Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States.
Epidemiology Department, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States.
Front Endocrinol (Lausanne). 2020 Feb 27;11:83. doi: 10.3389/fendo.2020.00083. eCollection 2020.
Prolactin and progesterone are implicated in glucose homeostasis in and outside of pregnancy. However, their associations with gestational diabetes (GDM) risk were not well-understood. This study investigates this question in a prospective and longitudinal cohort. This is a nested case-control study of 107 incident GDM cases and 214 matched non-GDM controls within the NICHD Fetal Growth Studies-Singleton Cohort. Blood samples were collected at gestational weeks 10-14, 15-26, 23-31, and 33-39. The odds ratios (OR) of GDM were estimated using conditional logistic regression. The longitudinal changes in prolactin and progesterone were estimated using linear mixed-effects models. Compared to controls, cases have significantly higher prolactin levels at weeks 10-14 (median: 50.4 vs. 42.1 ng/mL), and significantly lower progesterone levels at weeks 10-14 (median: 109.4 vs. 126.5 nmol/L). Prolactin levels at weeks 10-14 were significantly and positively associated with GDM risk; the adjusted ORs across increasing quartiles were 1.00, 1.13, 1.80, 2.33 (-trend = 0.02). A similar but slightly attenuated association was observed at weeks 15-26 (-trend = 0.05). Progesterone was not associated with GDM risk at either time points. Longitudinal changes in prolactin and progesterone between the first two visits were not associated with GDM risk. In addition, prolactin was significantly and positively associated with insulin and C-peptide levels at weeks 10-14, and significantly and inversely associated with C-peptide levels at weeks 15-26; progesterone was significantly and inversely associated with glucose and insulin levels. This study provided the first prospective evidence of a positive association between prolactin levels in early pregnancy and GDM risk.
催乳素和孕激素与妊娠期间和妊娠外的血糖稳态有关。然而，它们与妊娠糖尿病（GDM）风险的关联尚未得到很好的理解。本研究在一个前瞻性和纵向队列中调查了这个问题。这是一项嵌套病例对照研究，在 NICHD 胎儿生长研究- singleton 队列中，有 107 例新发生的 GDM 病例和 214 例匹配的非 GDM 对照。在妊娠 10-14 周、15-26 周、23-31 周和 33-39 周采集血样。使用条件逻辑回归估计 GDM 的比值比（OR）。使用线性混合效应模型估计催乳素和孕激素的纵向变化。与对照组相比，病例组在 10-14 周时催乳素水平显著升高（中位数：50.4 与 42.1ng/ml），而在 10-14 周时孕激素水平显著降低（中位数：109.4 与 126.5nmol/L）。10-14 周时催乳素水平与 GDM 风险显著正相关；在递增四分位数中，调整后的 OR 分别为 1.00、1.13、1.80、2.33（-趋势=0.02）。在 15-26 周时也观察到类似但略减弱的关联（-趋势=0.05）。在这两个时间点，孕激素与 GDM 风险均无关。第一次和第二次就诊之间催乳素和孕激素的纵向变化与 GDM 风险无关。此外，在 10-14 周时，催乳素与胰岛素和 C 肽水平显著正相关，与 15-26 周时的 C 肽水平显著负相关；孕激素与血糖和胰岛素水平显著负相关。本研究首次提供了前瞻性证据，表明妊娠早期催乳素水平与 GDM 风险呈正相关。
