孕期体质量增长及甲状腺激素水平对妊娠期糖尿病发病的影响
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摘要
目的探讨孕期体质量增长及血清甲状腺激素各项指标的变化对妊娠期糖尿病(GDM)发病的影响。方法收集2017年1月至2018年6月在汉中市中心医院产科就诊的243例GDM患者为病例组,并以年龄段为匹配因素进行l:1的频数配对,以243例糖耐量试验正常的孕妇作为对照组。收集两组孕妇的年龄、孕前体质量、身高、每次产检的孕周及体质量,检测孕早期(孕13周前)空腹血糖、糖耐量结果及孕早期(孕13周前)、孕中期(孕19～20周)、孕晚期(孕36～37周)的血清甲状腺激素水平等资料,分析GDM的影响因素。结果孕早期GDM组与对照组的空腹血糖分别为(5.21±0.52) mmol/L和(4.12±0.55) mmol/L,差异有统计学意义(P<0.05);孕中期,GDM组与对照组游离四碘甲状腺原氨酸(FT4)[(6.53±1.08) pmol/L vs (7.78±1.24) pmol/L]和促甲状腺激素(TSH)[(2.33±0.78) mIU/L vs (1.71±0.89) m IU/L]水平比较差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,孕前身体质量指数(BMI)≥24.0 kg/m2、孕早期空腹血糖≥5.20 mmol/L、孕中期FT4<4.0 pmol/L、孕中期TSH≥0.8 mU/L及孕中期平均每周体质量增长≥0.80 kg/(cm2·周)均是GDM发病的独立危险因素(P<0.05)。结论临床上应关注孕前BMI≥24.0 kg/cm2、孕早期空腹血糖≥5.20 mmol/L、孕中期平均每周体质量增长≥0.80 kg/(cm2·周)及孕中期FT4<4.0 pmol/L、TSH≥0.8 m IU/L的孕妇。
Objective To analyze the effect of body weight gain during pregnancy and the levels of the serum thyroid hormones on the occurrence of gestational diabetes mellitus(GDM). Methods Totally 243 gestational diabetes mellitus women(GDM group) in Hanzhong Central Hospital were recruited in this study from January 2017 to June2018. Meanwhile, 243 pregnant women whose levels of the glucose were normal were chosen as the control group. The age, body weight before pregnancy, height, gestational weeks and body weight of pregnant women in the two groups were collected. The results of fasting blood glucose, glucose tolerance, and serum thyroid hormone levels in early pregnancy(before 13 weeks of pregnancy), mid-pregnancy(19-20 weeks of pregnancy), and late pregnancy(36-37 weeks of pregnancy) were measured. The influencing factors of GDM were analyzed. Results There were significant differences between the GDM group and the control group in the levels of fasting blood glucose in early pregnancy, and in the levels of free tetraiodothyronine(FT4), thyroid-stimulating hormone(TSH) in mid-pregnancy: fasting blood glucose(5.21 ±0.52) mmol/L vs(4.12±0.55) mmol/L, P<0.05; FT4(6.53±1.08) pmol/L vs(7.78±1.24) pmol/L, P<0.05; TSH(2.33±0.78) mIU/L vs(1.71±0.89) m IU/L, P<0.05. Multivariate Logistic regression analysis showed that pre-pregnancy BMl≥24.0 kg/cm2, fasting blood glucose in early pregnancy≥5.20 mmol/L, mid-pregnancy FT4 <4.0 pmol/L, mid-pregnancy TSH≥0.8 mIU/L, and average weekly weight gain≥0.80 kg/(cm2·week) were the independent risk factors for the onset of GDM. Conclusion In clinical practice, the pregnant women with pre-pregnancy BMI≥24.0 kg/m2, fasting plasma glucose in early pregnancy≥5.2 mmol/L, average weekly weight gain of mid-pregnancy≥0.80 kg/(cm2·week), FT4 of mid-pregnancy<4.0 pmol/L, TSH≥0.8 m IU/L should be paid more attention.
Objective To analyze the effect of body weight gain during pregnancy and the levels of the serum thyroid hormones on the occurrence of gestational diabetes mellitus(GDM). Methods Totally 243 gestational diabetes mellitus women(GDM group) in Hanzhong Central Hospital were recruited in this study from January 2017 to June2018. Meanwhile, 243 pregnant women whose levels of the glucose were normal were chosen as the control group. The age, body weight before pregnancy, height, gestational weeks and body weight of pregnant women in the two groups were collected. The results of fasting blood glucose, glucose tolerance, and serum thyroid hormone levels in early pregnancy(before 13 weeks of pregnancy), mid-pregnancy(19-20 weeks of pregnancy), and late pregnancy(36-37 weeks of pregnancy) were measured. The influencing factors of GDM were analyzed. Results There were significant differences between the GDM group and the control group in the levels of fasting blood glucose in early pregnancy, and in the levels of free tetraiodothyronine(FT4), thyroid-stimulating hormone(TSH) in mid-pregnancy: fasting blood glucose(5.21 ±0.52) mmol/L vs(4.12±0.55) mmol/L, P<0.05; FT4(6.53±1.08) pmol/L vs(7.78±1.24) pmol/L, P<0.05; TSH(2.33±0.78) mIU/L vs(1.71±0.89) m IU/L, P<0.05. Multivariate Logistic regression analysis showed that pre-pregnancy BMl≥24.0 kg/cm2, fasting blood glucose in early pregnancy≥5.20 mmol/L, mid-pregnancy FT4 <4.0 pmol/L, mid-pregnancy TSH≥0.8 mIU/L, and average weekly weight gain≥0.80 kg/(cm2·week) were the independent risk factors for the onset of GDM. Conclusion In clinical practice, the pregnant women with pre-pregnancy BMI≥24.0 kg/m2, fasting plasma glucose in early pregnancy≥5.2 mmol/L, average weekly weight gain of mid-pregnancy≥0.80 kg/(cm2·week), FT4 of mid-pregnancy<4.0 pmol/L, TSH≥0.8 m IU/L should be paid more attention.
引文
[1] HOD M, KAPUR A, SACKS DA, et al. The international federation of gynecology and obstetrics(FIGO)initiative on gestational diabetes mellitus:a pragmatic guide for diagnosis, management, and care[J]. Int J Gynaecol Obstet, 2015, 131(Suppl 3):S173-S211.
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[4] FARAHVAR S, WALFISCH A, SHEINER E. Gestational diabetes risk factors and long-term consequences for both mother and offspring:a literature review[J]. Expert Rev Endocrinol Metab, 2019,14(1):63-74.
[5] YANG S, SHI FT, LEUNG PC, et al. Low thyroid hormone in early pregnancy is associated with an increased risk of gestational diabetes mellitus[J]. J Clin Endocrinol Metab, 2016, 101(11):4237-4243.
[6] COLAGIURI S, FALAVIGNA M, AGARWAL MM, et al. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemiafirst detected in pregnancy[J]. Diabetes Res Clin Pract, 2014, 103(3):364-372.
[7] ZHU WW, FAN L, YANG HX, et a1. Fasting plasma glucose at24-28 weeks to screen for gestational diabetes mellitus:new evidence from China[J]. Diabetes Care, 2013, 36(7):2038-2040.
[8] ZHU W, YANG H, WEI Y, et al. Comparing the diagnostic criteria for gestational diabetes mellitus of World Health Organization 2013with 1999 in Chinese population[J]. Chin Med J(En91), 2015, 128(1):125-127.
[9]唐恺,杨大刚,王惠群,等.妊娠期糖尿病的危险因素分析[J].贵州医科大学学报, 2018, 43(2):195-199.
[10] KAKOLY NS, EARNEST A, MORAN LJ, et al. Group-based developmental BMI trajectories, polycystic ovary syndrome, and gestational diabetes:a community-based longitudinal study[J]. BMC Med,2017, 15(1):195.
[11] BAO W, BAECKER A, SONG Y, et al. Adipokine levels during the first or early second trimester of pregnancy and subsequent risk of gestational diabetes mellitus:a systematic review[J]. Metabolism,2015, 64(6):756-764.
[12] RUCHAT SM, ALLARD C, DOYON M, et al. Timing of excessive weight gain during pregnancy modulates newborn anthropometry[J].J Obstet Gynaecol Can, 2016, 38(2):108-117.
[13] LI G, KONG L, ZHANG L, et al. Early pregnancy maternal lipid profiles and the risk of gestational diabetes mellitus stratifiedfor body mass index[J]. Reprod Sci, 2015, 22(6):712-717.
[14] RISKIN-MASHIAH S, DAMTI A, YOUNES G, et al. First trimester fasting hyperglycemia as a predictor for the development of gestational diabetes mellitus[J]. Eur J Obstet Gynecol Reprod Biol, 2010, 152(2):163-267.
[15]安燕,郭园园,孙少松,等.孕早期空腹血糖及白细胞计数对妊娠期糖尿病的预测价值[J].中国妇幼保健, 2018, 33(12):2704-2707.
[16]车荣华,黄亚绢.妊娠6~24周空腹血糖预测妊娠期糖尿病的意义[J].上海交通大学学报(医学版), 2013, 33(4):471-475.
[17] ALEXANDER EK, PEARCE EN, BRENT GA, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J].Thyroid, 2017, 27(3):315-389.
[18] FERNANDEZ MARTINEZ P, AGUADO GARCIA R, BARAJAS GALINDO DE, et al. Influence of thyroid peroxidase antibodies on TSH levels of pregnant women and maternal-fetal complications[J].Endocrinol Diabetes Nutr, 2018, 65(8):444-450.
[19]李萍,林硕,李玲,等.早孕期甲状腺功能状态与妊娠期糖尿病的相关性[J].中山大学学报(医学科学版), 2018, 39(6):879-883.
[2] LEE KW, CHING SM, RAMACHANDRAN V, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia:a systematic review and meta-analysis[J]. BMC Pregnancy Childbirth, 2018, 18(1):494.
[3] HUANG Y, FANG C, MA Z, et al. Betatrophin levels were increased in pregnant women with or without gestational diabetes mellitus and associated with beta cell function[J]. Rev Bras Ginecol Obstet, 2016,38(6):287-292.
[4] FARAHVAR S, WALFISCH A, SHEINER E. Gestational diabetes risk factors and long-term consequences for both mother and offspring:a literature review[J]. Expert Rev Endocrinol Metab, 2019,14(1):63-74.
[5] YANG S, SHI FT, LEUNG PC, et al. Low thyroid hormone in early pregnancy is associated with an increased risk of gestational diabetes mellitus[J]. J Clin Endocrinol Metab, 2016, 101(11):4237-4243.
[6] COLAGIURI S, FALAVIGNA M, AGARWAL MM, et al. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemiafirst detected in pregnancy[J]. Diabetes Res Clin Pract, 2014, 103(3):364-372.
[7] ZHU WW, FAN L, YANG HX, et a1. Fasting plasma glucose at24-28 weeks to screen for gestational diabetes mellitus:new evidence from China[J]. Diabetes Care, 2013, 36(7):2038-2040.
[8] ZHU W, YANG H, WEI Y, et al. Comparing the diagnostic criteria for gestational diabetes mellitus of World Health Organization 2013with 1999 in Chinese population[J]. Chin Med J(En91), 2015, 128(1):125-127.
[9]唐恺,杨大刚,王惠群,等.妊娠期糖尿病的危险因素分析[J].贵州医科大学学报, 2018, 43(2):195-199.
[10] KAKOLY NS, EARNEST A, MORAN LJ, et al. Group-based developmental BMI trajectories, polycystic ovary syndrome, and gestational diabetes:a community-based longitudinal study[J]. BMC Med,2017, 15(1):195.
[11] BAO W, BAECKER A, SONG Y, et al. Adipokine levels during the first or early second trimester of pregnancy and subsequent risk of gestational diabetes mellitus:a systematic review[J]. Metabolism,2015, 64(6):756-764.
[12] RUCHAT SM, ALLARD C, DOYON M, et al. Timing of excessive weight gain during pregnancy modulates newborn anthropometry[J].J Obstet Gynaecol Can, 2016, 38(2):108-117.
[13] LI G, KONG L, ZHANG L, et al. Early pregnancy maternal lipid profiles and the risk of gestational diabetes mellitus stratifiedfor body mass index[J]. Reprod Sci, 2015, 22(6):712-717.
[14] RISKIN-MASHIAH S, DAMTI A, YOUNES G, et al. First trimester fasting hyperglycemia as a predictor for the development of gestational diabetes mellitus[J]. Eur J Obstet Gynecol Reprod Biol, 2010, 152(2):163-267.
[15]安燕,郭园园,孙少松,等.孕早期空腹血糖及白细胞计数对妊娠期糖尿病的预测价值[J].中国妇幼保健, 2018, 33(12):2704-2707.
[16]车荣华,黄亚绢.妊娠6~24周空腹血糖预测妊娠期糖尿病的意义[J].上海交通大学学报(医学版), 2013, 33(4):471-475.
[17] ALEXANDER EK, PEARCE EN, BRENT GA, et al. 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum[J].Thyroid, 2017, 27(3):315-389.
[18] FERNANDEZ MARTINEZ P, AGUADO GARCIA R, BARAJAS GALINDO DE, et al. Influence of thyroid peroxidase antibodies on TSH levels of pregnant women and maternal-fetal complications[J].Endocrinol Diabetes Nutr, 2018, 65(8):444-450.
[19]李萍,林硕,李玲,等.早孕期甲状腺功能状态与妊娠期糖尿病的相关性[J].中山大学学报(医学科学版), 2018, 39(6):879-883.