Does pregnancy or pregnancy loss increase later maternal risk of diabetes?
Does pregnancy or pregnancy loss increase later maternal risk of diabetes?
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DOI：
10.1007/s10654-012-9683-9
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发表时间：
2012-05-01
影响因子：
13.6
通讯作者：
Kaaks, Rudolf
中科院分区：
文献类型：
--
作者：
Kharazmi, Elham;Lukanova, Annekatrin;Kaaks, Rudolf
生育与未来糖尿病发展相关的证据仍然相互矛盾，并且尚未研究妊娠丢失在此相关性中的作用。我们的目的是研究怀孕和/或流产（流产，流产或死产）是否与母亲日后患糖尿病的风险较高有关，使用基于人群的前瞻性队列研究（平均随访= 10.7年），包括13，612名女性（基线年龄为35-65岁）。我们发现，在考虑了教育、吸烟、饮酒、体力活动、BMI、腰臀比、高血压和高脂血症的影响后，妊娠本身并没有改变糖尿病的风险（完全校正OR：1.04，95%CI：0.82-1.31）。超过四个活产婴儿与以后生活中糖尿病的风险增加约两倍相关（完全校正的OR：1.77，95%CI：1.12-2.80）。超过两次流产与糖尿病风险增加约两倍相关（完全校正的比值比（OR）：1.85，95%CI：1.17-2.93）。在进一步调整产次后，那些有两次以上流产史的人患糖尿病的风险没有实质性变化（OR：1.82; 95% CI：1.15-2.88），但当考虑到妊娠丢失的作用时，超过4次活产与糖尿病之间的关联消失（完全校正的HR：1.06; 95% CI：0.54-2.08）。流产、死产和母亲患糖尿病的风险之间没有显著的联系。妊娠本身并不会增加糖尿病的风险。经历过两次以上流产的女性在以后的生活中患糖尿病的风险高出两倍左右。高产次和糖尿病之间的关联是由流产史和已知的糖尿病风险因素介导的。流产和糖尿病之间的联系的根本原因需要进一步调查。
Evidence that childbearing is associated with future development of diabetes remains conflicting and the role of pregnancy loss in this association has not been investigated. We aimed to examine whether pregnancy and/or pregnancy loss (miscarriage, abortion, or stillbirth) are associated with maternal higher risk of diabetes later in life, using a population-based prospective cohort study (mean follow-up = 10.7 years), including 13,612 women (aged 35-65 at baseline). We found pregnancy per se did not change the risk of diabetes after considering the effect of education, smoking, alcohol consumption, physical activity, BMI, waist/hip ratio, hypertension, and hyperlipidemia (fully-adjusted OR: 1.04, 95 % CI: 0.82-1.31). Having more than four live births was associated with around two times higher risk of diabetes later in life (fully-adjusted OR: 1.77, 95 % CI: 1.12-2.80). Having more than two miscarriages was associated with about two-fold higher risk of diabetes (fully-adjusted Odd ratio (OR): 1.85, 95 % CI: 1.17-2.93). After further adjustment for parity, the higher risk of diabetes in those who had history of more than two miscarriages did not change substantially (OR: 1.82; 95 % CI: 1.15-2.88), but the association between more than four live births and diabetes disappeared when the role of pregnancy loss was considered (fully-adjusted HR: 1.06; 95 % CI: 0.54-2.08). No significant association was found between abortion, stillbirth and risk of maternal diabetes. Pregnancy per se did not increase risk of diabetes. Women who experience more than two miscarriages are at around two times higher risk of diabetes later in life. The association between high parity and diabetes is mediated by history of miscarriages and known risk factors of diabetes. The underlying reason for association between miscarriage and diabetes needs further investigation.