A 20-year prospective study of childbearing and incidence of diabetes in young women, controlling for glycemia before conception - The Coronary Artery Risk Development in Young Adults (CARDIA) Study
A 20-year prospective study of childbearing and incidence of diabetes in young women, controlling for glycemia before conception - The Coronary Artery Risk Development in Young Adults (CARDIA) Study
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DOI：
10.2337/db07-1024
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发表时间：
2007-12-01
期刊：
影响因子：
7.7
通讯作者：
Sidney, Stephen
中科院分区：
文献类型：
--
作者：
Gunderson, Erica P.;Lewis, Cora E.;Sidney, Stephen
研究设计和方法--在1985-2006年的多中心、以美国人群为基础的年轻成人冠状动脉风险发展研究中，一个前瞻性的、双胎队列被检查了5次。该分析包括2，408名年龄在18-30岁之间的女性（1，226名黑人和1，182名白色），她们没有糖尿病，基线时空腹血糖（FPG）< 126 mg/dl。通过自我报告、糖尿病药物使用、FPG >= 126 mg/dl和/或口服葡萄糖2小时后血糖>= 200 mg/dl诊断糖尿病。时间依赖性中期出生组是那些零和那些有一个或多个分娩有或没有妊娠期糖尿病（GDM），分层的基线产次。互补双对数模型估计了经年龄、种族、糖尿病家族史和基线协变量（FPG、BMI、教育、吸烟和体力活动）调整的中期出生的糖尿病事件的相对危险度。在42，782人年（4.5例/1，000人年）的193例糖尿病事件中，84例（44%）有一个或多个中期出生。在基线时的初治者中，每1,000人年的发病率为3.2（95% CI 2.4-4.1）未生育者，2.9（1.8-3.9）一胎或多胎无GDM，和18.4（10.9-25.9）一次或多次分娩患有GDM;校正的相对危险度（95% CI）为0.9（0.6-1.4）一胎或多胎无GDM，3.8（2.2-6.6）。结论：在妊娠期糖耐量正常的人群中，生育不会增加糖尿病的发病率（没有GDM）。妊娠期糖尿病的发生风险最高，与糖尿病家族史、孕前肥胖和肥胖无关。
OBJECTIVE-We sought to determine whether childbearing increases incidence of type 2 diabetes after accounting for preconception glycemia and gestational glucose intolerance.RESEARCH DESIGN AND METHODS-A prospective, biracial cohort was examined up to five times during 1985-2006 in the multicenter, U.S. population-based Coronary Artery Risk Development in Young Adults Study. The analysis included 2,408 women (1,226 black and 1,182 white) aged 18-30 years who were free of diabetes and had a fasting plasma glucose (FPG) < 126 mg/dl at baseline. Incident diabetes was diagnosed by self-report, diabetes medication use, FPG >= 126 mg/dl, and/or plasma glucose >= 200 mg/dl after a 2-h oral glucose load. Time-dependent interim birth groups were those with zero and those with one or more births with or without gestational diabetes mellitus (GDM), stratified by baseline parity. Complementary log-log models estimated relative hazards of incident diabetes by interim births adjusted for age, race, family history of diabetes, and baseline covariates (FPG, BMI, education, smoking, and physical activity).RESULTS-Of 193 incident diabetes cases in 42,782 person-years (4.5 cases/1,000 person-years), 84 (44%) had one or more interim births. Among nulliparas at baseline, incident rates per 1,000 person-years were 3.2 (95% CI 2.4-4.1) for those with no births, 2.9 (1.8-3.9) for one or more births without GDM, and 18.4 (10.9-25.9) for one or more births with GDM; adjusted relative hazards (95% CI) were 0.9 (0.6-1.4) for one or more births without GDM and 3.8 (2.2-6.6) for one or more births with GDM versus no births.CONCLUSIONS-Childbearing did not elevate diabetes incidence among those with normal glucose tolerance during pregnancy (without GDM). GDM conferred the highest risk of developing diabetes independent of family history of diabetes and preconception glycemia and obesity.