Department of Obstetrics, Maternidade Bissaya Barreto - Centro Hospitalar e Universitário de Coimbra, Rua Augusta, 3000-061, Coimbra, Portugal.
Department of Nephrology, Hospital Curry Cabral - Centro Hospitalar Lisboa Central, Rua Beneficência 8, 1069-166, Lisbon, Portugal.
Acta Diabetol. 2018 Mar;55(3):243-251. doi: 10.1007/s00592-017-1090-y. Epub 2017 Dec 29.
Gestational diabetes mellitus (GDM) occurs in 5-15% of pregnancies, and lower maternal educational attainment has been associated with higher risk of GDM. We aimed to determine if maternal education level is associated with persistent post-partum glucose metabolism disorders in women with GDM.
Retrospective cohort study of women with GDM followed in 25 Portuguese health institutions between 2008 and 2012. Educational attainment was categorised into four levels. Prevalence of post-partum glucose metabolism disorders (type 2 diabetes mellitus, increased fasting plasma glucose or impaired glucose tolerance) was compared and adjusted odds ratios calculated controlling for confounders using logistic regression.
We included 4490 women diagnosed with GDM. Educational level ranged as follows: 6.8% (n = 307) were at level 1 (≤ 6th grade), 34.6% (n = 1554) at level 2 (6-9th grade), 30.4% (n = 1364) at level 3 (10-12th grade) and 28.2% (n = 1265) at level 4 (≥ university degree). At 6 weeks post-partum re-evaluation, 10.9% (n = 491) had persistent glucose metabolism disorders. Educational levels 1 and 2 had a higher probability of persistent post-partum glucose metabolism disorders when compared to level 4 (OR = 2.37 [1.69;3.32], p < 0.001 and OR = 1.39 [1.09;1.76], p = 0.008, for level 1 and 2, respectively), an association that persisted in multivariable logistic regression adjusting for confounders (level 1 OR = 2.25 [1.53;3.33], p < 0.001; level 2 OR = 1.43 [1.09;1.89], p = 0.01).
Persistent post-partum glucose metabolism disorders are frequent in women with GDM and associated with lower maternal educational level. Interventions aimed at this risk group may contribute towards a decrease in prevalence of post-partum glucose metabolism disorders.
妊娠糖尿病（GDM）在 5-15%的妊娠中发生，而母亲受教育程度较低与 GDM 的风险增加有关。我们旨在确定母亲的教育水平是否与 GDM 女性产后持续的葡萄糖代谢紊乱有关。
这是一项回顾性队列研究，纳入了 2008 年至 2012 年间在 25 家葡萄牙医疗机构接受随访的 GDM 女性。教育程度分为四个等级。比较产后葡萄糖代谢紊乱（2 型糖尿病、空腹血浆葡萄糖升高或糖耐量受损）的患病率，并使用逻辑回归控制混杂因素后计算调整后的优势比。
共纳入 4490 名 GDM 女性。教育程度如下：6.8%（n=307）为 1 级（≤6 年级），34.6%（n=1554）为 2 级（6-9 年级），30.4%（n=1364）为 3 级（10-12 年级），28.2%（n=1265）为 4 级（≥大学学历）。产后 6 周复查时，10.9%（n=491）存在持续的葡萄糖代谢紊乱。与 4 级相比，1 级和 2 级持续产后葡萄糖代谢紊乱的可能性更高（OR=2.37[1.69;3.32]，p<0.001和 OR=1.39[1.09;1.76]，p=0.008），这种关联在调整混杂因素的多变量逻辑回归中仍然存在（OR=2.25[1.53;3.33]，p<0.001；OR=1.43[1.09;1.89]，p=0.01）。
GDM 女性产后持续的葡萄糖代谢紊乱较为常见，且与母亲受教育程度较低有关。针对这一风险群体的干预措施可能有助于降低产后葡萄糖代谢紊乱的患病率。
