孕早期超重肥胖和白细胞计数与孕期血糖水平关联  

Correlation of maternal overweight/obesity and white blood cell count during first trimester with gestational blood glucose level

作　　者：潘蕾[1] 冷俊宏[1] PAN Lei;LENG Jun-hong(Department of Child Healthcare Instruction,Tianjin Women and Children′s Health Centre,Tianjin 300070,China)

机构地区：[1]天津市妇女儿童保健中心儿保指导科

出　　处：《中国公共卫生》2019年第9期1156-1160,共5页Chinese Journal of Public Health

基　　金：国家自然科学基金青年科学基金(81703247)

摘　　要：目的探索孕早期超重肥胖和白细胞计数(WBCC)对孕期血糖水平的影响。方法利用天津市妇幼卫生信息系统记录的2009—2010年在天津市内6区和滨海新区孕早期接受第1次产检的30792名单胎妊娠孕妇的孕期基本信息、孕早期WBCC、孕早期体质指数(BMI)和50g葡萄糖负荷试验(GCT)检测结果,通过logistic回归分析孕早期超重肥胖单独/联合WBCC对于孕期血糖水平的影响。结果30792名孕妇孕早期WBCC中位数水平为8.2×109/L[四分位数界值:(6.9~9.7)×10^9/L],WBCC>10×10^9/L占19.9%,GCT≥7.8mmol/L占18.8%。多因素logistic回归结果显示,同孕早期WBCC≤10×10^9/L者相比,WBCC>10×10^9/L的孕妇GCT阳性(≥7.8mmol/L)的比例明显升高(OR=1.271,95%CI=1.186~1.362)。同孕早期BMI为18.5~23.9kg/m^2者相比,超重(BMI为24.0~27.9kg/m^2)、肥胖(BMI≥28.0kg/m^2)均是GCT阳性发生的危险因素(OR=1.553,95%CI=1.445~1.669;OR=1.801,95%CI=1.608~2.016)。以WBCC≤10×10^9/L且BMI<24kg/m^2为参照组,多因素分析中,孕早期超重肥胖使WBCC>10×10^9/L增加GCT阳性发生风险的OR值从1.257(95%CI=1.151~1.371)增加至2.162(95%CI=1.946~2.402),且相加交互作用的3个指标交互作用超额相对危险度(RERI)、交互作用归因比(AP)和交互作用指数(S)均具有统计学意义(P<0.05)。结论孕早期WBCC升高是孕期血糖异常的独立危险因素,而且孕早期孕妇超重肥胖会加重升高的WBCC引发孕期高血糖风险的效应,即存在相加交互作用。Objective To evaluate effects of maternal overweight/obesity and white blood cell count (WBCC) during first trimester on gestational blood glucose level. Methods We extracted records of 30 792 women with singleton pregnancy attending their first antenatal care visit before 13 gestational weeks in 7 urban districts of Tianjin city between 2009 through 2010 from Tianjin Maternal and Child Health Information System. The collected information of the women included demographics, general status of the pregnancy, WBCC and body mass index (BMI) during the first trimester, and 50 g oral glucose challenge test (GCT). Multivariable logistic regression was performed to assess independent and joint effects of WBCC and overweight/obesity in first trimester on blood glucose level in during pregnancy. Results For all the pregnant women the median of WBCC was 8.2 × 10^9/L, with the quartile cutoff values of 6.9 × 10^9/L – 9.7 × 10^9/L, and 19.9% of the women had the WBCC of greater than 10 × 10^9/L and 18.8% of the women had the GCT of ≥ 7.8 mmol/L. The results of multivariate logistic regression analysis revealed that the women with the WBCC of > 10 × 10^9/L during the first trimester had an increased risk of elevated blood glucose level in the second trimester (odds ratio [OR]= 1.271, 95% confidence interval [CI]: 1.186 – 1.362) compared to those with the WBCC of ≤ 10 × 10^9/L. The pregnant women with overweight (BMI: 24.0 – 27.9 kg/m^2) and obesity (BMI ≥ 28.0 kg/m^2) during the first trimester had an increased risk of elevated blood glucose level (for overweight: OR = 1.553, 95% CI: 1.445 – 1.669;for obesity: OR = 1.801, 95% CI: 1.608 – 2.016) in comparison with those with normal weight (BMI: 18.5 – 23.9 kg/m^2). Compared to those with low WBCC (≤ 10 × 10^9/L) and low BMI (< 24 kg/m^2), the pregnant women with high WBCC (> 10 × 10^9/L) but low BMI had an OR of 1.257 (95% CI: 1.151 – 1.371) for elevated blood glucose but the OR increased to 2.162 (95% CI:1.946 – 2.402) for the women with both hi

关 键 词：超重肥胖 白细胞计数 50g葡萄糖负荷试验 

分 类 号：R715.3[医药卫生—妇产科学]