Department of Maternity-Child Health and Family Planning Services, Nanning Maternal and Child Health Hospital, Nanning, China.
Front Endocrinol (Lausanne). 2023 May 10;14:1158969. doi: 10.3389/fendo.2023.1158969. eCollection 2023.
The prevalence of gestational diabetes mellitus (GDM) and advanced maternal age (AMA, ≥ 35 years) has shown an increasing trend worldwide. This study aimed to evaluate the risk of pregnancy outcomes among younger (20-34 years) and older (≥ 35 years) women with GDM and further analyze the epidemiologic interaction of GDM and AMA on these outcomes.
This historical cohort study included 105 683 singleton pregnant women aged 20 years or older between January 2012 and December 2015 in China. Stratified by maternal age, the associations between GDM and pregnancy outcomes were analyzed by performing logistic regression. Epidemiologic interactions were assessed by using relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) with their 95% confidence intervals (95%CIs).
Among younger women, individuals with GDM had a higher risk of all maternal outcomes, preterm birth (relative risk [RR] 1.67, 95%CI 1.50-1.85), low birthweight (RR 1.24, 95%CI 1.09-1.41), large for gestational age (RR 1.51, 95%CI 1.40-1.63), macrosomia (RR 1.54, 95%CI 1.31-1.79), and fetal distress (RR 1.56, 95%CI 1.37-1.77) than those without GDM. Among older women, GDM increased the risk of gestational hypertension (RR 2.17, 95%CI 1.65-2.83), preeclampsia (RR 2.30, 95%CI 1.81-2.93), polyhydramnios (RR 3.46, 95%CI 2.01-5.96), cesarean delivery (RR 1.18, 95%CI 1.10-1.25), preterm birth (RR 1.35, 95%CI 1.14-1.60), large for gestational age (RR 1.40, 95%CI 1.23-1.60), macrosomia (RR 1.65, 95%CI 1.28-2.14) and fetal distress (RR 1.46, 95%CI 1.12-1.90). Additive interactions of GDM and AMA on polyhydramnios and preeclampsia were found, with RERI of 3.11 (95%CI 0.05-6.16) and 1.43 (95%CI 0.09-2.77), AP of 0.51 (95%CI 0.22-0.80) and 0.27 (95%CI 0.07-0.46), and SI of 2.59 (95%CI 1.17-5.77) and 1.49 (95%CI 1.07-2.07), respectively.
GDM is an independent risk factor for multiple adverse pregnancy outcomes, and may exert additive interactions with AMA on the risk of polyhydramnios and preeclampsia.
妊娠糖尿病（GDM）和高龄产妇（AMA，≥35 岁）的患病率在全球呈上升趋势。本研究旨在评估年轻（20-34 岁）和高龄（≥35 岁）GDM 产妇的妊娠结局风险，并进一步分析 GDM 和 AMA 对这些结局的流行病学交互作用。
本历史队列研究纳入了 2012 年 1 月至 2015 年 12 月期间中国 105683 名 20 岁及以上的单胎孕妇。根据产妇年龄分层，采用 logistic 回归分析 GDM 与妊娠结局的关系。使用相对超额风险比（RERI）、归因比例（AP）和协同指数（SI）及其 95%置信区间（95%CI）评估流行病学交互作用。
在年轻女性中，GDM 患者发生所有母婴结局的风险较高，包括早产（相对风险[RR]1.67，95%CI 1.50-1.85）、低出生体重（RR 1.24，95%CI 1.09-1.41）、巨大儿（RR 1.51，95%CI 1.40-1.63）、胎儿窘迫（RR 1.56，95%CI 1.37-1.77）等。在高龄女性中，GDM 增加了妊娠高血压（RR 2.17，95%CI 1.65-2.83）、子痫前期（RR 2.30，95%CI 1.81-2.93）、羊水过多（RR 3.46，95%CI 2.01-5.96）、剖宫产（RR 1.18，95%CI 1.10-1.25）、早产（RR 1.35，95%CI 1.14-1.60）、巨大儿（RR 1.40，95%CI 1.23-1.60）、胎儿窘迫（RR 1.46，95%CI 1.12-1.90）等风险。GDM 和 AMA 在羊水过多和子痫前期方面存在相加交互作用，RERI 为 3.11（95%CI 0.05-6.16）和 1.43（95%CI 0.09-2.77），AP 为 0.51（95%CI 0.22-0.80）和 0.27（95%CI 0.07-0.46），SI 为 2.59（95%CI 1.17-5.77）和 1.49（95%CI 1.07-2.07）。
GDM 是多种不良妊娠结局的独立危险因素，并且可能与 AMA 对羊水过多和子痫前期的风险产生相加交互作用。
