Patterns of Gestational Weight Gain in Early Pregnancy and Risk of Gestational Diabetes Mellitus.
Patterns of Gestational Weight Gain in Early Pregnancy and Risk of Gestational Diabetes Mellitus.
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DOI：
10.1097/ede.0000000000000629
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发表时间：
2017-05
期刊：
影响因子：
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通讯作者：
Hutcheon JA
中科院分区：
文献类型：
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作者：
MacDonald SC;Bodnar LM;Himes KP;Hutcheon JA
尽管有人呼吁研究体重增加模式对妊娠期糖尿病发展的影响，但很少有研究正确地调整了妊娠早期体重增加的独立影响。我们使用条件百分位数方法来模拟妊娠早期和中期体重增加轨迹与妊娠糖尿病发展之间的独立关联。我们采用病例队列设计对1998-2010年在宾夕法尼亚州匹兹堡magee妇女医院分娩的单胎婴儿进行了抽样（n=124,590）。我们使用有条件的体重增加百分位数对妊娠早期和中期的体重增加轨迹进行建模，并使用多变量逻辑回归来评估该轨迹与妊娠糖尿病的独立关联。我们分别研究了孕前体重指数类别的相关性。最后的队列包括806名患有妊娠糖尿病的妇女和4819名随机抽样的没有妊娠糖尿病的妇女。在正常体重的妇女中，妊娠早期体重增加的每一个标准偏差高于其预测的增加与妊娠糖尿病的几率增加23%相关[95% CI: 0.2%, 51%]。妊娠中期体重增加轨迹与妊娠糖尿病无关（OR: 1.1, [95% CI: 0.9, 1.3]），尽管影响方向为正相关。这种模式在1级和2级肥胖女性中相似，但在超重和3级肥胖女性中则不同。对于大多数孕前BMI类型的女性来说，妊娠早期体重增加的轨迹与妊娠糖尿病呈正相关。妊娠中期体重增加轨迹与任何组的妊娠糖尿病无关。
Despite a call to study the effect of weight gain pattern on development of gestational diabetes mellitus, few studies have correctly adjusted for independent effects of gain after the first trimester. We used a conditional percentile approach to model the independent association between first and second trimester weight-gain trajectories and development of gestational diabetes. We sampled women delivering singleton infants from 1998–2010 at Magee-Womens Hospital in Pittsburgh, PA (n=124,590) using a case–cohort design. We modeled weight-gain trajectories in the first and second trimesters of pregnancy using conditional weight-gain percentiles, and used multivariable logistic regression to assess independent associations of the trajectory with gestational diabetes. We studied associations separately by pre-pregnancy body mass index category. The final cohort included 806 women with gestational diabetes and 4,819 randomly sampled women who delivered without gestational diabetes. In normal-weight women, every standard deviation increase in weight gain in the first trimester above her predicted gain was associated with a 23% increased odds of gestational diabetes [95% CI: 0.2%, 51%]. Second trimester gain trajectory was not associated with gestational diabetes (OR: 1.1, [95% CI: 0.9, 1.3]) although the direction of effect was positive. This pattern was similar in obese class I and II but not in overweight and obese class III women. An upward weight gain trajectory in the first trimester was positively associated with gestational diabetes for women of most pre-pregnancy BMI categories. Second trimester weight gain trajectory was not associated with gestational diabetes for any group.