Department of Nutrition and Toxicology, Hangzhou Normal University School of Public Health, Hangzhou, China.
Department of Obstetrics, The Affiliated Hangzhou Women's Hospital, Hangzhou Normal University, Hangzhou, China.
BMC Pregnancy Childbirth. 2022 Jul 20;22(1):580. doi: 10.1186/s12884-022-04908-4.
Studies have demonstrated the associations between pre-pregnancy obesity, thyroid dysfunction, dyslipidemia, and increased risk of gestational diabetes mellitus (GDM) in pregnant women. This study was designed to investigate whether and to what extent, the interactions between these factors contribute to the risk of GDM.
A case-control study of 232 GDM cases and 696 controls was conducted among pregnant women from Hangzhou, China. Multiple logistic regression analysis was applied to identify independent risk factors of GDM. Crossover analysis was performed to assess the interactive effects of pre-pregnancy body mass index (pBMI), thyroid hormones, and blood lipid profiles on the risk of GDM. The indexes including attributable proportion (AP) to the interaction and the relative excess risk due to interaction (RERI) were calculated.
Chinese pregnant women with pBMI > 23 kg/m (adjusted: OR = 4.162, p < 0.001), high triglyceride levels (> 2.30 mmol/L) (adjusted: OR = 1.735, p < 0.001), and the free triiodothyronine/free thyroxine (FT3/FT4) ratio ≥ 0.502 (OR = 4.162, p < 0.001) have significantly increased risk of GDM. Crossover analysis indicated that there were significant interactions between pre-pregnancy overweight/obesity and FT3/FT4 ≥ 0.502 (AP = 0.550, p < 0.001; RERI = 7.586, p = 0.009), high TG levels and FT3/FT4 ≥ 0.502 (AP = 0.348, 95%CI = 0.081-0.614, P = 0.010; RERI = 2.021, 95%CI = 0.064-3.978, p = 0.043) on the risk of GDM.
The interactions between pBMI and FT3/FT4 ratio, TG level and FT3/FT4 ratio may have significant impacts on the risk of GDM in pregnant women. Such findings may help improve our understanding of the pathogenesis of GDM as well as develop comprehensive strategies for the management of GDM.
研究表明，孕前肥胖、甲状腺功能障碍、血脂异常与孕妇发生妊娠期糖尿病（GDM）的风险增加有关。本研究旨在探讨这些因素之间的相互作用是否以及在多大程度上导致 GDM 的发生。
采用病例对照研究，对来自中国杭州的 232 例 GDM 病例和 696 例对照进行研究。应用多因素 logistic 回归分析识别 GDM 的独立危险因素。进行交叉分析以评估孕前体重指数（pBMI）、甲状腺激素和血脂谱对 GDM 风险的交互作用。计算归因比例（AP）和交互超额相对危险度（RERI）。
中国孕妇 pBMI>23kg/m2（校正：OR=4.162，p<0.001）、甘油三酯水平升高（>2.30mmol/L）（校正：OR=1.735，p<0.001）和游离三碘甲状腺原氨酸/游离甲状腺素（FT3/FT4）比值≥0.502（OR=4.162，p<0.001）的孕妇 GDM 风险显著增加。交叉分析表明，孕前超重/肥胖与 FT3/FT4≥0.502（AP=0.550，p<0.001；RERI=7.586，p=0.009）、高甘油三酯水平与 FT3/FT4≥0.502（AP=0.348，95%CI=0.081-0.614，p=0.010；RERI=2.021，95%CI=0.064-3.978，p=0.043）之间存在显著交互作用。
pBMI 与 FT3/FT4 比值、TG 水平与 FT3/FT4 比值之间的相互作用可能对孕妇 GDM 的发生有显著影响。这些发现可能有助于我们更好地理解 GDM 的发病机制，并制定 GDM 的综合管理策略。
