Li Guoju, Wei Tao, Ni Wei, Zhang Ai, Zhang Jun, Xing Yuhan, Xing Quansheng
Qingdao Women and Children's Hospital, Qingdao University, Qingdao City, China.
Qingdao Women and Children's Health Care and Family Planning Service Center, Qingdao City, China.
Front Endocrinol (Lausanne). 2020 Sep 11;11:636. doi: 10.3389/fendo.2020.00636. eCollection 2020.
Obesity and maternal age are the two most important factors independently affecting the risk of gestational diabetes mellitus (GDM). However, the age differences in the association between obesity and GDM remain unclear. The objectives of this cohort study included: (1) to determine the current incidence of GDM in Qingdao; and (2) to evaluate the risk factors for GDM, such as the interaction between pre-pregnancy body mass index (BMI) and age. The cohort included 17,145 pregnant women who registered at 15 to 20 gestational weeks from August 1, 2018, to March 1, 2019. A 75-g 2-h oral glucose tolerance test (OGTT) was conducted for each participant at 24-28 gestational weeks. The age-adjusted incidence of GDM was calculated using logistic regression. Multivariate logistic regression analysis was used to identify risk factors. Interaction between age (reference group <30 years) and BMI (reference group <25 kg/m) was determined using strata-specific analysis. The incidence and age-adjusted incidence of GDM in Qingdao were 17.42 and 17.45%, respectively. The incidence of GDM appeared to increase steadily with age in all pre-pregnancy BMI groups (all < 0.05). Older age (≥30 years), gestational BMI gain from pre-pregnancy to 15-20 weeks of gestation, history of GDM and thyroid diseases were risk factors for GDM. There were significant interactions between pre-pregnancy BMI and age ( < 0.05) after adjustment for other confounders. The odds ratio (OR) of pre-pregnancy BMI ≥ 30 kg/m at the age of <30 years, 30-34 years and ≥35 years was 1.30 (95% CI: 0.74-2.28, = 0.36), 3.21 (95% CI: 2.28-4.52, < 0.0001) and 1.55 (95% CI: 1.02-2.36, = 0.0424), respectively. This indicated that pre-pregnancy BMI ≥ 30 kg/m had a stronger effect on GDM in the group aged 30-34 years than those under 30 years old. The incidence of GDM was high in Qingdao. Overweight and obesity prior to pregnancy, gestational BMI gain from conception to 15-20 weeks of gestation and older age were correlated with an increased risk of GDM. Public health measures may be helpful to prevent excessive gestational weight gain.
肥胖和产妇年龄是独立影响妊娠期糖尿病（GDM）风险的两个最重要因素。然而，肥胖与GDM之间关联的年龄差异仍不明确。这项队列研究的目的包括：（1）确定青岛地区GDM的当前发病率；（2）评估GDM的风险因素，如孕前体重指数（BMI）与年龄之间的相互作用。该队列包括2018年8月1日至2019年3月1日期间在妊娠15至20周登记的17145名孕妇。在妊娠24 - 28周时对每位参与者进行75克2小时口服葡萄糖耐量试验（OGTT）。使用逻辑回归计算GDM的年龄调整发病率。采用多变量逻辑回归分析来识别风险因素。使用分层特定分析确定年龄（参照组<30岁）与BMI（参照组<25 kg/m²）之间的相互作用。青岛地区GDM的发病率和年龄调整发病率分别为17.42%和17.45%。在所有孕前BMI组中，GDM的发病率似乎都随着年龄的增长而稳步上升（均P<0.05）。年龄较大（≥30岁）、孕前至妊娠15 - 20周的孕期BMI增加、GDM病史和甲状腺疾病是GDM的风险因素。在调整其他混杂因素后，孕前BMI与年龄之间存在显著的相互作用（P<0.05）。孕前BMI≥30 kg/m²在<30岁、30 - 34岁和≥35岁时的优势比（OR）分别为1.30（95%CI：0.74 - 2.28，P = 0.36）、3.21（95%CI：2.28 - 4.52，P<0.0001）和1.55（95%CI：1.02 - 2.36，P = 0.0424）。这表明孕前BMI≥30 kg/m²对30 - 34岁组的GDM影响比对30岁以下组更强。青岛地区GDM的发病率较高。孕前超重和肥胖、受孕至妊娠15 - 20周的孕期BMI增加以及年龄较大与GDM风险增加相关。公共卫生措施可能有助于预防孕期体重过度增加。
