浙江省舟山市不同亚型妊娠期糖尿病与胰岛素水平对新生儿出生体质量的交互作用  

Interaction between gestational diabetes mellitus subtypes and insulin levels on neonatal birth weight in Zhoushan,Zhejiang

作　　者：沈海红 黄满仙 蒲柳艳 顾雷君 迪丽亚尔·艾尼宛 邱逸文 黄烨 吴金华 Shen Haihong;Huang Manxian;Pu Liuyan;Gu Leijun;Diliyaer Ainiwan;Qiu Yiwen;Huang Ye;Wu Jinhua(Zhoushan Women and Children Hospital,Zhoushan 316000,Zhejiang,China;Department of Epidemiology&Health Statistics,School of Public Health,Zhejiang University,Hangzhou 310058,Zhejiang,China)

机构地区：[1]舟山市妇女儿童医院,浙江舟山316000 [2]浙江大学公共卫生学院流行病学与卫生统计室,浙江杭州310058

出　　处：《疾病监测》2024年第10期1373-1378,共6页Disease Surveillance

基　　金：浙江省医药卫生科技计划项目(No.2015RCA026);浙江省舟山市科技计划项目(No.2015C31038,No.2016C31034);舟山市医药卫生科技计划项目(No.2015A02)。

摘　　要：目的阐明不同亚型妊娠期糖尿病(GDM)与胰岛素水平对新生儿出生体质量的共同作用,为GDM孕妇的孕期管理提供循证依据。方法采用前瞻性队列研究设计,以2022年1月至2023年5月在浙江省舟山市妇女儿童医院建册并符合标准的孕妇为研究对象,收集孕妇社会人口学、婚育史和饮食营养等信息,在孕中期进行口服葡萄糖耐量试验并检测空腹胰岛素水平,随访新生儿生长发育信息。采用线性回归模型分析胰岛素指标与出生体质量的关联;采用多分类logistic回归模型分析胰岛素指标与低出生体质量、巨大儿的关联,并根据是否患有GDM对孕妇进行分组,分析组内胰岛素指标与出生体质量的关联;采用叉生分析探索GDM亚型和胰岛素抵抗对出生体质量的交互作用。结果调整孕妇年龄、分娩孕周、孕次和产次后,孕妇胰岛素水平和胰岛素抵抗指数均与新生儿出生体质量呈正相关(胰岛素水平:β=3.01±1.21,P=0.013;胰岛素抵抗指数:β=14.99±5.24,P=0.004)。在调整孕前体质量指数和孕期增重后,孕妇胰岛素分泌指数与出生体质量呈负相关(β=-0.06±0.03,P=0.046);根据是否患有GDM分组,仅非GDM孕妇中存在与上述相似关联。高胰岛素水平(≥75.00%)和胰岛素抵抗(≥75.00%)分别与巨大儿发生率呈正相关[高胰岛素水平:比值比(OR)=2.03,95%置信区间(CI):1.08~3.83,P=0.028;胰岛素抵抗:OR=3.69,95%CI:1.91~5.95,P=0.002]。未发现GDM亚型和胰岛素抵抗对出生体质量存在交互作用(P交互>0.05)。结论孕妇胰岛素抵抗、胰岛素分泌和整体胰岛素水平对新生儿出生体质量均有重要影响,应注重监测GDM孕妇以胰岛素抵抗指数为代表的各项胰岛素指标,制定基于亚型的孕期管理指南与不良围产期结局防治措施。Objective To evaluate the interaction between different subtypes of gestational diabetes mellitus(GDM)and insulin level on newborn birth weight,and provide evidence for the management of GDM.Methods A prospective cohort study design was used,and the pregnant women who met the inclusion criteria were selected by using the register in Zhoushan Women and Children's Hospital from January 2022 to May 2023,the information about the socio-demographic characteristics,marital status and childbearing history,dietary pattern and nutritional status of pregnant women were collected,and oral glucose tolerance test was conducted for the pregnant women in the second trimester,their fasting insulin levels were detected,and the information about neonatal growth and development were collected in follow up.Linear regression model was used to analyze the association between insulin level and birth weight.Multinomial logistic regression model was used to analyze the association of insulin level with low birth weight and macrosomia.Pregnant women were grouped according to GDM definition and the association between insulin level and birth weight within the groups were analyzed.The interaction between GDM subtype and insulin resistance on birth weight was investigated by crossover analysis.Results After adjusting for maternal age,gestational week,gravidity and parity,maternal insulin level and insulin resistance were positively correlated with newborn birth weight(insulin level:β=3.01±1.21,P=0.013;Insulin resistance index:β=14.99±5.24,P=0.004);After further adjustment of pre-pregnancy BMI and pregnancy weight gain,insulin secretion was negatively correlated with birth weight(β=-0.06±0.03,P=0.046).After grouping according to GDM definition,similar results were found only in non-GDM pregnant women.High insulin level(≥75.00%)and insulin resistance(≥75.00%)were positively correlated with the incidence of macrosomia[high insulin level:OR=2.03,95%CI:1.08–3.83,P=0.028;Insulin resistance:OR=3.69,95%CI:1.91–5.95,P=0.002].No interact

关 键 词：妊娠期糖尿病 胰岛素水平 胰岛素抵抗 出生体质量 低出生体质量 巨大儿 

分 类 号：R211[医药卫生—中医学] R714.25