孕早期铁代谢水平与妊娠期糖尿病和巨大儿相关  

Maternal iron status in the first trimester is associated with gestational diabetes mellitus and macrosomia

作　　者：黄菲玲 马良坤[1] 马帅 侯益轩 姚爱民 夏良裕[5] 禹松林[5] 李珊珊[6] 罗昊泽 周子坤 张家新 刘燕萍[6] Huang Feiling;Ma Liangkun;Ma Shuai;Hou Yixuan;Yao Aimin;Xia Liangyu;Yu Songlin;Li Shanshan;Luo Haoze;Zhou Zikun;Zhang Jiaxin;Liu Yanping(Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;School of Public Health,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;School of Nursing,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Obstetrics and Gynecology,Shunyi Women′s and Children′s Hospital of Beijing Children′s Hospital,Beijing 101300,China;Department of Clinical Laboratory,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Clinical Nutrition,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院妇产科,100730 [2]中国医学科学院北京协和医学院公共卫生学院,100730 [3]中国医学科学院北京协和医学院护理学院,100730 [4]北京儿童医院顺义妇儿医院妇产科,101300 [5]中国医学科学院北京协和医学院北京协和医院检验科,100730 [6]中国医学科学院北京协和医学院北京协和医院临床营养科,100730

出　　处：《中华健康管理学杂志》2020年第6期515-520,共6页Chinese Journal of Health Management

摘　　要：目的:探讨孕早期体内铁代谢水平是否与妊娠期糖尿病(GDM)和巨大儿有关。方法:纳入2018年11月至2019年8月在北京儿童医院顺义妇儿医院建档产检的378例孕早期孕妇,首次产检时(孕12周内)采集空腹静脉血测定血红蛋白及铁代谢指标如血清铁、铁蛋白、转铁蛋白、总铁结合力、铁饱和度、转铁蛋白饱和度等,随访并收集GDM和巨大儿的发生率。利用Logistic回归分析孕早期体内铁代谢水平与GDM和巨大儿的关系。结果:本研究GDM发生率为16.9%,孕早期贫血发生率为2.4%,铁缺乏发生率为2.5%。Logistic回归分析显示,调整年龄、孕前BMI、糖尿病家族史、产次等变量后,铁饱和度>50% ( OR=0.238,95% CI:0.068~0.831)、转铁蛋白饱和度>50% ( OR=0.08,95% CI:0.010~0.677)为GDM的保护因素;铁饱和度25%~50% ( OR=0.361,95% CI:0.143~0.908);转铁蛋白饱和度25%~50% ( OR=0.383,95% CI:0.165~0.891);铁蛋白>30 ng/ml ( OR=0.418,95% CI:0.186~0.939)为巨大儿的保护因素。 结论:孕早期的铁代谢水平可能与GDM和巨大儿的发生相关,有必要在孕早期对孕妇进行铁营养状态评估。Objective To evaluate the association of maternal nutrition status in the first trimester with gestational diabetes mellitus(GDM)and macrosomia.Methods 378 pregnant women who took prenatal care in Shunyi Women′s and Children′s Hospital of Beijing Children′s Hospital were enrolled in the study.Blood samples were collected at first prenatal visit(<12 gestation weeks)to measure the level of hemoglobin and iron status indexes including serum iron,ferritin,transferrin,total iron binding capacity,iron saturation,transferrin saturation.The incidence of GDM and macrosomia were collected and Logistic regression was used to evaluate the associations of maternal nutrients status in the first trimester with GDM and macrosomia.Results The incidence rate of GDM was16.9%,the incidence of anemia and iron deficiency in the first trimester were2.4%and 2.5%,respectively.After adjustment for variables such as maternal age,pre-pregnancy BMI,family history of diabetes,and parity,Logistic regression showed that in the first trimester,iron saturation>50%(OR=0.238,95%CI 0.068-0.831),transferrin saturation>50%(OR=0.08,95%CI 0.010-0.677)were protective factors of GDM;iron saturation 25%-50%(OR=0.361,95%CI 0.143-0.908);transferrin saturation 25%-50%(OR=0.383,95%CI 0.165-0.891);ferritin>30 ng/ml(OR=0.418,95%CI 0.186-0.939)were protective factors of macrosomia.Conclusion Maternal iron status in the first trimester might be associated with GDM and macrosomia.Thus,maternal iron status assessment in the first trimester is necessary.

关 键 词：铁蛋白质类 糖尿病 妊娠 巨大胎儿 

分 类 号：R714.256[医药卫生—妇产科学]