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目的妊娠期糖尿病(GDM)患者产后体重变化特点尚不清晰。本研究旨在探讨GDM与非GDM产妇产后1年的体重滞留差异以及体脂在其中的作用。方法采用前瞻性队列研究设计,通过75 g口服葡萄糖耐量试验(OGTT)进行GDM诊断,采用双能X骨密度仪(DXA)测量产后6个月时体脂含量并获取脂肪质量指数(FMI),并随访至产后1年测量体重。利用Log-binomial回归模型进行多因素分析。结果 (1)810名产妇在产后1年时的体重变化平均为(2.1±4.2) kg,其中GDM和非GDM产妇平均体重增加分别为(0.9±4.4) kg和(2.3±4.1) kg。GDM产妇的产后体重滞留率低于非GDM产妇(11.9%vs 26.4%,P=0.000 3)。(2)单因素分析显示,GDM与产后体重滞留发生风险存在负相关(RR=0.45,95%CI:0.28～0.72);而产后6个月脂肪质量指数(FMI)高则增加产后体重滞留风险(RR=1.92,95%CI:1.48～2.49)。(3)多因素分析显示,在调整了可能的混杂因素之后,GDM(RR=0.47,95%CI:0.28～0.78)和产后高FMI(RR=3.48,95%CI:2.60～4.66)与产后体重滞留之间的关联仍然具有统计学意义。(4)无论产前是否诊断为GDM,高体脂产妇的产后体重滞留率均是正常体脂产妇的2倍。结论广州地区GDM患者的产后体重滞留率处于较低水平,而非GDM产妇亟需加强体脂控制及体重管理。
Abstract：Objective Change of postpartum weight in patients with gestational diabetes mellitus( GDM) is still unclear. This study aimed to explore the differences of 1-year postpartum weight retention between GDM and non-GDM participants and the role of body fat in the process. Methods The research was designed a prospective cohort study. GDM was diagnosed by 75 g oral glucose tolerance test( OGTT); 6-month postpartum fat mass index( FMI) was obtained by dual-energy x-ray absorptiometry( DXA); 1-year postpartum body weight was measured at the follow-up period. Log-binomial regression model was used for multivariate analysis.Results(1) The average weight change of 810 participants at 1 year postpartum was( 2. 1 ± 4. 2) kg,the average weight change of GDM and non-GDM women was( 0. 9 ± 4. 4) kg and( 2. 3 ± 4. 1) kg,respectively. The rate of postpartum weight retention of GDM women was lower than that of non-GDM women( 11. 9% vs 26. 4%,P = 0. 000 3) ．(2) Univariate analysis showed that GDM was negatively correlated with postpartum weight retention( RR = 0. 45,95% CI: 0. 28-0. 72),while high FMI at 6-month postpartum increased the risk of postpartum weight retention( RR = 1. 92,95% CI: 1. 48-2. 49) ．(3) Multivariate analysis showed that GDM( RR = 0. 47,95% CI: 0. 28-0. 78) and high FMI( RR = 3. 48,95% CI: 2. 60-4. 66) was significantly associated with postpartum weight retention after adjusting for potential confounders．(4)The rate of postpartum weight retention of participants with high FMI was approximately twice that of participants with normal body fat in both GDM women and non-GDM women. Conclusion Postpartum weight retention of GDM patients is well-controlled in Guangzhou,while body fat control and weight management among non-GDM pregnant women should be strengthened urgently.
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基本信息:
DOI：10.19757/j.cnki.issn1674-7763.2021.04.003
中图分类号:R714.256
引用信息:
[1]谢君宜,肖晚晴,郭怡欣,等.妊娠期糖尿病与产后体脂对体重滞留的影响[J].中国妇幼卫生杂志,2021,12(04):9-15.DOI:10.19757/j.cnki.issn1674-7763.2021.04.003.
基金信息:
广州市卫生和计划生育科技项目—妊娠糖尿病患者产后体成分变化趋势与心血管疾病风险因子关系的前瞻性研究(2018A010031)
2021-07-20
2021-07-20