with Type 1 diabetes. Interventions to modify the behaviours associated with these body weight factors before pregnancy and after delivery may help women with Type 1 diabetes maintain good glycaemic control after pregnancy.
研究1型糖尿病女性孕前体重指数（BMI）和产后体重滞留与产后糖化血红蛋白（HbA1c）水平之间的关联。
我们对136例1型糖尿病女性进行了纵向评估，这些女性在2004年至2009年期间通过乔斯林糖尿病中心的糖尿病与妊娠项目接受了产前、孕期及产后护理。在本次妊娠前评估体重、BMI和HbA1c浓度，并在分娩后反复监测直至产后12个月。我们使用线性混合模型评估产后HbA1c与孕前BMI和产后体重滞留之间的关联。
产后6周时HbA1c平均浓度从49 mmol/mol（6.6%）增加到产后10个月时的58 mmol/mol（7.5%），这一水平与孕前HbA1c平均浓度相似。产后体重滞留呈每周下降0.06 kg的线性趋势（P < 0.0001），产后1年平均产后体重滞留为-0.1 kg。在调整了多个社会人口学、生殖及糖尿病相关因素后，与孕前BMI≥25 kg/m²的女性相比，孕前BMI较低的女性HbA1c浓度低3.4 mmol/mol（0.31%）（P = 0.03）。HbA1c与产后体重滞留之间存在随时间变化的正相关迹象，产后体重滞留≥5 kg的女性与产后体重滞留<5 kg的女性相比，在产后30周时差异最为显著，为3.7 mmol/mol（0.34%；P = 0.05）。
1型糖尿病女性在产后第一年，孕前BMI和产后体重滞留与HbA1c呈正相关。在怀孕前和分娩后采取干预措施改变与这些体重因素相关的行为，可能有助于1型糖尿病女性在产后维持良好的血糖控制。
