Kakoly Nadira Sultana, Earnest Arul, Moran Lisa J, Teede Helena J, Joham Anju E
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, 3168, Australia.
Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, 3168, Australia.
BMC Med. 2017 Nov 6;15(1):195. doi: 10.1186/s12916-017-0957-7.
Obesity is common in young women, increasing insulin resistance (IR) and worsening pregnancy complications, including gestational diabetes (GDM). Women with polycystic ovary syndrome (PCOS) are commonly obese, which aggravates the severity of PCOS clinical expression. Relationships between these common insulin-resistant conditions, however, remain unclear.
We conducted a secondary analysis of the Australian Longitudinal Study on Women's Health (ALSWH) database, including data from 8009 women aged 18-36 years across six surveys. We used latent-curve growth modelling to identify distinct body mass index (BMI) trajectories and multinomial logistic regression to explore sociodemographic and health variables characterizing BMI group membership. Logistic regression was used to assess independent risk of GDM.
A total of 662 women (8.29%, 95% CI 7.68-8.89) reported PCOS. Three distinct BMI trajectories emerged, namely low stable (LSG) (63.8%), defined as an average trajectory remaining at ~25 kg/m; moderately rising (MRG) (28.8%), a curvilinear trajectory commencing in a healthy BMI and terminating in the overweight range; and high-rising (HRG) (7.4%), a curvilinear trajectory starting and terminating in the obese range. A high BMI in early reproductive life predicted membership in higher trajectories. The HRG BMI trajectory was independently associated with GDM (OR 2.50, 95% CI 1.80-3.48) and was a stronger correlate than PCOS (OR 1.89, 95% CI 1.41-2.54), maternal age, socioeconomic status, or parity.
Our results suggest heterogeneity in BMI change among Australian women of reproductive age, with and without PCOS. Reducing early adult life weight represents an ideal opportunity to intervene at an early stage of reproductive life and decreases the risk of long-term metabolic complications such as GDM.
肥胖在年轻女性中很常见，会增加胰岛素抵抗（IR）并加重妊娠并发症，包括妊娠期糖尿病（GDM）。多囊卵巢综合征（PCOS）女性通常肥胖，这会加重PCOS临床表现的严重程度。然而，这些常见的胰岛素抵抗状况之间的关系仍不清楚。
我们对澳大利亚女性健康纵向研究（ALSWH）数据库进行了二次分析，包括来自六次调查的8009名18 - 36岁女性的数据。我们使用潜在曲线增长模型来识别不同的体重指数（BMI）轨迹，并使用多项逻辑回归来探索表征BMI组归属的社会人口统计学和健康变量。逻辑回归用于评估GDM的独立风险。
共有662名女性（8.29%，95%可信区间7.68 - 8.89）报告患有PCOS。出现了三种不同的BMI轨迹，即低稳定轨迹（LSG）（63.8%），定义为平均轨迹维持在约25kg/m²；中度上升轨迹（MRG）（28.8%），一条从健康BMI开始并在超重范围内终止的曲线轨迹；以及高上升轨迹（HRG）（7.4%），一条始于并终止于肥胖范围内的曲线轨迹。早期生殖生活中的高BMI预测了更高轨迹的归属。HRG BMI轨迹与GDM独立相关（比值比2.50，95%可信区间1.80 - 3.48），并且比PCOS（比值比1.89，95%可信区间1.41 - 2.54）、母亲年龄、社会经济地位或产次的相关性更强。
我们的结果表明，有或没有PCOS的澳大利亚育龄女性在BMI变化方面存在异质性。降低成年早期体重是在生殖生活早期进行干预的理想时机，并可降低诸如GDM等长期代谢并发症的风险。
