孕期睡眠时点与小于胎龄儿发生风险的关系  

A birth cohort study on the effect of chronotype during pregnancy on small for gestational age and the mediating effect of glucose-lipid metabolism

作　　者：解钧 陶瑞雪[2] 刘洋 焦雪纯 尹万军 肖敏[2] 高宗侠[2] 朱鹏[1] Xie Jun;Tao Ruixue;Liu Yang;Jiao Xuechun;Yin Wanjun;Xiao Min;Gao Zongxia;Zhu Peng(School of Public Health,Anhui Medical University,Hefei 230000,China;Department of Obstetrics,the First People′s Hospital of Hefei,Anhui Province,Hefei 230000,China)

机构地区：[1]安徽医科大学公共卫生学院儿少卫生与妇幼保健学系,合肥230000 [2]合肥市第一人民医院妇产科,合肥230000

出　　处：《中华医学杂志》2021年第23期1805-1811,共7页National Medical Journal of China

基　　金：国家自然科学基金面上项目(81872631,81472991);安徽省高校优秀青年人才基金重点项目(gxyqZD2018025);安徽省学术和技术带头人后备人选科研资助项目(2017H141);合肥市卫计委应用医学研究项目(hwk2018zd002)。

摘　　要：目的探讨孕期睡眠时点与小于胎龄儿(small for gestation age,SGA)的关系,并分析糖脂代谢在其中的作用。方法选择2015年3月至2019年4月在合肥市第一人民医院、安徽省妇幼保健院和安徽医科大学第一附属医院产科门诊产检的6821例孕中期孕妇,通过面对面问卷调查收集一般人口特征、饮食和生活行为等指标。通过孕妇自评获得其近1个月就寝时点、晨起时点、睡眠时长等睡眠信息,并于孕晚期再次调查,分娩时收集母婴妊娠结局,最终获得5488对母婴健康资料。采用限制性立方样条回归模型探索睡眠时点与SGA风险的非线性关系,采用基于Bootstrap法的中介模型探索糖脂代谢在睡眠时点与SGA关联中的作用。结果SGA发生率为8.4%(459/5488)。多因素logistic回归模型结果显示,与21∶00前就寝相比,23∶00后就寝孕妇的SGA发生风险显著增加(OR=1.54,95%CI:1.01~2.34);与8∶00前晨起相比,8∶00后晨起孕妇的SGA发生风险显著增加(OR=1.31,95%CI:1.05~1.62)。睡眠时长与SGA的关联无统计学意义(P>0.05)。限制性立方样条回归结果显示,睡眠中点从凌晨02∶45开始,SGA风险逐渐增加(P<0.05)。进一步的中介模型结果显示,孕中期睡眠中点迟(即晚睡晚起的睡眠模式)对SGA的负性影响可能部分通过糖脂代谢通路实现(均P<0.05)。结论孕中期可能是影响SGA的关键期,睡眠中点迟可能是SGA风险增加的潜在危险因素,且可能通过改变糖脂代谢水平,进而影响SGA的发生。Objective To explore the relationship between maternal sleep time and the risk of small for gestational age(SGA),and to evaluate the role of glucose-lipid metabolism in the association.Methods A total of 6821 women who was second pregnancy were recruited from pregnancies consulted at Hefei First People′s Hospital,Anhui Province Maternity&Child Health Hospital and the First Affiliated Hospital of Anhui Medical University from March 2015 to April 2019,and a face-to-face questionnaire survey was conducted to collect general demographic characteristics,dietary habits and routine lifestyles.Sleep information including bedtime,getup and sleep duration were reported by pregnant woman herself,and this survey as well as the third trimester of gestation.Pregnancy and birth outcomes were collected at delivery.A total of 5488 mother-pairs with complete data were obtained in the final data.The non-linear relationship between chronotype and SGA risk was explored by restricted cubic spline regression model,and the role of glucose-lipid metabolism in the association between sleep midpoint and SGA was explored by using the mediating model based on bootstrap method.Results The incidence of SGA was 8.4%(459/5488)in eligible pregnant women.Compared with the pregnant women who went to bed before 21∶00,the risk of SGA of women who went to bed after 23∶00 am(OR=1.54,95%CI:1.01-2.34)was significantly higher in the multivariate logistic regression model.Additionally,the risk of SGA in pregnant women who got up after 8∶00 am was significantly higher than those women who got up before 8 o′clock(OR=1.31,95%CI:1.05-1.62).However,the significant association between sleep duration and SGA was not found.In the restricted cubic spline regression,the risk of SGA was significantly increased from the specific midpoint of 02∶45 am(P<0.05).Moreover,mediation model showed that the negative effect of late sleep in the second trimester on SGA may be partially explained through glucose-lipid metabolism(all P<0.05).Conclusion Maternal sleep st

关 键 词：睡眠 妊娠 糖脂代谢 小于胎龄儿 

分 类 号：R714.5[医药卫生—妇产科学]