世代研究:孕婦患有妊娠糖尿病可預測丈夫的糖尿病風險


  【24drs.com】魁北克一篇長達廿年的大型研究發現,妻子患有妊娠糖尿病(gestational diabetes,GDM)的先生們,他們自己發生糖尿病的風險也增加,這篇研究即將登載於9月的糖尿病照護期刊。
  
  第一作者、魁北克蒙特婁McGill大學醫學副教授Kaberi Dasgupta醫師表示,在這篇研究中,我們發現,妻子在懷孕期間患有妊娠糖尿病者,在之後13年間發生糖尿病的風險增加33%。
  
  她表示,執業醫師應為患者們說明這個議題,為了寶寶的健康,不只是媽媽們要做一些改變。孕婦的情況當然重要,但是,必須全家人一起面對。我認為,這讓我們這些執業醫師有機會對患者們說,藉由全家合作,你們將可以改善自己的健康與孩子未來的健康。
  
  根據該文獻的背景資料,懷孕期間發生妊娠糖尿病的婦女,後來發展成第二型糖尿病的風險增加達7倍之多。Dasgupta醫師指出,以前的研究顯示,夫妻之間通常會共享生活習慣,當其中一人變胖或者增加運動,另一人往往也會。
  
  在這篇研究中,Dasgupta醫師等人更進一步假設,妻子患有妊娠糖尿病的男性,其第二型糖尿病風險也會增加。
  
  這篇研究使用的資料來自魁北克省的行政管裡、出生與死亡登記,對象是納入全民醫療保險的住民。研究者使用ICD-9和ICD-10診斷碼,隨機選取在1990年4月至2007年12月間生產過單胞胎且診斷有妊娠糖尿病的孕婦,之後依據年齡、分娩年份、健康區域等資料與沒有妊娠糖尿病的婦女配對。最後,他們探討那些在伴侶懷孕時沒有糖尿病的先生們後來發生糖尿病的情況。
  
  Dasgupta醫師指出,這篇研究並未測量實際的健康行為,因為它是根據行政管理資料而未能有此資訊。
  
  這篇分析包括了70,890名父親,其中50%的伴侶有妊娠糖尿病,這些男性超過90%和伴侶同住、超過90%與伴侶有著相同的種族文化背景。
  
  相較於那些伴侶沒有妊娠糖尿病的爸爸們,伴侶有妊娠糖尿病的爸爸們大部份住在社會經濟貧困社區(屬於最貧困的五分之一人口的比率分別為43.3% vs 37.3%),非歐洲背景比率也比較高(23.2% vs 18.1%)。
  
  平均追蹤13年間, 伴侶有妊娠糖尿病的爸爸們,糖尿病發生率比伴侶沒有妊娠糖尿病的爸爸們高出33%(分別是1838人[5.2%] vs 1397人[3.9%];風險比[HR]為1.33;95% CI 1.24–1.43)。
  
  校正年齡、共病症、同居、種族文化背景、匱乏程度之後,伴侶有妊娠糖尿病的爸爸們發生糖尿病的風險比伴侶沒有妊娠糖尿病的那些爸爸們高出18% (HR, 1.18;95% CI 1.09–1.27)。
  
  作者們寫道,共同的生活與社會經濟環境,或許可以部份地解釋妊娠糖尿病婦女之伴侶的糖尿病風險增加原因。
  
  Dasgupta醫師強調,關鍵是,我們知道,基因和生物家族史是糖尿病風險的主因,但是,我們不能淡化行為和環境之重要性。要一個人自己改變行為有其困難性,因為與社區與團體有關,在這篇研究中,則是與家庭、家人的一起改變有關。
  
  安大略多倫多大學醫學系副教授Baiju Shah博士表示同意,這篇研究的結果相當有趣,因為他們強調了糖尿病不只是受基因影響,它也受到環境之影響這個事實。伴侶們住在一起、飲食也類似、可能還有著相同的行為,如果有人容易發生糖尿病,住在同一個屋簷下的另一半也會容易發生糖尿病。
  
  Shah博士並未參與這次研究,他是另一篇相關主題研究的共同作者,該研究認為懷有男嬰的孕婦比懷有女嬰的孕婦更可能發生妊娠糖尿病(J Clin Endocrinol Metab. 2015;100:2574-2580)。
  
  根據Shah博士表示,要從社區和鄰里的角度思考糖尿病,而不是根據個體從臨床角度觀之,這是一個演變中的框架轉變。
  
  Shah博士強調,關鍵是思考糖尿病預防。我們對妊娠糖尿病孕婦的生活型態改變提供諮商,這對她們的產後時期相當重要。我認為,我們要記得的是,這對爸爸們也一樣重要。而全家一起改變生活型態、成為孩子的行為模範,也至關重要,這有助於讓全家一起有健康的生活型態。
  
  資料來源:http://www.24drs.com/
  
  Native link:Gestational Diabetes in Mom Predicts Diabetes Risk in Dad: Cohort Study

Gestational Diabetes in Mom Predicts Diabetes Risk in Dad: Cohort Study

By Veronica Hackethal, MD
Medscape Medical News

A large study covering over 20 years of data from Quebec has found that fathers with partners who have had gestational diabetes (GDM) may be at increased risk for developing diabetes themselves. The study is to be published in the September issue of Diabetes Care.

"In this study we demonstrated that men whose partners had a history of GDM in pregnancy had a relative risk increase of 33% of developing diabetes in the 13 years that followed," commented first author Kaberi Dasgupta, MD, MSc, an associate professor of Medicine at McGill University in Montreal, Quebec.

"Practicing clinicians should frame this as an issue for the family, so it's not just an issue for Mom to make some changes so that the baby is healthy. Of course that's important, but it's something that everyone needs to tackle together," she said, "I think it gives us as practicing clinicians a lever to say, 'By working together now, you're going to improve your personal health and the health of your child in the future.' "

Women who develop GDM during pregnancy may have up to seven times increased risk of developing type 2 diabetes in later life, according to background information in the article. Past studies have shown that partners often share lifestyle habits — when one partner gains weight or becomes more physically active, the other one often does, too, according to Dr Dasgupta.

In this study, Dr Dasgupta and colleagues went a step further and hypothesized that men whose partners have GDM might also have increased risk for type 2 diabetes.

The study used information from administrative, birth, and death registries from Quebec province, which provides universal health coverage to its residents. The researchers used ICD-9 and -10 diagnostic codes to randomly select women diagnosed with GDM who had singleton births between April 1990 and December 2007. Then they matched these women by age, year of delivery, and health region to other women who did not have GDM. Finally, they looked at the development of diabetes in fathers who did not have diabetes at the time of their partners' pregnancies.

The study did not measure actual health behaviors, Dr Dasgupta pointed out, because it was based on administrative data that did not include this information.

The analysis included 70,890 fathers, 50% of whom were partners of women with GDM. Over 90% of these men lived with their partners, and over 90% shared the same ethnocultural background as their partner.

Compared with fathers with partners without GDM, fathers with partners with GDM tended to live in socioeconomically deprived neighborhoods (43.3% vs 37.3% for the two most deprived quintiles), and were of non-European background (23.2% vs 18.1%).

Over a mean follow-up of 13 years, fathers with partners with GDM had 33% higher incidence of developing diabetes compared with fathers with partners without GDM (1838 [5.2%] vs 1397 [3.9%], respectively; hazard ratio [HR], 1.33; 95% CI 1.24–1.43).

After adjustment for age, comorbidities, cohabitation, ethnocultural background, and deprivation level, the risk of developing diabetes was 18% higher in fathers with partners with GDM compared with fathers with partners without GDM (HR, 1.18; 95% CI 1.09–1.27).

Shared living and socioeconomic environments may partly explain the increased risk for diabetes in male partners of women with GDM, the authors wrote.

"The key is that we acknowledge that genes and biological family history are big drivers for diabetes risk, but we can't underplay the importance of our behaviors and our environments," Dr Dasgupta emphasized. "It's hard for individuals to make behavioral changes on their own. It's really about communities and groups and, in this case, about families changing things together."

"The findings of this study are really interesting because they highlight the fact that diabetes is not just about genetics, it's also about the environmental impact. Partners will be living in similar neighborhoods, eating similar diets, and will probably have similar behaviors. If somebody is prone to have diabetes, then other people living in that household are also prone to have diabetes," agreed Baiju Shah, MD, PhD, associate professor in the department of medicine at the University of Toronto, Ontario.

Dr Shah, who was not involved in the research, is the coauthor of a study on a related topic, which suggested that pregnant women who carry sons may be more likely to develop GDM than women who carry daughters (J Clin Endocrinol Metab. 2015;100:2574-2580).

Thinking about diabetes from a community and neighborhood perspective, rather than from a clinical perspective based mostly on the individual, is an "evolving frame shift," according to Dr Shah.

"The key is to think about diabetes prevention. We counsel women with GDM that [lifestyle change] is really important for them in the postpartum period. I think we should remember that it's also important for the fathers," Dr Shah emphasized, "Making lifestyle changes as a family and modeling that behavior for the children is really important. It helps set a healthy lifestyle in the whole household."

The authors and Dr Shah report no relevant financial relationships.

Diabetes Care. Published online June 26, 2015.

    
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