Dai Z Y, Liu D, Li R, Wang Y, Zhang J, Liu J, Zhou R, Zeng G
Department of Nutrition, Food Hygiene and Toxicology, West China School of Public Health, Sichuan University, Chengdu 610041, China.
Department of Health Care, Maternity and Child Health Care Central Hospital of Sichuan, Chengdu 610045, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2016 Oct 10;37(10):1336-1340. doi: 10.3760/cma.j.issn.0254-6450.2016.10.004.
To understand the association between gestational weight gain (GWG) per trimester/total (GWG) and gestational diabetes mellitus (GDM). A prospective cohort study was conducted among 829 healthy pregnant women from Chengdu who delivered a singleton during March-September 2013. Basic information about pre-pregnancy was collected at the first time, exercise information per trimester, dietary intake information per trimester and gestational age at delivery were obtained by questionnaire. Weight at the (12 ± 1), (28 ± 1), (36 ± 1) and last week before delivery were measured. GDM was diagnosed according to the National Diabetes and Pregnancy Prevention Guidelines (2014). At last, a total of 682 pregnant women were analyzed. After controlling the potential confounders, multiple logistic regression models were used to test the associations between GWG per trimester/total GWG and GDM. After adjusting for age at delivery, pre-pregnancy body mass index, family histories of type 2 diabetes and hypertension, exercise in the first trimester, parity and energy intake in trimester and other potential confounders. Compared with adequate GWG in the first trimester, insufficient and excessive GWG in the first trimester were associated with increased risk of GDM (=1.23, 95: 0.63-2.38, and =2.20, 95: 1.12-4.35). Compared with adequate GWG in the second trimester, insufficient and excessive GWG in the second trimester were associated with decreased risk of GDM (=0.47, 95: 0.18-1.19, and =0.78, 95: 0.43-1.42). Compared with adequate GWG in the third trimester, insufficient GWG in the third trimester was associated with increased risk of GDM (=1.48, 95: 0.77-2.84), excessive GWG in the third trimester was associated with decreased risk of GDM (= 0.53, 95: 0.28-0.99). Compared with adequate total GWG in pregnancy, insufficient GWG in pregnancy was associated with increased risk of GDM (=2.16, 95: 1.04-4.46), excessive GWG in pregnancy was associated with decreased risk of GDM (=0.74, 95: 0.38-1.46). Insufficient and excessive GWG in the first trimester were associated with increased risk of GDM, the first trimester may represent a critical period for risk of GDM. The effects of GWG in the second and third trimester on GDM need further study.
了解孕期各阶段体重增加（GWG）/总体重增加（GWG）与妊娠期糖尿病（GDM）之间的关联。对2013年3月至9月期间在成都分娩单胎的829名健康孕妇进行了一项前瞻性队列研究。首次收集孕前基本信息，通过问卷调查获取各孕期运动信息、各孕期饮食摄入信息以及分娩时的孕周。测量妊娠（12±1）、（28±1）、（36±1）周及分娩前最后一周的体重。根据《国家糖尿病与妊娠预防指南（2014）》诊断妊娠期糖尿病。最后，共分析了682名孕妇。在控制潜在混杂因素后，使用多元逻辑回归模型检验各孕期GWG/总体GWG与妊娠期糖尿病之间的关联。在调整了分娩年龄、孕前体重指数、2型糖尿病家族史和高血压家族史、孕早期运动、产次以及各孕期能量摄入等其他潜在混杂因素后。与孕早期体重增加充足相比，孕早期体重增加不足和过多与妊娠期糖尿病风险增加相关（比值比=1.23，95%置信区间：0.63 - 2.38，以及比值比=2.20，95%置信区间：1.12 - 4.35）。与孕中期体重增加充足相比，孕中期体重增加不足和过多与妊娠期糖尿病风险降低相关（比值比=0.47，95%置信区间：0.18 - 1.19，以及比值比=0.78，95%置信区间：0.43 - 1.42）。与孕晚期体重增加充足相比，孕晚期体重增加不足与妊娠期糖尿病风险增加相关（比值比=1.48，95%置信区间：0.77 - 2.84），孕晚期体重增加过多与妊娠期糖尿病风险降低相关（比值比=0.53，95%置信区间：0.28 - 0.99）。与孕期总体重增加充足相比，孕期体重增加不足与妊娠期糖尿病风险增加相关（比值比=2.16，95%置信区间：1.04 - 4.46），孕期体重增加过多与妊娠期糖尿病风险降低相关（比值比=0.74，95%置信区间：0.38 - 1.46）。孕早期体重增加不足和过多与妊娠期糖尿病风险增加相关，孕早期可能是妊娠期糖尿病风险的关键时期。孕中期和孕晚期体重增加对妊娠期糖尿病的影响需要进一步研究。
