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孕早期生活方式和妊娠期糖尿病关系的前瞻性队列研究

王雅文,  冯雅慧,  吴散散,  蔡姝雅,  马良坤,  江宇

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文章导航 > 中华疾病控制杂志  > 2020 >  24(1): 14-19
王雅文, 冯雅慧, 吴散散, 蔡姝雅, 马良坤, 江宇. 孕早期生活方式和妊娠期糖尿病关系的前瞻性队列研究[J]. 中华疾病控制杂志, 2020, 24(1): 14-19. doi: 10.16462/j.cnki.zhjbkz.2020.01.004
引用本文: 王雅文, 冯雅慧, 吴散散, 蔡姝雅, 马良坤, 江宇. 孕早期生活方式和妊娠期糖尿病关系的前瞻性队列研究[J]. 中华疾病控制杂志, 2020, 24(1): 14-19. doi: 10.16462/j.cnki.zhjbkz.2020.01.004
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WANG Ya-wen, FENG Ya-hui, WU San-san, CAI Shu-ya, MA Liang-kun, JIANG Yu. A prospective cohort study of the relationship between unhealthy lifestyle and gestational diabetes mellitus[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2020, 24(1): 14-19. doi: 10.16462/j.cnki.zhjbkz.2020.01.004
Citation: WANG Ya-wen, FENG Ya-hui, WU San-san, CAI Shu-ya, MA Liang-kun, JIANG Yu. A prospective cohort study of the relationship between unhealthy lifestyle and gestational diabetes mellitus[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2020, 24(1): 14-19. doi: 10.16462/j.cnki.zhjbkz.2020.01.004
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孕早期生活方式和妊娠期糖尿病关系的前瞻性队列研究

doi: 10.16462/j.cnki.zhjbkz.2020.01.004
  • 1.

    100730 北京, 中国医学科学院北京协和医学院公共卫生学院

  • 2.

    100730 北京, 中国医学科学院北京协和医院妇产科

基金项目: 中国医学科学院医学与健康科技创新工程(2016-I2M-1-008);北京市科委首都临床特色应用研究(Z161100000516117);北京市卫计委首发基金自主创新项目(2016-2-40113)
详细信息
    通讯作者:

    马良坤, E-mail:maliangkun@pumch.cn

    江宇, E-mail:jiangyu@pumc.edu.cn

  • 中图分类号: R714.14;R587.1

A prospective cohort study of the relationship between unhealthy lifestyle and gestational diabetes mellitus

  • 1.

    School of Public Health, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100730, China

  • 2.

    Chinese Academy of Medical Sciences, Department of Gynaecology and Obstetrics, Peking Union Medic al College Hospital 100730, China

Funds: CAMS Innovation Fund for Medical Sciences(CIFMS)(2016-I2 M-1-008); Application of Beijing Science and Technology Commission's Capital Clinical Characteristics(Z161100000516117); Beijing Municipal Health Planning Commission Initial Fund Independent Innovation Project(2016-2-40113)
More Information

    摘要
  • 摘要:   目的   分析我国孕妇妊娠期糖尿病(gestational diabetes mellitus, GDM)的发病率及不健康生活方式在孕妇人群中的分布, 并探究二者之间的关联性, 以期为降低孕期合并症提供理论依据。   方法   收集2018年12月31日前分娩的中国孕产妇队列中纳入的孕妇, 通过调查问卷收集孕妇孕早期的体力活动、久坐、烟草暴露、酒精摄入、饮食及睡眠水平共6项生活方式指标, 并收集孕妇GDM发病情况。采用二分类Logistic回归分析模型分析不健康生活方式与GDM之间的关联性。   结果   在3 162例孕妇中有372例孕妇被诊断为GDM。单因素分析结果显示缺乏体力活动(RR=1.015, 95% CI=1.005~1.279, P=0.046)和低睡眠水平(RR=1.019, 95% CI=1.004~1.196, P=0.047)是GDM的独立危险因素。与无不健康行为的孕妇相比, 6种全部有表现者有更高的GDM发病风险(RR=1.530, 95% CI=1.263~8.880, P=0.036)。   结论   我国孕妇的GDM发病率为11.76%, 缺乏体力活动和低睡眠水平会增加GDM的发病风险, 有多种不健康生活方式会增大GDM风险。适量运动、戒烟戒酒、合理饮食等多种健康生活方式是预防GDM合理有效的方式。
    Abstract:   Objective   To analyze the incidence of gestational diabetes mellitus(GDM) among Chinese pregnant women and the distributions of unhealthy lifestyles. Exploring the association between these behaviors and GDM to provide some suggestions to GDM prevention.   Methods   Women who were enrolled by the Chinese Pregnant Women Cohort Study and delivered before the 31 st December, 2018 were enrolled by this study. The characters of physical activity, sedentary lifestyle, tobacco exposure, alcohol consumption, unhealthy diet and low sleep level were assessed by questionnaire and also the pregnancy complications. Binary Logistic regression model was adopted to analyzed the relationship between the dependent and independent variables.   Results   A total of 3 162 women were enrolled in this study and 372 of them were diagnosed GDM. Single variable analysis showed that lack of leisure time physical activity(RR=1.015, 95% CI=1.005-1.279, P=0.046) and low sleep quality(RR=1.019, 95% CI: 1.004-1.196, P=0.047) were two risk factors of GDM. Compared with women who showed none of these unhealthy lifestyle, those who showed all six unhealthy behaviors had higher risk of GDM(RR=1.530, 95% CI: 1.263-8.880, P=0.036).   Conclusions   The incidence of GDM among Chinese women was 11.76%. Lack of physical activity and poor sleep quality could increase the risk of GDM and the cluster of unhealthy lifestyles is associated with higher GDM risk. Adequate physical activity, no smoking and drinking, balanced diet and other healthy behaviors are important to GDM prevention.
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  • 表  1  社会人口学特征[n(%)]

    Table  1.   Socio-demographic characteristics of respondents [n(%)]

    条目 x±s/n(%) GDM t/χ2值 P值
    是(n=372) 否(n=2 790)
    年龄(岁) 28.93±4.62 30.65(4.53) 28.70(4.58) -7.715 < 0.001
    年龄分组     57.206 < 0.001
         < 25 423(13.38) 22(5.91) 401(14.37)
        25~ 1 472(46.55) 137(36.83) 1 335(47.85)
        30~ 1 267(40.07) 213(57.26) 1 054(37.78)
    受教育水平 0.5490.760
        高中及以下 1 163(36.78) 133(35.75) 1 030(36.92)
        大学及大专 1 779(56.26) 210(56.45) 1 569(56.24)
        硕士及以上 220(6.96) 29(7.80) 191(6.84)
    职业     1.176 0.278
        在业 2 236(70.71) 272(73.12) 1 964(70.39)
        无业 926(29.29) 100(26.88) 826(29.61)
    家庭月收入(元/月) 2.5030.286
        ＜5 000 794(25.11) 82(22.05) 712(25.52)
        5 000~ 1 038(32.83) 132(35.48) 906(32.47)
        10 000~ 1 330(42.06) 158(42.47) 1 172(42.01)
    民族     0.019 0.891
        汉 3 072(97.15) 361(97.04) 2 711(97.17)
        少数民族 90(2.85) 11(2.96) 79(2.83)
    孕前BMI (kg/m2) 21.80(3.16) 22.85(3.40) 21.66(3.10) -6.418 < 0.001
    孕前BMI分类 36.596 < 0.001
        过低 417(13.19) 33(8.87) 384(13.76)
        标准 2 056(65.02) 214(57.53) 1842(66.02)
        超重/肥胖 689(21.79) 125(33.60) 564(20.22)
        早孕周(周) 8.14(4.30) 8.31(4.20) 8.11(4.31) -0.829 0.407
    下载: 导出CSV

    表  2  不健康生活方式分布[n (%)]

    Table  2.   The distribution of unhealthy lifestyle [n (%)]

    生活指数组成 n(%) 不健康生活指数
    0 1 2 3 4 5 6
    体力活动缺乏 2 079(65.75) 0 83(3.99) 476(22.90) 757(36.41) 579(27.85) 170(8.18) 14(0.67)
    久坐 1 330(42.06) 0 37(2.78) 229(17.22) 463(34.81) 431(32.41) 156(11.73) 14(1.05)
    烟草暴露 1 401(44.31) 0 39(2.78) 228(16.27) 473(33.76) 479(34.19) 168(11.99) 14(1.00)
    酒精摄入 172(5.44) 0 1(0.58) 6(3.49) 39(22.67) 63(36.63) 49(28.49) 14(8.14)
    不健康饮食 1 375(43.49) 0 24(1.75) 193(14.04) 478(34.76) 498(36.22) 168(12.22) 14(1.02)
    低睡眠水平 2 510(79.38) 0 140(5.58) 654(26.06) 886(35.30) 642(25.58) 174(6.93) 14(0.56)
    下载: 导出CSV

    表  3  不健康生活方式组合和GDM的关联性

    Table  3.   The association between each unhealthy lifestyle components and GDM

    生活指数组成 GDM (n) 未调整 模型1 模型2
    RR(95%CI)值 P值 RR(95%CI)值 P值 RR(95%CI)值 P值
    体力活动缺乏 242 0.866(0.770~1.212) 0.763 1.000(0.994~1.259) 0.989 1.015(1.005~1.279) 0.046
    久坐 168 1.154(0.928~1.434) 0.197 1.182(0.948~1.474) 0.139 1.180(0.946~1.473) 0.143
    烟草暴露 162 0.966(0.776~1.201) 0.754 0.976(0.782~1.218) 0.781 0.980(0.785~1.224) 0.814
    酒精摄入 20 0.986(0.611~1.592) 0.954 0.987(0.607~1.605) 0.966 1.028(0.630~1.677) 0.902
    不健康饮食 150 0.863(0.693~1.076) 0.190 0.881(0.704~1.101) 0.255 0.901(0.718~1.130) 0.354
    低睡眠水平 280 1.004(0.893~1.184) 0.137 1.009(0.898~1.186) 0.148 1.019(1.004~1.196) 0.047
    下载: 导出CSV

    表  4  不健康生活方式指数与GDM的关联性

    Table  4.   The association between unhealthy lifestyle index and GDM

    条目 GDM (n) 未调整 模型1
    RR(95%CI)值 P值 RR(95%CI)值 P值
    不健康生活方式指数(连续) 372 1.015(1.003~1.046) 0.043 1.017(1.007~1.065) 0.046
    不健康生活方式指数(分类)
    0 49 1.00 1.000
    1 324 1.067(0.428~2.661) 0.889 1.097(0.434~2.773) 0.881
    2 893 0.986(0.410~2.371) 0.875 1.109(0.455~2.702) 0.861
    3 1 032 0.925(0.386~2.220) 0.862 1.045(0.430~2.542) 0.962
    4 673 0.994(0.410~2.409) 0.990 1.107(0.451~2.719) 0.863
    5 177 0.616(0.223~1.696) 0.348 0.685(0.245~1.916) 0.438
    6 14 1.194(1.013~6.694) 0.041 1.530(1.263~8.880) 0.036
    下载: 导出CSV
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