孕早期和孕中期体重增加较多与妊娠期糖尿病风险增加相关：一项前瞻性队列研究。
Greater early and mid-pregnancy gestational weight gain are associated with increased risk of gestational diabetes mellitus: A prospective cohort study.
作者信息
Zhong Chunrong, Li Xiating, Chen Renjuan, Zhou Xuezhen, Liu Chaoqun, Wu Jiangyue, Xu Shangzhi, Wang Weiye, Xiao Mei, Xiong Guoping, Wang Jing, Yang Xuefeng, Hao Liping, Yang Nianhong
机构信息
Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, China.
Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, China.
出版信息
Clin Nutr ESPEN. 2017 Dec;22:48-53. doi: 10.1016/j.clnesp.2017.08.013. Epub 2017 Sep 19.
BACKGROUND & AIMS: Gestational diabetes mellitus is associated with adverse short- and long-term consequences for both the mother and the offspring. To examine the relationship between the rates of gestational weight gain (RGWG) during early and mid-pregnancy and the risk of gestational diabetes mellitus (GDM).
METHODS
2090 singleton pregnant women from the Tongji Maternal and Child Health Cohort (TMCHC) without overt diabetes before pregnancy were analyzed in our study. Gestational weight were measured regularly in every antenatal visit. Gestational diabetes mellitus was assessed with the 75-g, 2-h oral glucose tolerance test at 24-28 weeks of gestation. Multivariable logistic regression was performed to estimate effect of RGWG on GDM.
RESULTS
A total of 8.3% (n = 173) of pregnant women were diagnosed with GDM. Women with elevated rate of gestational weight gain prior to glucose screening test (RGWG-PG) increased the risk of GDM (adjusted p-trend = 0.004; odds ratios (OR) 1.64, 95% confidence intervals (CI) 1.01-2.68 and OR 2.30,95% CI 1.44-3.66 for 0.297-0.384 kg/wk and 0.385 kg/wk or more vs. 0.213 kg/wk or less, respectively). Women with greater rate of gestational weight gain in the first trimester (RGWG-F) increased the risk of GDM (adjusted p-trend = 0.048; OR 1.83, 95% CI 1.14-2.94 and OR 1.76, 95% CI 1.10-2.83 for 0.086-0.200 kg/wk and 0.201 kg/wk or more vs. -0.025 kg/wk or less, respectively). The rate of gestational weight gain in the second trimester (RGWG-S) was significantly associated with GDM only among women with RGWG-F more than 0.086 kg/wk (adjusted p-trend = 0.035; OR 2.04, 95% CI 1.16-3.59 for 0.658 kg/wk or more vs. 0.418 kg/wk or less).
CONCLUSIONS
Greater early pregnancy weight gain are associated with increased risk of GDM. Elevated weight gain in mid-pregnancy increased the risk of GDM only among pregnant women with greater weight gain in the first trimester.
背景与目的
妊娠期糖尿病对母亲和后代均有不良的短期和长期影响。本研究旨在探讨孕早期和孕中期的孕期体重增加速率（RGWG）与妊娠期糖尿病（GDM）风险之间的关系。
方法
本研究分析了来自同济妇幼队列（TMCHC）的2090名单胎孕妇，这些孕妇在孕前无明显糖尿病。每次产前检查时均定期测量孕期体重。在妊娠24 - 28周时采用75克、2小时口服葡萄糖耐量试验评估妊娠期糖尿病。采用多变量逻辑回归分析来估计RGWG对GDM的影响。
结果
共有8.3%（n = 173）的孕妇被诊断为GDM。在葡萄糖筛查试验前孕期体重增加速率升高（RGWG - PG）的女性患GDM的风险增加（校正p趋势 = 0.004；对于每周增加0.297 - 0.384千克和每周增加0.385千克及以上与每周增加0.213千克及以下相比，优势比（OR）分别为1.64，95%置信区间（CI）为1.01 - 2.68和OR 2.30，95%CI为1.44 - 3.66）。孕早期体重增加速率较高（RGWG - F）的女性患GDM的风险增加（校正p趋势 = 0.048；对于每周增加0.086 - 0.200千克和每周增加0.201千克及以上与每周减少0.025千克及以下相比，OR分别为1.83，95%CI为1.14 - 2.94和OR 1.76，95%CI为1.10 - 2.83）。仅在孕早期体重增加速率超过0.086千克/周的女性中，孕中期的孕期体重增加速率（RGWG - S）与GDM显著相关（校正p趋势 = 0.035；对于每周增加0.658千克及以上与每周增加0.418千克及以下相比，OR为2.04，95%CI为1.16 - 3.59）。
结论
孕早期体重增加较多与GDM风险增加相关。孕中期体重增加升高仅在孕早期体重增加较多的孕妇中增加GDM风险。
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