青少年体重指数及孕前体重指数变化与妊娠期糖尿病风险的关系
Adolescent body mass index and changes in pre-pregnancy body mass index in relation to risk of gestational diabetes.
作者信息
Chodick Gabriel, Omer-Gilon Maayan, Derazne Estela, Puris Gal, Rotem Ran, Tzur Dorit, Pinhas-Hamiel Orit, Cukierman-Yaffe Tali, Shina Avi, Zucker Inbar, Tirosh Amir, Afek Arnon, Shalev Varda, Twig Gilad
机构信息
Maccabitech Research Institute, Maccabi Healthcare Services, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
EClinicalMedicine. 2021 Nov 19;42:101211. doi: 10.1016/j.eclinm.2021.101211. eCollection 2021 Dec.
BACKGROUND
Pregestational excessive body mass index (BMI) is linked to an increased risk for gestational diabetes mellitus (GDM), but less is known on the effect of adolescent BMI on GDM occurrence. The study aimed to investigate possible associations of adolescent BMI and changes in BMI experienced before first pregnancy, with gestational diabetes risk.
METHODS
This retrospective study was based on linkage of a military screening database of adolescent health status (Israel Defence Forces) including measured height and weight, with medical records (Maccabi Healthcare Services, MHS) of a state-mandated health provider. The latter covers about 25% of the Israeli population; about 90% of pregnant women undergo screening by the two-step Carpenter-Coustan method. Adolescent BMI was categorized according to Center of Disease Control and Prevention percentiles. Only first documented pregnanies were analyzed and GDM was the outcome.
FINDINGS
Of 190,905 nulliparous women, 10,265 (5.4%) developed GDM. Incidence proportions of GDM were 5.1%, 6.1%, 7.3%, and 8.9% among women with adolescent normal BMI, underweight, overweight, and obesity (p<0.001), respectively. In models that accounted for age at pregnancy, birth year, and sociodemographic variables, the adjusted odd ratios (aORs) for developing GDM were: 1.2 (95%CI, 1.1-1.3), 1.5 (1.4-1.6), and 1.9 (1.7-2.1) for adolescent underweight, overweight, and obesity (reference group, normal BMI). Adolescent BMI tracked with BMI notes in the pre-pregnancy period (r=63%). Resuming normal pre-pregnancy BMI from overweight or obesity in adolescence diminished GDM risk, but this diminished risk was not observed among those who returned to a normal per-pre-pregnancy BMI from being underweight in adolescence. Sustained overweight or obesity conferred an aOR for developing GDM of 2.5 (2.2-2.7); weight gain from adolescent underweight and normal BMI to pre-pregnancy excessive BMI conferred aORs of 3.1 (1.6-6.2) and 2.6 (2.2-2.7), respectively.
INTERPRETATION
Change in BMI status from adolescence to pre-pregnancy may contribute to GDM risk. Identifying at-risk populations is important for early preventive interventions.
FUNDING
None.
背景
孕前体重指数（BMI）过高与妊娠期糖尿病（GDM）风险增加有关，但青少年BMI对GDM发生的影响知之甚少。本研究旨在调查青少年BMI及首次怀孕前BMI的变化与妊娠期糖尿病风险之间的可能关联。
方法
这项回顾性研究基于一个青少年健康状况军事筛查数据库（以色列国防军）与一家国家指定健康服务机构（马卡比医疗服务公司，MHS）的医疗记录的关联，前者包含测量的身高和体重。后者覆盖了约25%的以色列人口；约90%的孕妇通过两步法卡彭特-库斯坦方法进行筛查。青少年BMI根据疾病控制和预防中心百分位数进行分类。仅分析首次记录的妊娠情况，GDM为研究结果。
结果
在190,905名未生育女性中，10,265名（5.4%）患了GDM。青少年BMI正常、体重过轻、超重和肥胖的女性中，GDM的发病率分别为5.1%、6.1%、7.3%和8.9%（p<0.001）。在考虑怀孕年龄、出生年份和社会人口统计学变量的模型中，患GDM的调整后比值比（aOR）分别为：青少年体重过轻、超重和肥胖（参照组为正常BMI）时，aOR分别为1.2（95%CI，1.1 - 1.3）、1.5（1.4 - 1.6）和1.9（1.7 - 2.1）。青少年BMI与孕前BMI记录相关（r = 63%）。青少年期超重或肥胖后恢复到孕前正常BMI可降低GDM风险，但青少年期体重过轻恢复到孕前正常BMI者未观察到这种风险降低。持续超重或肥胖使患GDM的aOR为2.5（2.2 - 2.7）；青少年体重过轻和BMI正常者到孕前BMI过高的体重增加分别使aOR为3.1（1.6 - 6.2）和2.6（2.2 - 2.7）。
解读
从青少年期到孕前BMI状态的变化可能导致GDM风险增加。识别高危人群对早期预防性干预很重要。
资金
无。
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