Department of Obstetrics, The First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, Liaoning Province, China.
Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
BMC Pregnancy Childbirth. 2019 Aug 1;19(1):272. doi: 10.1186/s12884-019-2423-3.
Gestational diabetes mellitus (GDM) is a common cause of maternal morbidity, and can lead to the development of diabetes later in life. Pre-pregnancy body weight is associated with the change in body mass index (BMI) between a first and second pregnancy. Compared with long-term change in BMI between pregnancies, the most accessible follow-up point to investigate BMI change is 6 weeks after the initial pregnancy. The present study aimed to assess the association between weight retention at 6 weeks postpartum and the risk of GDM in a subsequent pregnancy.
We recruited 6429 singleton pregnancies into this retrospective cohort study. For each pregnancy, we calculated weight retention at 6 weeks postpartum after the first pregnancy, the interpregnancy BMI change between pregnancies, and the gestational weight gain in the second pregnancy. Risk was represented by the odds ratio (OR) and 95% confidence intervals (CIs). We then determined the relationship between postpartum weight retention at 6 weeks after the initial pregnancy, and the interpregnancy change in BMI between pregnancies. Analyses were stratified by BMI during the first pregnancy.
Compared to women with a stable BMI (- 1 to 1), interpregnancy BMI gains were associated with an increased risk of GDM in the second pregnancy. Risk increased significantly for women with a BMI below and above 25 during the first pregnancy, although the increase was greater in the women with a BMI < 25. The risk of GDM in the second pregnancy was higher in women with inadequate weight gain during the second gestation. The weight retention at 6 weeks postpartum, where there was a gain of > 3 BMI units was significantly more related to weight gain more than when there was 1 BMI unit gain between pregnancies (P < 0.05) and associated with an increased incidence of GDM in the second pregnancy (OR = 2.95, 95% CI: 1.95 ~ 4.45). Women who showed a change in BMI that was > 3 units at 6 weeks postpartum after the first pregnancy showed an increased risk for BMI subsequently (OR = 1.42, 95% CI: 1.08~1.87).
Women who gained more than 3 BMI units at 6 weeks postpartum were associated with an increased risk of BMI in a subsequent pregnancy. Six weeks postpartum provides a new early window of opportunity to identify risk factors for a subsequent pregnancy and allows us to implement primary prevention strategies.
妊娠糖尿病（GDM）是产妇发病率高的常见原因，并且可能导致以后生活中发生糖尿病。孕前体重与第一次和第二次妊娠之间的体重指数（BMI）变化有关。与妊娠期间 BMI 的长期变化相比，最容易随访的 BMI 变化点是初次妊娠后 6 周。本研究旨在评估初次妊娠后 6 周时的体重保留与随后妊娠中 GDM 风险之间的关系。
我们将 6429 例单胎妊娠纳入本回顾性队列研究。对于每一次妊娠，我们计算了初次妊娠后 6 周时的体重保留、两次妊娠之间的孕期 BMI 变化和第二次妊娠的孕期体重增加。风险用比值比（OR）和 95%置信区间（CI）表示。然后我们确定了初次妊娠后 6 周时的产后体重保留与两次妊娠之间的 BMI 变化之间的关系。分析按第一次妊娠时的 BMI 进行分层。
与稳定 BMI（-1 至 1）的女性相比，孕期 BMI 增加与第二次妊娠中 GDM 的风险增加有关。尽管 BMI<25 的女性风险增加更为明显，但 BMI<25 的女性风险增加更为明显。第二次妊娠时体重增加不足的女性发生 GDM 的风险更高。初次妊娠后 6 周时体重增加超过 3 BMI 单位的体重保留与两次妊娠之间体重增加 1 BMI 单位的体重保留显著相关（P<0.05），并且与第二次妊娠 GDM 的发生率增加相关（OR=2.95，95%CI：1.954.45）。初次妊娠后 6 周时 BMI 变化超过 3 个单位的女性发生随后 BMI 增加的风险增加（OR=1.42，95%CI：1.081.87）。
初次妊娠后 6 周时体重增加超过 3 BMI 单位的女性与随后妊娠 BMI 增加的风险增加有关。初次妊娠后 6 周提供了一个新的早期机会窗口，可以识别随后妊娠的危险因素，并允许我们实施初级预防策略。
