Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 07345, South Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, South Korea.
Sci Rep. 2020 Aug 17;10(1):13901. doi: 10.1038/s41598-020-70873-7.
The relationship between maternal smoking and gestational diabetes mellitus (GDM) is inconclusive. We investigated whether prepregnancy smoking is a risk factor for insulin-requiring GDM in Korean women. Using the National Health Insurance Service database, 325,297 women who delivered between 2011 and 2015 and who received a health examination within 52 weeks before pregnancy were included. Insulin-requiring GDM was defined as no claims for diabetes mellitus and a fasting blood glucose level of < 126 mg/dL before pregnancy, and initiation of insulin treatment during pregnancy. Smoking status was identified in a self-reported questionnaire completed during the health examination. There were 2,114 women (0.65%) with GDM who required insulin therapy. Compared with nonsmokers, the fully adjusted odd ratios (ORs) of former smokers and current smokers for insulin-requiring GDM were 1.55 (95% confidence interval [CI] 1.27-1.90) and 1.73 (1.42-2.09), respectively. The ORs (95% CIs) of insulin-requiring GDM among women who reported ≤ 2, 2-≤ 4, 4-≤ 6, 6-≤ 8, 8-≤ 10, and > 10 pack-years of smoking were 1.50 (1.22-1.84), 1.71 (1.31-2.22), 1.60 (1.13-2.26), 1.97 (1.14-3.40), 2.34 (1.22-4.51), and 2.29 (1.25-4.22), respectively, compared with nonsmokers (P for trend < 0.001). This association was similar in women with or without obesity and abdominal obesity. In conclusions, women who smoke have a significantly higher risk of GDM requiring insulin therapy, which may be proportional to the cumulative exposure to smoking. Cessation of smoking should be emphasized in women of childbearing age for the prevention of GDM.
母亲吸烟与妊娠糖尿病（GDM）之间的关系尚无定论。我们研究了孕前吸烟是否是韩国女性患需要胰岛素治疗的 GDM 的危险因素。使用国家健康保险服务数据库，纳入了 2011 年至 2015 年间分娩且在妊娠前 52 周内接受健康检查的 325297 名女性。需要胰岛素治疗的 GDM 定义为妊娠前无糖尿病索赔且空腹血糖水平<126mg/dL，并在妊娠期间开始胰岛素治疗。吸烟状况是通过健康检查期间完成的自我报告问卷确定的。有 2114 名（0.65%）患有 GDM 的女性需要胰岛素治疗。与不吸烟者相比，曾经吸烟者和当前吸烟者患需要胰岛素治疗的 GDM 的校正比值比（OR）分别为 1.55（95%置信区间[CI] 1.27-1.90）和 1.73（1.42-2.09）。报告吸烟量≤2、2-≤4、4-≤6、6-≤8、8-≤10 和>10 包年的女性中，需要胰岛素治疗的 GDM 的 OR（95%CI）分别为 1.50（1.22-1.84）、1.71（1.31-2.22）、1.60（1.13-2.26）、1.97（1.14-3.40）、2.34（1.22-4.51）和 2.29（1.25-4.22），与不吸烟者相比（P趋势<0.001）。在肥胖和腹型肥胖的女性中，这种关联相似。总之，吸烟的女性患需要胰岛素治疗的 GDM 的风险显著增加，且可能与吸烟的累积暴露量成正比。应强调育龄妇女戒烟以预防 GDM。
