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糖尿病家族史与后代长期心血管疾病住院治疗之间是否存在关联?

Is there an association between family history of diabetes mellitus and long-term cardiovascular hospitalizations of offspring?

作者信息

Bitton Sapir, Wainstock Tamar, Sheiner Eyal, Landau Daniella, Avigan Laura, Pariente Gali

机构信息

Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

出版信息

Prim Care Diabetes. 2019 Dec;13(6):529-534. doi: 10.1016/j.pcd.2019.03.001. Epub 2019 Apr 4.

Abstract

OBJECTIVE

Gestational diabetes mellitus (GDM) was previously found to be an independent risk factor for long-term cardiovascular morbidity of parturients and their offspring. The objective of this study was to investigate the association between family history of diabetes mellitus (DM) in non-diabetic mothers and long-term pediatric cardiovascular hospitalizations of their offspring.

STUDY DESIGN

In a hospital-based cohort study, the incidence of cardiovascular disorders was compared between offspring of non-diabetic mothers with and without a family history of DM. Cardiovascular hospitalizations were assessed up until 18years of age according to a predefined set of ICD-9 codes associated with hospitalization of offspring. Exclusion criteria included multiple gestations, mothers with pre-gestational or gestational diabetes, lack of prenatal care, and children with congenital malformations and chromosomal abnormalities. A Kaplan-Meier survival curve was used to compare cumulative hospitalizations incidence. A cox proportional hazards model was performed to control for confounders.

RESULTS

A total of 208,728 deliveries were included in the study. Of them, 17,040 (8.2%) offspring were born to non-diabetic mothers with a family history of DM. Significant differences in the rates of IVF, induction of labor, obesity, hypertensive disorders of pregnancy, smoking and birth weight were found between the two study groups. Total cardiovascular hospitalizations were comparable between the study groups (0.6% vs. 0.7%, p=0.416). The Kaplan-Meier survival curve exhibited no difference in the cumulative incidence of total cardiovascular hospitalizations of the offspring (log-rank test, p=0.271). A Cox regression model found that a family history of DM in non-diabetic mothers was not independently associated with long-term cardiovascular hospitalizations of the offspring after controlling for the following confounders: maternal age, birth weight, caesarian section and maternal hypertensive disorders (aHR=1.130, 95% CI 0.930-1.374, p=0.220).

CONCLUSION

A family history of DM in non-diabetic parturients, does not increase the risk for cardiovascular hospitalizations of their offspring.

摘要

目的

既往研究发现,妊娠期糖尿病(GDM)是产妇及其后代发生长期心血管疾病的独立危险因素。本研究旨在探讨非糖尿病母亲的糖尿病家族史(DM)与后代长期儿科心血管住院之间的关联。

研究设计

在一项基于医院的队列研究中,比较了有和没有糖尿病家族史的非糖尿病母亲后代的心血管疾病发病率。根据与后代住院相关的一组预定义的ICD-9编码,评估直至18岁的心血管住院情况。排除标准包括多胎妊娠、孕前或妊娠期糖尿病母亲、缺乏产前护理以及患有先天性畸形和染色体异常的儿童。采用Kaplan-Meier生存曲线比较累积住院发病率。进行Cox比例风险模型以控制混杂因素。

结果

本研究共纳入208,728例分娩。其中,17,040例(8.2%)后代的母亲为有糖尿病家族史的非糖尿病患者。两个研究组在体外受精率、引产率、肥胖、妊娠高血压疾病、吸烟和出生体重方面存在显著差异。两组的总心血管住院率相当(0.6%对0.7%,p=0.416)。Kaplan-Meier生存曲线显示后代总心血管住院的累积发病率无差异(对数秩检验,p=0.271)。Cox回归模型发现,在控制以下混杂因素后,非糖尿病母亲的糖尿病家族史与后代长期心血管住院无独立关联:母亲年龄、出生体重、剖宫产和母亲高血压疾病(调整后风险比=1.130,95%置信区间0.930-1.374,p=0.220)。

结论

非糖尿病产妇的糖尿病家族史不会增加其后代心血管住院的风险。

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