Departments of Epidemiology and Biostatistics and Environmental and Occupational Health, School of Public Health, Indiana University Bloomington, Bloomington, Indiana; the Kaiser Permanente Center for Health Research NW, Portland, Oregon; the Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, California; the Department of Public Health Science, School of Medicine, University of California, Davis, Davis, California; the College of Public Health, The Ohio State University, Columbus, Ohio; and the Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Obstet Gynecol. 2019 Sep;134(3):591-599. doi: 10.1097/AOG.0000000000003407.
To examine associations among parity, breastfeeding history, and risk of developing type 2 diabetes among postmenopausal women.
A prospective cohort study was conducted. One hundred thirty-six thousand six hundred fifty-two postmenopausal women aged 50-79 years participating in the Women's Health Initiative recruited from 40 clinical centers throughout the United States between 1993 and 1998, without baseline cancer or diabetes were followed for 14.2 years. Parity and breastfeeding data were collected by questionnaires administrated to all participants at baseline. Incident diabetes was assessed via validated self-report of physician-diagnosed diabetes treated with insulin or other hypoglycemic medications. Multivariable Cox proportional hazards regression models were used to assess associations between parity, breastfeeding and diabetes incidence, and racial-ethnic differences in the associations.
During follow-up, 18,812 cases of incident diabetes were identified. Overall, a greater number of term pregnancies was associated with increased risk of diabetes (P for trend=.002), and longer duration of breastfeeding was associated with lower risk of diabetes (P for trend <.01). After further adjusting for adult weight gain among a subset of the cohort (n=75,558) with 9,110 cases, the association between parity and risk of diabetes were attenuated and became nonsignificant. Also, parous women with fewer than five term pregnancies did not have increased diabetes risk when breastfeeding for 3 months or more per child, which was associated with less weight gain.
The results of this large, prospective study showed that the association between parity and risk of type 2 diabetes was most likely confounded by adult weight gain among postmenopausal women.
探讨绝经后妇女的生育史和哺乳史与 2 型糖尿病发病风险之间的关系。
采用前瞻性队列研究。本研究纳入了 1993 年至 1998 年期间在美国 40 个临床中心参与妇女健康倡议的 136652 名年龄在 50-79 岁之间的绝经后妇女，这些妇女无基线癌症或糖尿病，随访时间为 14.2 年。通过基线时对所有参与者进行问卷调查收集生育史和哺乳史数据。通过经医生诊断、使用胰岛素或其他降血糖药物治疗的糖尿病自我报告评估糖尿病的发病情况。多变量 Cox 比例风险回归模型用于评估生育史、哺乳史与糖尿病发病风险之间的关系，以及这些关系在不同种族和民族之间的差异。
在随访期间，共发现 18812 例新发糖尿病病例。总体而言，较多的足月产次与糖尿病发病风险增加相关（趋势 P 值<.002），哺乳时间越长与糖尿病发病风险降低相关（趋势 P 值<.01）。在进一步调整了队列中一部分人群（n=75558，9110 例）的成人体重增加后，生育史与糖尿病发病风险之间的关联减弱且变得无统计学意义。此外，生育次数较少（<5 次）的经产妇在每个孩子哺乳 3 个月或以上时，其糖尿病发病风险并未增加，这与体重增加较少有关。
这项大型前瞻性研究的结果表明，在绝经后妇女中，生育史与 2 型糖尿病发病风险之间的关联很可能是由成人体重增加所导致的。
