Weight retention at six weeks postpartum and the risk of gestational diabetes mellitus in a second pregnancy
Weight retention at six weeks postpartum and the risk of gestational diabetes mellitus in a second pregnancy
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产后六周的体重保留和第二次怀孕时患妊娠糖尿病的风险
DOI：
10.1186/s12884-019-2423-3
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发表时间：
2019-08-01
影响因子：
3.1
通讯作者：
Guo, Songning
中科院分区：
文献类型：
--
作者：
Liu, Jing;Song, Guang;Guo, Songning
研究背景妊娠期糖尿病(GDM)是孕产妇发病的常见原因之一，并可导致糖尿病的发生。孕前体重与第一次和第二次怀孕之间的身体质量指数(BMI)的变化有关。与两次妊娠之间BMI的长期变化相比，研究BMI变化最容易获得的随访点是首次妊娠后6周。本研究旨在评估产后6周体重滞留与再次怀孕时发生妊娠期糖尿病的风险之间的关系。对于每一次妊娠，我们计算了第一次怀孕后产后6周的体重保留量，两次怀孕之间的解释BMI变化，以及第二次怀孕时的妊娠体重增加。风险由优势比(OR)和95%可信区间(CI)表示。然后，我们确定了初次怀孕后6周产后体重滞留与不同孕期BMI的解释变化之间的关系。结果与体重指数稳定(− 为1：1)的女性相比，解释体重指数的增加与第二次怀孕时妊娠期糖尿病的风险增加相关。首次怀孕期间体重指数在25以下和以上的女性的风险显著增加，尽管体重指数 <； 为25的女性风险增加更大。在第二次怀孕期间体重增加不足的妇女在第二次怀孕中患GDM的风险更高。与两次妊娠间体重增加1个体重指数单位相比，产后6周体重滞留与体重增加显著相关(P<；0.0 5)，与第二次妊娠妊娠期糖尿病发病率增加相关(OR 2.95，95%CI：1.95~ 4.45)。首次妊娠后6周体重指数变化为>； 3单位的妇女发生体重指数的危险性增加(OR = 1.42，95%CI：1.0 8~1.87)。产后六周提供了一个新的早期机会窗口，以确定后续怀孕的危险因素，并使我们能够实施初级预防策略。
BackgroundGestational diabetes mellitus (GDM) is a common cause of maternal morbidity, and can lead to the development of diabetes later in life. Pre-pregnancy body weight is associated with the change in body mass index (BMI) between a first and second pregnancy. Compared with long-term change in BMI between pregnancies, the most accessible follow-up point to investigate BMI change is 6 weeks after the initial pregnancy. The present study aimed to assess the association between weight retention at 6 weeks postpartum and the risk of GDM in a subsequent pregnancy.MethodsWe recruited 6429 singleton pregnancies into this retrospective cohort study. For each pregnancy, we calculated weight retention at 6 weeks postpartum after the first pregnancy, the interpregnancy BMI change between pregnancies, and the gestational weight gain in the second pregnancy. Risk was represented by the odds ratio (OR) and 95% confidence intervals (CIs). We then determined the relationship between postpartum weight retention at 6 weeks after the initial pregnancy, and the interpregnancy change in BMI between pregnancies. Analyses were stratified by BMI during the first pregnancy.ResultsCompared to women with a stable BMI (− 1 to 1), interpregnancy BMI gains were associated with an increased risk of GDM in the second pregnancy. Risk increased significantly for women with a BMI below and above 25 during the first pregnancy, although the increase was greater in the women with a BMI < 25. The risk of GDM in the second pregnancy was higher in women with inadequate weight gain during the second gestation. The weight retention at 6 weeks postpartum, where there was a gain of > 3 BMI units was significantly more related to weight gain more than when there was 1 BMI unit gain between pregnancies (P< 0.05) and associated with an increased incidence of GDM in the second pregnancy (OR = 2.95, 95% CI: 1.95 ~ 4.45). Women who showed a change in BMI that was > 3 units at 6 weeks postpartum after the first pregnancy showed an increased risk for BMI subsequently (OR = 1.42, 95% CI: 1.08~1.87).ConclusionsWomen who gained more than 3 BMI units at 6 weeks postpartum were associated with an increased risk of BMI in a subsequent pregnancy. Six weeks postpartum provides a new early window of opportunity to identify risk factors for a subsequent pregnancy and allows us to implement primary prevention strategies.