Kunshan Maternity and Children's Health Care Hospital, Kunshan, China.
Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China.
J Cell Mol Med. 2020 Feb;24(4):2416-2422. doi: 10.1111/jcmm.14924. Epub 2020 Jan 10.
Prior studies indicated that urea increased insulin resistance and higher blood urea nitrogen (BUN) was associated with incident diabetes mellitus. However, it remains unclear whether BUN during the first trimester of pregnancy increases risk of gestational diabetes mellitus (GDM). We aimed to investigate the association between first-trimester BUN and risk of incident GDM. We conducted a prospective, multicenter cohort study of pregnant women. A total of 13 448 eligible pregnant women with measured first-trimester BUN levels were included in this analysis. Logistic regression analysis was used to estimate the relationship between BUN and GDM. Discrimination and reclassification for GDM by BUN were analysed. A total of 2973 (22.1%) women developed GDM. Compared with the lowest quartile of BUN, the third and fourth quartiles were associated with increased risk of GDM (adjusted odds ratios 1.21 [95% CI 1.07-1.37] and 1.50 [95% CI 1.33-1.69], respectively, P for trend <.001). The addition of BUN to conventional factor model improved discrimination (C statistic 0.2%, P = .003) and reclassification (net reclassification index 14.67%, P < .001; integrated discrimination improvement 0.12%, P < .001) for GDM. In conclusion, higher BUN concentrations during the first trimester of pregnancy were associated with increased risk of GDM, suggesting that BUN could be a potential predictor for GDM.
先前的研究表明，尿素会增加胰岛素抵抗，而较高的血尿素氮（BUN）与糖尿病的发生有关。然而，目前尚不清楚妊娠早期的 BUN 是否会增加妊娠糖尿病（GDM）的风险。我们旨在研究妊娠早期 BUN 与 GDM 发病风险之间的关系。我们进行了一项前瞻性、多中心队列研究，共纳入了 13448 名有测量妊娠早期 BUN 水平的孕妇。采用 logistic 回归分析来评估 BUN 与 GDM 之间的关系。分析了 BUN 对 GDM 的区分和重新分类能力。共有 2973 名（22.1%）孕妇发生 GDM。与 BUN 最低四分位数相比，第三和第四四分位数与 GDM 风险增加相关（调整后的优势比为 1.21 [95%CI 1.07-1.37]和 1.50 [95%CI 1.33-1.69]，P 趋势 <0.001）。将 BUN 添加到常规因素模型中提高了对 GDM 的区分能力（C 统计量增加 0.2%，P=0.003）和重新分类能力（净重新分类指数增加 14.67%，P<0.001；综合区分改善 0.12%，P<0.001）。综上所述，妊娠早期较高的 BUN 浓度与 GDM 风险增加相关，提示 BUN 可能是 GDM 的潜在预测因子。
