Gestational age, infant birth weight, and subsequent risk of type 2 diabetes in mothers: Nurses' Health Study II.
Gestational age, infant birth weight, and subsequent risk of type 2 diabetes in mothers: Nurses' Health Study II.
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DOI：
10.5888/pcd10.120336
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发表时间：
2013-09-19
影响因子：
5.5
通讯作者：
Rich-Edwards JW
中科院分区：
文献类型：
--
作者：
James-Todd TM;Karumanchi SA;Hibert EL;Mason SM;Vadnais MA;Hu FB;Rich-Edwards JW
有妊娠期糖尿病（GDM）病史的女性发生2型糖尿病（T2 DM）的风险较高;然而，对其他常见妊娠并发症（如早产、巨大儿）与T2 DM风险之间的关系知之甚少。我们研究了首次妊娠早产、过期分娩、低出生体重和巨大儿与随后的T2 DM风险之间的关系。我们对护士健康研究II（NHSII）参与者进行了一项前瞻性队列研究;研究中的51，728名妇女有一次活产和完整的妊娠史。NHSII通过补充问卷确认了糖尿病事件。参与者从第一次出生到2005年进行了跟踪。我们将胎龄定义为极早产（20至≤32周）、中度早产（33至≤37周）、足月（38至≤42周）和过期（≥43周）。我们将低出生体重定义为足月出生体重小于5.5磅的婴儿，我们将巨大儿定义为足月出生体重10磅或以上的婴儿。我们使用考克斯比例风险模型，调整潜在的混杂因素。极早产妇女（2%）的T2 DM风险增加（校正风险比，1.34; 95%置信区间[CI]，1.05-1.71）。这种增加的风险出现在怀孕后的十年中。校正包括GDM在内的风险因素后，巨大儿（1.5%）与T2 DM风险增加1.61相关（95% CI，1.24-2.08）。这种关联在怀孕后的前5年内很明显。在35年的随访时间内，中度早产和足月低出生体重并没有显著增加T2 DM的风险。经历过极早产或婴儿体重10磅或以上的妇女可能会从生活方式干预中受益，以降低T2 DM风险。如果重复这些发现，可以通过改善对早产妇女或出生体重异常婴儿的初级保健来降低T2 DM的风险。
Women with a history of gestational diabetes mellitus (GDM) are at higher risk of developing type 2 diabetes (T2DM); however, little is known about the association between other common pregnancy complications (eg, preterm birth, macrosomia) and T2DM risk. We examined the associations between first-pregnancy preterm, postterm birth, low birth weight, and macrosomia with subsequent risk of T2DM. We conducted a prospective cohort study of Nurses’ Health Study II (NHSII) participants; 51,728 women in the study had a single live birth and complete pregnancy history. NHSII confirmed incident diabetes mellitus through supplemental questionnaires. Participants were followed from year of first birth until 2005. We defined gestational age as very preterm (20 to ≤32 weeks), moderate preterm (33 to ≤37 weeks), term (38 to ≤42 weeks), and postterm (≥43 weeks). We defined low birth weight as an infant born at term weighing less than 5.5 pounds, and we defined macrosomia as an infant born at term weighing 10 pounds or more. We used Cox proportional hazards models, adjusting for potential confounders. Women with a very preterm birth (2%) had an increased T2DM risk (adjusted hazard ratio, 1.34; 95% confidence interval [CI], 1.05–1.71). This increased risk emerged in the decade following pregnancy. Macrosomia (1.5%) was associated with a 1.61 increased T2DM risk, after adjusting for risk factors, including GDM (95% CI, 1.24–2.08). This association was apparent within the first 5 years after pregnancy. Moderate preterm and term low birth weight did not significantly increase the risk of T2DM over the 35-year follow-up time. Women who experienced a very preterm birth or had an infant that weighed 10 pounds or more may benefit from lifestyle intervention to reduce T2DM risk. If replicated, these findings could lead to a reduced risk of T2DM through improved primary care for women experiencing a preterm birth or an infant of nonnormal birth weight.
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