Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study.
Lactation and Progression to Type 2 Diabetes Mellitus After Gestational Diabetes Mellitus: A Prospective Cohort Study.
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DOI：
10.7326/m15-0807
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发表时间：
2015-12-15
影响因子：
39.2
通讯作者：
Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy Investigators
中科院分区：
文献类型：
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作者：
Gunderson EP;Hurston SR;Ning X;Lo JC;Crites Y;Walton D;Dewey KG;Azevedo RA;Young S;Fox G;Elmasian CC;Salvador N;Lum M;Sternfeld B;Quesenberry CP Jr;Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy Investigators
哺乳改善糖代谢，但其在预防妊娠期糖尿病（GDM）后2型糖尿病（DM）中的作用仍不确定。评估GDM妊娠后哺乳和2年DM发病率。近期GDM女性的前瞻性观察队列。（ClinicalTrials.gov：NCT 01967030）综合医疗保健系统。1035名诊断为GDM的妇女在妊娠35周或更晚分娩单胎，并参加了2008年至2011年GDM妊娠后妇女、婴儿喂养和2型糖尿病的研究。分娩后6 - 9周（基线）进行三次面对面研究检查，每年随访2年，包括2小时75 g口服葡萄糖耐量试验;人体测量学;和访谈。多变量威布尔回归模型评估独立的关联泌乳措施与事件DM调整潜在的混杂因素。在1010名基线时无糖尿病的女性中，959名（95%）在2年后进行了评估; 113名（11.8%）发生了糖尿病事件。基线时泌乳强度与发生DM呈分级负相关，主要配方奶喂养或混合/不一致喂养、主要泌乳喂养和纯母乳喂养与纯配方奶喂养的校正风险比分别为0.64、0.54和0.46（P趋势= 0.016）。时间依赖性哺乳期持续时间与DM事件呈分级负相关，大于2至5个月、大于5至10个月和大于10个月与0至2个月的校正风险比分别为0.55、0.50和0.43（P趋势= 0.007）。体重变化轻微降低了风险比。随机化设计对于哺乳期临床研究是不可行或不可取的。较高的泌乳强度和较长的持续时间与GDM妊娠后2年DM发病率较低独立相关。哺乳可预防GDM分娩后的DM。
Lactation improves glucose metabolism, but its role in preventing type 2 diabetes mellitus (DM) after gestational diabetes mellitus (GDM) remains uncertain. To evaluate lactation and the 2-year incidence of DM after GDM pregnancy. Prospective, observational cohort of women with recent GDM. (ClinicalTrials.gov: NCT01967030) Integrated health care system. 1035 women diagnosed with GDM who delivered singletons at 35 weeks' gestation or later and enrolled in the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy from 2008 to 2011. Three in-person research examinations from 6 to 9 weeks after delivery (baseline) and annual follow-up for 2 years that included 2-hour, 75-g oral glucose tolerance testing; anthropometry; and interviews. Multivariable Weibull regression models evaluated independent associations of lactation measures with incident DM adjusted for potential confounders. Of 1010 women without diabetes at baseline, 959 (95%) were evaluated up to 2 years later; 113 (11.8%) developed incident DM. There were graded inverse associations for lactation intensity at baseline with incident DM and adjusted hazard ratios of 0.64, 0.54, and 0.46 for mostly formula or mixed/inconsistent, mostly lactation, and exclusive lactation versus exclusive formula feeding, respectively (P trend = 0.016). Time-dependent lactation duration showed graded inverse associations with incident DM and adjusted hazard ratios of 0.55, 0.50, and 0.43 for greater than 2 to 5 months, greater than 5 to 10 months, and greater than 10 months, respectively, versus 0 to 2 months (P trend = 0.007). Weight change slightly attenuated hazard ratios. Randomized design is not feasible or desirable for clinical studies of lactation. Higher lactation intensity and longer duration were independently associated with lower 2-year incidences of DM after GDM pregnancy. Lactation may prevent DM after GDM delivery.