Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Pregnancy Childbirth. 2021 Mar 16;21(1):210. doi: 10.1186/s12884-021-03695-8.
Gestational diabetes mellitus (GDM) and macrosomia are associated with several adverse outcomes including diabetes mellitus and cardiovascular diseases, however, the relationship between GDM/macrosomia with incident chronic kidney disease (CKD) is a matter of debate. The purpose of this study was to examine the association between the history of macrosomia with or without GDM and incident maternal CKD.
The study population includes 2669 women aged 18-50 years without known diabetes mellitus and CKD from participants of the Tehran Lipid and Glucose Study. The study population was categorized into 3 groups; group 1: GDM/macrosomia and without diabetes mellitus (n = 204), group 2: newly diagnosed incident diabetes mellitus (NDM) in the presence or abcence of GDM/Macrosomia (n = 113), and, group 3: the reference group including women without prior history of GDM/macrosomia and free of NDM (n = 2352). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m. Multivariable Cox proportional hazard regression adjusted for baseline values of age, body mass index, waist circumference, parity numbers, smoking, educational level, gestational hypertension, eGFR, systolic and diastolic blood pressures (SBP and DBP, respectively), anti-hypertensive medication, and family history of diabetes mellitus was applied for data analyses.
During a median follow-up of 11.9 years, 613 incident CKD cases were identified. The multivariable hazard ratio (HR) and 95% confidence interval (CI) on GDM/macrosomia group was [1.32 (1.02-1.72)]; the risk was more prominent among non-hypertensive women [1.41 (1.07-1.85); P for interaction: 0.046]. Moreover, the history of macrosomia alone also showed a significant risk [1.36 (1.04-1.78)]; however, history of GDM alone did not have a significant risk [0.92 (0.34-2.46)]. Age, current smoking, eGFR, and SBP remained as independent risk factors for incident CKD.
A history of GDM/macrosomia or macrosomia alone, independent of subsequent diabetes mellitus was associated with significant risk for incident maternal CKD. Pregnancy may provide a unique situation to identify high-risk women at risk for CKD that could benefit from regular monitoring of kidney function and providing risk modifying strategies.
妊娠糖尿病（GDM）和巨大儿与多种不良结局相关，包括糖尿病和心血管疾病，但 GDM/巨大儿与慢性肾脏病（CKD）发病之间的关系存在争议。本研究旨在探讨既往巨大儿史合并或不合并 GDM 与产妇 CKD 发病的关系。
研究人群包括来自德黑兰血脂和血糖研究的 2669 名年龄在 18-50 岁之间、无已知糖尿病和 CKD 的女性。研究人群分为 3 组：第 1 组：GDM/巨大儿且无糖尿病（n=204）；第 2 组：存在或不存在 GDM/巨大儿时新诊断的糖尿病（n=113）；第 3 组：既往无 GDM/巨大儿史且无 NDM 者作为参考组（n=2352）。CKD 定义为估算肾小球滤过率（eGFR）<60ml/min/1.73m。多变量 Cox 比例风险回归调整了基线年龄、体重指数、腰围、产次、吸烟、教育程度、妊娠期高血压、eGFR、收缩压和舒张压（SBP 和 DBP）、降压药物和糖尿病家族史等因素，用于数据分析。
在中位随访 11.9 年期间，共发现 613 例 CKD 发病病例。多变量 HR（95%CI）为 GDM/巨大儿组[1.32（1.02-1.72）]；非高血压女性的风险更高[1.41（1.07-1.85）；P 交互作用：0.046]。此外，单纯巨大儿史也显示出显著的风险[1.36（1.04-1.78）]；然而，单纯 GDM 史没有显著的风险[0.92（0.34-2.46）]。年龄、当前吸烟、eGFR 和 SBP 仍然是 CKD 发病的独立危险因素。
既往 GDM/巨大儿或单纯巨大儿史与 CKD 发病风险显著相关，无论随后是否发生糖尿病。妊娠可能是一个独特的时机，可以识别出患有 CKD 的高危女性，这些女性可能受益于定期监测肾功能和提供风险修正策略。
