兩次懷孕期間的BMI上升會增加妊娠糖尿病風險


【24drs.com】根據發表於6月婦產科(Obstetrics & Gynecology)期刊、研究對象為22,351名婦女的回溯世代分析結果,第一胎和第二胎懷孕之間身體質量指數增加,與第二次懷孕時的妊娠糖尿病風險有關。
  
  奧克蘭北加州Kaiser Permanente醫學中心研究小組的Samantha F. Ehrlich等人寫道,產後體重沒有減輕與生活型態改變及婦女懷孕後幾年體重過重有關,因此增加了發生非胰島素依賴型糖尿病的風險;懷孕前體重增加和妊娠時期體重增加都會增加妊娠糖尿病風險,不過,懷孕前體重減輕是否可降低妊娠糖尿病風險則依舊未知。妊娠糖尿病造成的懷孕併發症會使後來懷孕時復發妊娠糖尿病的風險增高,但是,兩次懷孕之間的體重增減對於這個風險的影響則未曾被探討。
  
  研究人員定義1 BMI單位相當於研究對象平均身高5呎4吋(163公分)、體重5.9磅(2.67公斤)【2.67/1.632= 1】。如果BMI波動沒有超過 ± 1.0 BMI單位,則被視為穩定BMI。根據邏輯回歸模式,他們估計BMI單位增加3.0以上、增加2.0 - 2.9、增加1.0-1.9、或減少1.0-2.0、減少超過2.0之婦女的校正妊娠糖尿病風險,比較兩次懷孕之間的風險,也與BMI穩定婦女進行比較。
  
  至於第一胎懷孕的婦女妊娠糖尿病,校正年紀之後,第二胎懷孕時的妊娠糖尿病風險為38.19% (95%信心區間[CI]為34.96 - 41.42);對於第一胎懷孕沒有妊娠糖尿病的婦女,第二胎懷孕時的妊娠糖尿病風險為3.52% (95% CI,3.27 - 3.76)。
  
  兩次懷孕之間BMI增加的婦女,第二胎懷孕時的妊娠糖尿病風險大於穩定BMI的婦女(增加1.0 - 1.9 BMI單位者的校正風險比[OR])為1.71 [95% CI,1.42 - 2.07];增加2.0 - 2.9 BMI單位者的校正OR為2.46 [95% CI,2.00 - 3.02];增加≧3.0 BMI單位者的校正OR為3.40 [95% CI,2.81- 4.12] )。
  
  對於第一胎懷孕時過重或肥胖的婦女,兩次懷孕之間減少BMI與第二次懷孕的妊娠糖尿病風險降低有關,減少2.0 BMI單位以上者之OR為 0.26(95% CI,0.14 -0.47),但是體重正常者無此關聯。
  
  相較於兩次懷孕時都發生妊娠糖尿病的過重和肥胖婦女,只有第一次懷孕有妊娠糖尿病者的BMI增加較少(平均改變為0.66單位 [95% CI,0.25 - 1.07],兩次懷孕時都發生妊娠糖尿病者則是增加2.00 BMI單位 [95% CI,1.56 - 2.43]。
  
  作者們寫道,兩次懷孕之間的BMI增加會提高婦女的妊娠糖尿病風險。
  
  研究限制包括,使用懷孕期間測量的體重計算BMI、缺乏所有婦女的身高體重資料、回溯研究設計而有一些可能因素的資料闕如。
  
  研究者結論表示,研究發現認為懷孕前的身體質量指數增加會提高婦女妊娠糖尿病風險,身體質量指數降低,特別是過重或肥胖婦女,則可對抗併發症。這些結果和有妊娠糖尿病史的婦女特別有關,這類婦女在後續懷孕時發生妊娠糖尿病的風險增加。建議進行探討減重或維持體重以預防發生妊娠糖尿病之效果的隨機試驗。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6528&x_classno=0&x_chkdelpoint=Y
  

Interpregnancy BMI Gain May Raise Risk for Gestational DM

By Laurie Barclay, MD
Medscape Medical News

May 24, 2011 — Interpregnancy increases in body mass index (BMI) between the first and second pregnancy are linked to the risk for gestational diabetes mellitus (GDM) in the second pregnancy, according to the results of a retrospective cohort analysis of 22,351 women reported in the June issue of Obstetrics & Gynecology.

"Excessive postpartum weight retention and lifestyle changes have been associated with a woman being overweight years after pregnancy, thereby increasing her risk of developing noninsulin-dependent DM," write Samantha F. Ehrlich, MPH, from the Division of Research, Kaiser Permanente of Northern California in Oakland, and colleagues. "Pregravid weight gain and gestational weight gain have similarly been shown to increase the risk of GDM, yet whether pregravid weight loss reduces the risk of GDM remains unknown. A pregnancy complicated by GDM is associated with a high risk of recurrent GDM in a subsequent pregnancy, but potential modification of this risk by interpregnancy weight gain and loss has also not been explored."

The investigators defined 1 BMI unit as 5.9 pounds for the average height (5 feet 4 inches) of the study population. Women were considered to have stable BMIs if they fluctuated by no more than ± 1.0 BMI unit. Using logistic regression models, the investigators obtained adjusted estimates of the risk for GDM in women gaining 3.0 or more, 2.0 to 2.9, and 1.0 to 1.9 BMI units, or losing 1.0 to 2.0 and more than 2.0 BMI units between pregnancies vs women who had stable BMI.

For women with GDM in the first pregnancy, the age-adjusted risk for GDM in the second pregnancy was 38.19% (95% confidence interval [CI], 34.96 - 41.42).

For women without GDM in the first pregnancy, the age-adjusted risk for GDM in the second pregnancy was 3.52% (95% CI, 3.27 - 3.76).

Women with interpregnancy BMI gains had a greater risk for GDM in the second pregnancy than women who had stable BMI (adjusted odds ratio [OR], 1.71 [95% CI, 1.42 - 2.07] for gaining 1.0 - 1.9 BMI units; adjusted OR, 2.46 [95% CI, 2.00 - 3.02] for 2.0 - 2.9 BMI units; and adjusted OR, 3.40 [95% CI, 2.81- 4.12] for ? 3.0 BMI units).

For women who were overweight or obese in the first pregnancy, but not for those of normal weight, loss of BMI units between pregnancies was associated with a lower risk for GDM in the second pregnancy (OR, 0.26; 95% CI, 0.14 -0.47) for the loss of 2.0 BMI units or more.

Compared with overweight and obese women who had GDM in both pregnancies, those with GDM only in the first pregnancy gained fewer BMI units (mean change, 0.66 [95% CI, 0.25 - 1.07] vs 2.00 [95% CI, 1.56 - 2.43] BMI units, respectively).

"Interpregnancy increases in BMI between the first and second pregnancy increases a woman's risk of GDM pregnancy," the study authors write.

Limitations of this study include use of body weight measured during pregnancy to calculate BMI, lack of height and weight data in all women, and retrospective design with data unavailable on several potential confounding factors.

"Our findings suggest that gains in body mass before pregnancy could increase a woman's risk of GDM, whereas reductions in body mass, particularly in overweight or obese women, could protect against the complication," the study authors conclude. "These results are particularly relevant to women with a history of GDM, who are at increased risk of developing GDM again in a subsequent pregnancy. Randomized trials investigating the efficacy of weight loss or weight maintenance interventions in preventing subsequent GDM remain to be conducted."

The National Institute of Diabetes and Digestive and Kidney Diseases and a Community Benefit grant from Kaiser Permanente Northern California supported this study. The study authors have disclosed no relevant financial relationships.

Obstet Gynecol. 2011;117:1323-1330.

    
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