轻度妊娠期糖尿病诊断后的妊娠情况与心脏代谢紊乱风险
Pregnancies After the Diagnosis of Mild Gestational Diabetes Mellitus and Risk of Cardiometabolic Disorders.
作者信息
Varner Michael W, Rice Madeline Murguia, Landon Mark B, Casey Brian M, Reddy Uma M, Wapner Ronald J, Rouse Dwight J, Tita Alan T N, Thorp John M, Chien Edward K, Saade George R, Peaceman Alan M, Blackwell Sean C, Vandorsten J Peter
机构信息
Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, Utah, The Ohio State University, Columbus, Ohio, University of Texas Southwestern Medical Center, Dallas, Texas, Columbia University, New York, New York, Brown University, Providence, Rhode Island, University of Alabama at Birmingham, Birmingham, Alabama, University of North Carolina, Chapel Hill, North Carolina; MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio, University of Texas Medical Branch, Galveston, Texas, Northwestern University, Chicago, Illinois, University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, Texas, and Medical University of South Carolina, Charleston, South Carolina; the George Washington University Biostatistics Center, Washington, DC; and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
出版信息
Obstet Gynecol. 2017 Feb;129(2):273-280. doi: 10.1097/AOG.0000000000001863.
OBJECTIVE
To assess the association of subsequent pregnancy with subsequent metabolic syndrome and type II diabetes mellitus after a pregnancy complicated by mild gestational diabetes mellitus (GDM).
METHODS
We conducted a prospective observational follow-up study of women with mild GDM randomized from 2002 to 2007 to usual care or dietary intervention and glucose self-monitoring. Women were evaluated 5-10 years after the parent study. Participants were grouped according to the number of subsequent pregnancies (group A, none [reference]; group B, one; group C, two or greater). Serum triglycerides, glucose tolerance, high-density lipoprotein cholesterol, blood pressure, and waist circumference were assessed. Metabolic syndrome was diagnosed by American Heart Association and National Heart Lung and Blood Institute criteria. Multivariable regression was used to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs).
RESULTS
Of 905 eligible women from the original trial, 483 agreed to participate, 426 of whom were included in this analysis. Groups A, B, and C consisted of 212, 143, and 71 women, respectively. Of women with subsequent pregnancies, 32% (69/214) had another pregnancy complicated with GDM. No difference between groups was observed for metabolic syndrome (group A, 34%; group B, 33%; group C, 30%). Subsequent pregnancies were associated with diabetes mellitus outside of pregnancy (group A, 5.2%; group B, 10.5%, RR 2.62, 95% CI 1.16-5.91; group C, 11.3%, RR 2.83, 95% CI 1.06-7.59), and if complicated with GDM (no subsequent GDM pregnancy, RR 1.99, 95% CI 0.82-4.84; subsequent GDM pregnancy, RR 3.75, 95% CI 1.60-8.82).
CONCLUSION
In women with prior mild GDM, subsequent pregnancies did not increase the frequency of metabolic syndrome, but subsequent pregnancies with GDM increased the risk of diabetes mellitus outside of pregnancy.
目的
评估妊娠合并轻度妊娠期糖尿病（GDM）后再次妊娠与后续代谢综合征及2型糖尿病之间的关联。
方法
我们对2002年至2007年随机分配至常规护理或饮食干预及血糖自我监测组的轻度GDM女性进行了一项前瞻性观察性随访研究。在母研究结束5至10年后对女性进行评估。根据后续妊娠次数对参与者进行分组（A组，无后续妊娠[参照组]；B组，1次；C组，2次或更多次）。评估血清甘油三酯、糖耐量、高密度脂蛋白胆固醇、血压和腰围。根据美国心脏协会和美国国立心肺血液研究所的标准诊断代谢综合征。使用多变量回归来估计调整后的相对风险（RR）和95%置信区间（CI）。
结果
在原试验的905名符合条件的女性中，483名同意参与，其中426名纳入本分析。A组、B组和C组分别由212名、143名和71名女性组成。在有后续妊娠的女性中，32%（69/214）再次妊娠合并GDM。各组之间在代谢综合征方面未观察到差异（A组，34%；B组，33%；C组，30%）。后续妊娠与妊娠外糖尿病相关（A组，5.2%；B组，10.5%，RR 2.62，95%CI 1.16 - 5.91；C组，11.3%，RR 2.83，95%CI 1.06 - 7.59），并且如果合并GDM（无后续GDM妊娠，RR 1.99，95%CI 0.82 - 4.84；后续GDM妊娠，RR 3.75，95%CI 1.60 - 8.82）。
结论
既往有轻度GDM的女性，后续妊娠并未增加代谢综合征的发生率，但后续妊娠合并GDM会增加妊娠外糖尿病的风险。
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