Liu Huikun, Zhang Shuang, Wang Leishen, Leng Junhong, Li Weiqin, Li Nan, Li Min, Qiao Yijuan, Tian Huiguang, Tuomilehto Jaakko, Yang Xilin, Yu Zhijie, Hu Gang
Tianjin Women's and Children's Health Center, 96 Guizhou Road, Heping District, Tianjin 300070, China.
Department of Public Health, University of Helsinki, Helsinki, Finland; Centre for Vascular Prevention, Danube-University Krems, 3500 Krems, Austria; Department of Chronic Disease Prevention, National Institute for Health and Welfare, 00271 Helsinki, Finland; Diabetes Research Group, King Abdulaziz University, 21589 Jeddah, Saudi Arabia.
Diabetes Res Clin Pract. 2016 Feb;112:30-36. doi: 10.1016/j.diabres.2015.11.007. Epub 2015 Nov 23.
Very few studies have assessed the association of fasting and 2h glucose, and HbA1c during pregnancy with postpartum diabetes risk among women with prior gestational diabetes mellitus (GDM). We assessed the association of fasting glucose, 2h glucose and HbA1c at 26-30 gestational weeks with postpartum diabetes risk among women with prior GDM.
A cohort study in 1263 GDM women at 1-5 years after delivery was performed. Cox proportional hazards regression models were used to evaluate the association of fasting and 2h plasma glucose, and HbA1c at 26-30 gestational weeks with the risk of diabetes at postpartum.
The multivariable-adjusted (age, pre-pregnancy body mass index, weight gain during pregnancy, current body mass index, family history of diabetes, marital status, education, family income, smoking status, passive smoking, leisure-time physical activity, alcohol drinking, and intake of energy, saturated fat, and dietary fiber) hazard ratios of postpartum diabetes were 1.61 (95% confidence interval [CI]: 1.36-1.91) for each 1 mmol/l increase in fasting glucose during pregnancy, 1.63 (95% CI: 1.45-1.84) for each 1 mmol/l increase in 2h glucose during pregnancy, 2.11 (95% CI: 1.50-2.97) for each 1 unit (%) increase in HbA1c during pregnancy. When fasting glucose, 2h glucose and HbA1c during pregnancy were entered multivariable-adjusted model simultaneously, 2h glucose and HbA1c but not fasting glucose remained to be significant and positive predictors for postpartum diabetes.
For women with prior GDM, 2h plasma glucose and HbA1c during pregnancy are independent predictors of postpartum diabetes, but fasting plasma glucose during pregnancy is not.
极少有研究评估既往患有妊娠期糖尿病(GDM)的女性孕期空腹血糖、2小时血糖及糖化血红蛋白(HbA1c)与产后糖尿病风险之间的关联。我们评估了孕26 - 30周时空腹血糖、2小时血糖及HbA1c与既往患有GDM的女性产后糖尿病风险之间的关联。
对1263名产后1 - 5年的GDM女性进行了一项队列研究。采用Cox比例风险回归模型评估孕26 - 30周时空腹血糖、2小时血浆葡萄糖及HbA1c与产后糖尿病风险之间的关联。
在多变量调整(年龄、孕前体重指数、孕期体重增加、当前体重指数、糖尿病家族史、婚姻状况、教育程度、家庭收入、吸烟状况、被动吸烟、休闲时间身体活动、饮酒以及能量、饱和脂肪和膳食纤维摄入量)后,孕期空腹血糖每升高1 mmol/l,产后糖尿病的风险比为1.61(95%置信区间[CI]:1.36 - 1.91);孕期2小时血糖每升高1 mmol/l,风险比为1.63(95% CI:1.45 - 1.84);孕期HbA1c每升高1个百分点(%),风险比为2.11(95% CI:1.50 - 2.97)。当将孕期空腹血糖、2小时血糖及HbA1c同时纳入多变量调整模型时,2小时血糖和HbA1c仍是产后糖尿病的显著且正向预测因素,而空腹血糖不再显著。
对于既往患有GDM的女性,孕期2小时血浆葡萄糖和HbA1c是产后糖尿病的独立预测因素,但孕期空腹血浆葡萄糖不是。