Interactions between general and central obesity in predicting gestational diabetes mellitus in Chinese pregnant women: A prospective population-based study in Tianjin, China
单纯性肥胖和中心性肥胖在预测中国孕妇妊娠糖尿病中的交互作用:一个中国天津前瞻性人群队列研究
Abstract
enBackground
The aim of the present study was to define cut-off points of body mass index (BMI) and waist circumference (WC) for gestational diabetes mellitus (GDM) and to investigate any interactions between high BMI and high WC on the risk of GDM in pregnant Chinese women.
Methods
From 2010 to 2012, 17 803 women in Tianjin, China, who were at 4–12 weeks gestation were recruited to the study. Gestational diabetes mellitus was diagnosed according to the criteria of the International Association of Diabetes and Pregnancy Study Group at 24–28 weeks gestation. Binary logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) while controlling for the confounding effects of traditional risk factors. Restricted cubic spline was used to identify cut-off points of WC and BMI, if any, for GDM.
Results
Gestational diabetes mellitus developed in 1383 (7.8%) women. The risk of GDM increased steeply with increasing WC from ≥78.5 cm and BMI ≥22.5 kg/m2. If BMI <22.5 kg/m2 and WC <78.5 cm were used as the reference, BMI between ≥22.5 and <24.0 kg/m2 (multivariable OR 1.76; 95%CI 1.47–2.10) and WC between ≥78.5 and <85.0 cm (multivariable OR 1.53; 95%CI 1.31–1.78) were independently associated with increased risks of GDM. In addition, the presence of both BMI ≥22.5 kg/m2 and WC ≥78.5 cm further increased the OR to 2.83 (95% CI 2.44–3.28), with significant additive interaction.
Conclusions
Body mass index ≥22.5 kg/m2 and WC ≥78.5 cm measured up to 12 weeks of gestation were independently and synergistically associated with increased risks of GDM in Chinese pregnant women.
摘要
zh背景
此项研究的目的在于确定中国孕妇妊娠糖尿病(GDM)发生风险增高的体重指数(BMI)和腰围(WC)截点, 并且探究高BMI和高腰围在GDM发病风险方面有无交互作用。
方法
2010-2012年, 中国天津市17803名孕4-12周的孕妇被纳入此项研究。GDM的诊断于孕24-28周进行, 诊断标准采用国际糖尿病和妊娠研究协会的标准。采用二元logistic回归分析控制传统的混杂因素并得到OR值及其95%置信区间。采用限制性立方锥模型得到GDM发生风险增高的腰围及BMI截点。
结果
1383(7.8%)名孕妇发生了GDM。腰围≥ 78.5 cm和BMI ≥ 22.5 kg/m2时, GDM的发生风险显著增加。分别以BMI < 22.5 kg/m2 和腰围< 78.5 cm作为参照组, 22.5 ≤ BMI < 24.0 kg/m2(多因素分析OR 1.76;95%CI:1.47-2.10)及78.5 ≤腰围< 85.0 cm(多因素分析OR 1.53;95%CI:1.31-1.78)与GDM的发生风险增高独立相关。当BMI ≥ 22.5 kg/m2与腰围≥ 78.5 cm同时存在时, GDM的发病风险提高至2.83倍(95% CI 2.44-3.28), 且两者之间存在交互作用。
结论
在中国孕妇中孕12周以内BMI ≥ 22.5 kg/m2及腰围≥ 78.5 cm可以独立及协同增加GDM的发生风险。
