Longitudinal Study of Prepregnancy Cardiometabolic Risk Factors and Subsequent Risk of Gestational Diabetes Mellitus The CARDIA Study
Longitudinal Study of Prepregnancy Cardiometabolic Risk Factors and Subsequent Risk of Gestational Diabetes Mellitus The CARDIA Study
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DOI：
10.1093/aje/kwq267
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发表时间：
2010-11-15
影响因子：
5
通讯作者：
Sidney, Stephen
中科院分区：
文献类型：
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作者：
Gunderson, Erica P.;Quesenberry, Charles P., Jr.;Sidney, Stephen
本研究探讨了孕前心脏代谢危险因素和妊娠期糖尿病（GDM）在随后的怀孕。作者选择了1,164名孕前无糖尿病的妇女，她们在1985年至2006年的年轻人冠状动脉风险发展（CARDIA）研究中连续5次检查期间分娩了1,809名活产婴儿。作者测量了孕前心脏代谢危险因素，并进行了多变量重复测量logistic回归，以计算调整种族、年龄、产次、胎次和其他协变量后的GDM几率。妊娠前空腹血糖受损（100-125 vs < 90 mg/dL）、空腹胰岛素升高（> 15-20和> 20 vs < 10 mu U/mL）和低水平高密度脂蛋白胆固醇（< 40 vs. >50 mg/dL）与GDM直接相关：优势比4.74（95%置信区间（CI）：2.14，10.51）空腹血糖，2.19（95% CI：1.15，4.17）中胰岛素水平和2.36（95% CI：1.20，4.63），最高胰岛素水平为3.07糖尿病家族史阴性的女性患者高密度脂蛋白胆固醇水平较低（95%CI：1.62，5.84）;均P < 0.01。在超重妇女中，26.7%有一个或多个心脏代谢危险因素发展为GDM，而7.4%没有。非糖尿病妇女在妊娠期糖尿病前存在代谢损害。概念间代谢筛查可以包括在常规的健康评估，以确定高危妇女GDM在随后的怀孕，并可能减少胎儿暴露于代谢异常，规划未来的疾病。
This study examined prepregnancy cardiometabolic risk factors and gestational diabetes mellitus (GDM) in subsequent pregnancies. The authors selected 1,164 women without diabetes before pregnancy who delivered 1,809 livebirths between 5 consecutive examinations from 1985 to 2006 in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The authors measured prepregnancy cardiometabolic risk factors and performed multivariate repeated-measures logistic regression to compute the odds of GDM adjusted for race, age, parity, birth order, and other covariates. Impaired fasting glucose (100-125 vs. < 90 mg/dL), elevated fasting insulin (> 15-20 and > 20 vs. < 10 mu U/mL), and low levels of high-density lipoprotein cholesterol (< 40 vs. > 50 mg/dL) before pregnancy were directly associated with GDM: The odds ratios 4.74 (95% confidence interval (CI): 2.14, 10.51) for fasting glucose, 2.19 (95% CI: 1.15, 4.17) for middle insulin levels and 2.36 (95% CI: 1.20, 4.63) for highest insulin levels, and 3.07 (95% CI: 1.62, 5.84) for low levels of high-density lipoprotein cholesterol among women with a negative family history of diabetes; all P < 0.01. Among overweight women, 26.7% with 1 or more cardiometabolic risk factors developed GDM versus 7.4% with none. Metabolic impairment exists before GDM pregnancy in nondiabetic women. Interconceptual metabolic screening could be included in routine health assessments to identify high-risk women for GDM in a subsequent pregnancy and to potentially minimize fetal exposure to metabolic abnormalities that program future disease.