Sexual dimorphism in the association between gestational diabetes mellitus and overweight in offspring at 5-7 years: The OBEGEST cohort study.
Sexual dimorphism in the association between gestational diabetes mellitus and overweight in offspring at 5-7 years: The OBEGEST cohort study.
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DOI：
10.1371/journal.pone.0195531
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Favier F
中科院分区：
文献类型：
--
作者：
Le Moullec N;Fianu A;Maillard O;Chazelle E;Naty N;Schneebeli C;Gérardin P;Huiart L;Charles MA;Favier F
关于母体妊娠期糖尿病（GDM）与后代超重的可能关联，文献证据不一。性别二态性，或在GDM暴露与超重之间的发病机制中的性别差异，可能在起作用。本研究的目的是调查GDM与5-7岁儿童超重之间的关系。600对（1:1）从医院出生登记处选择的活产单胎，性别、胎龄和出生时间相匹配，进行了前瞻性的家庭随访，并分析了他们对GDM的暴露情况。根据国际肥胖工作组的定义，主要结果是5-7岁的儿童超重。使用条件logistic回归模型，通过比值比（OR）估计GDM暴露与儿童超重之间的关系。对于有可用母亲血糖数据的暴露于GDM的儿童亚组，我们使用线性回归模型分析了怀孕期间母亲血糖水平与5-7岁儿童体重指数（BMI）之间的关系。鉴于性别与GDM之间的显著相互作用，所有的统计分析都按性别分层。在控制孕前BMI和母亲社会人口学特征后，男孩的超重风险随着GDM的暴露而增加（校正OR: 2.34； 95%置信区间= 1.26-4.34,P = 0.007），而女孩则没有（校正OR: 0.56; 95% ci = 0.28-1.10, P = 0.093）。与此相一致的是，在暴露组中，5-7岁男孩的BMI与母亲妊娠期间的血糖水平呈线性增长，表现出剂量-反应关系。我们的研究结果表明，接触GDM是男孩儿童期超重的一个危险因素，而不是女孩，这增加了越来越多的证据表明，男性后代对宫内高血糖更敏感。
Evidence from literature is mixed regarding a possible association of maternal gestational diabetes mellitus (GDM) and overweight in the offspring. Sexual dimorphism, or sex disparities in the pathogenesis linking GDM exposure to overweight, could be at play. The objective of this study was to investigate the association between GDM and child overweight at 5–7 years. Six hundred pairs (1:1) of Reunionese liveborn singletons selected from a hospital-based birth registry, matched for sex, gestational age, and birth period, underwent a prospective in-home follow-up and were analyzed with respect to their exposure to GDM. The primary outcome was child overweight at 5–7 years, as defined by the International Obesity Task Force. The association between GDM exposure and child overweight was estimated by the odds ratio (OR) using conditional logistic regression models. For the subset of children exposed to GDM with available maternal glycemic data, we analyzed the relationship between maternal glycemic levels during pregnancy and child body mass index (BMI) at 5–7 years with a linear regression model. In light of the significant interaction between sex and GDM, all statistical analyses were then stratified by sex. After controlling for pre-pregnancy BMI and maternal sociodemographic characteristics, the risk of overweight increased with exposure to GDM for boys (adjusted OR: 2.34; 95% confidence interval = 1.26–4.34, P = 0.007) but not for girls (adjusted OR: 0.56; 95%CI = 0.28–1.10, P = 0.093). Consistent with this, the linear increase of boys’ BMI at 5–7 years with maternal blood glucose levels during pregnancy, in the exposed group, displayed a dose-response relationship. Our findings indicate that exposure to GDM is a risk factor for childhood overweight in boys but not in girls, which adds to the growing body of evidence suggesting greater sensitivity of male offspring to intrauterine hyperglycemia.
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