Connors Center for Women's Health and Gender Biology, Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, MA
Harvard Medical School, Boston, MA.
Diabetes Care. 2019 Jan;42(1):44-49. doi: 10.2337/dc18-1532. Epub 2018 Nov 19.
To study the extent to which BMI after pregnancy adds to the elevated risk of postpregnancy type 2 diabetes in women with a history of hypertensive disorders of pregnancy (HDP) (preeclampsia or gestational hypertension).
We used data from the Nurses' Health Study II, a prospective cohort study. In women aged 45-54 years without prior gestational diabetes mellitus, we investigated the interaction between BMI and HDP history on the risk of type 2 diabetes. For clinical and public health relevance, we focused on additive interaction. The main outcome measure was the relative excess risk due to interaction calculated from multivariable Cox proportional hazards models using normal weight as the reference group.
In total, 6,563 (11.7%) of 56,159 participants had a history of HDP and 1,341 women developed type 2 diabetes during 436,333 person-years. BMI was a strong risk factor for type 2 diabetes regardless of HDP history. However, there was evidence of an additive interaction between BMI and HDP for the risk of type 2 diabetes ( = 0.004). The attributable proportion of risk due to the interaction ranged from 0.12 (95% CI -0.22, 0.46) in women who were overweight to 0.36 (95% CI 0.13, 0.59) in women with obesity class I.
Maintaining a healthy weight may be of even greater importance in women with a history of HDP, compared with other women with a history of only normotensive pregnancies, to reduce midlife risk of type 2 diabetes.
研究妊娠后 BMI 对有妊娠高血压疾病（HDP）（子痫前期或妊娠期高血压）病史的女性产后 2 型糖尿病风险升高的影响程度。
我们使用了护士健康研究 II 的数据，这是一项前瞻性队列研究。在年龄在 45-54 岁且没有妊娠糖尿病史的女性中，我们研究了 BMI 和 HDP 病史之间的相互作用对 2 型糖尿病风险的影响。为了临床和公共卫生的相关性，我们关注的是附加交互作用。主要观察指标是从多变量 Cox 比例风险模型中计算出的由于相互作用导致的相对超额风险，使用正常体重作为参考组。
共有 6563 名（11.7%）56159 名参与者有 HDP 病史，1341 名女性在 436333 人年中患上 2 型糖尿病。BMI 是 2 型糖尿病的一个强烈危险因素，无论 HDP 病史如何。然而，BMI 和 HDP 之间存在 2 型糖尿病风险的附加交互作用的证据（ = 0.004）。由于相互作用导致的风险归因比例范围从超重女性的 0.12（95%CI-0.22，0.46）到肥胖 I 级女性的 0.36（95%CI0.13，0.59）。
与其他只有正常血压妊娠史的女性相比，对于有 HDP 病史的女性，保持健康的体重可能对降低中年 2 型糖尿病风险更为重要。
