孕中期妇女体力活动与血糖代谢的关联性

吴雁娟; 吴维佳; 陈倩; 赖丽娟; 陈雅; 王文静; 王冬昱; 静进; 陈亚军; 蔡莉

doi:10.16462/j.cnki.zhjbkz.2020.04.003

孕中期妇女体力活动与血糖代谢的关联性

doi: 10.16462/j.cnki.zhjbkz.2020.04.003

1.
510080 广州, 中山大学公共卫生学院妇幼卫生系
2.
510080 广州, 中山大学附属第一医院妇产科

基金项目: 国家自然科学基金青年项目(81602862;81571452);深圳市“三名”工程项目(SZSM201803061)

详细信息

通讯作者:
蔡莉, E-mail:caili5@mail.sysu.edu.cn

中图分类号: R714.14
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出版历程
- 收稿日期: 2019-09-02
- 修回日期: 2020-01-27
- 刊出日期: 2020-04-10

Association between physical activity and glucose metabolism in pregnant women

1.
Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
2.
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China

Funds: Youth Project of National Natural Science Foundation of China(81602862; 81571452); Sanming Project of Medicine in Shenzhen(SZSM201803061)

More Information

Corresponding author: CAI Li, E-mail:caili5@mail.sysu.edu.cn

摘要

摘要: 目的探究孕中期体力活动与血糖水平及妊娠期糖尿病(gestational diabetes mellitus, GDM)的关联。方法采用横断面调查的方法, 于2017-2018年在广州市纳入孕周在20~28周的孕妇1 083人。采用面对面调查收集一般人口学和生活方式等资料, 采用国际体力活动问卷调查过去一周的体力活动, 通过口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)测量孕妇血糖和诊断GDM。运用多重线性回归和Logistic回归分析模型分别探讨不同类型体力活动和静坐行为与血糖及GDM的关联。结果 36.57%的孕妇体力活动达到推荐值(中高体力活动≥150 min/week)。多重线性回归结果表明, 孕中期妇女总体力活动强度与OGTT-2 h血糖水平呈负相关关系(β=-0.10, P=0.017);运动锻炼和休闲体力活动强度与OGTT-1 h血糖呈负相关(β=-0.11, P=0.042), 未发现其他类型体力活动或静坐时间与血糖之间的关联。Logistic回归分析模型分析未发现各类型体力活动或静坐时间与GDM风险之间的关联。结论孕中期妇女体力活动水平较低, 近2/3妇女未达到推荐值。孕中期妇女总体力活动、运动锻炼和休闲体力活动有助于降低餐后血糖。
- 孕中期 /
- 体力活动 /
- 血糖水平 /
- 妊娠期糖尿病
Abstract: Objective To investigate the association between physical activity and glucose metabolism during the second trimester of pregnancy. Methods A cross-sectional study was conducted from March 2017 to November 2018. 1 083 pregnant women at 20-28 weeks of gestation in Guangzhou, China were recruited into this study. A standardized questionnaire was used to collect demographics and lifestyles. Physical activity was assessed by the international physical activity questionnaire. The participants underwent an oral glucose tolerance test. Multiple linear regression was used to analyze the association between physical activity and blood glucose. Logistic regression analysis model was used to analyze the association between physical activity and gestational diabetes mellitus(GDM). Results Only 36.57% of pregnant women met the recommended level of total physical activity. There was a negative correlation(β=-0.104, P=0.017) between total physical activity and postprandial 2 h blood glucose. Results from different types of physical activities showed that the recreation, sport, and leisure-time physical activity were negatively associated with postprandial 1 h blood glucose(β=-0.114, P=0.042). No significant association was found between either various types of physical activities or sedentary time and GDM. Conclusions Physical activity during mid-pregnancy is inadequate in pregnant women in Guangzhou, China. Higher total physical activity and recreation, sport, and leisure-time physical activity in the second trimester of pregnancy are associated with lower postprandial blood glucose.
- Second trimester of pregnancy /
- Physical activity /
- Blood glucose /
- Gestation diabetes mellitus

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表 1 两组研究对象的基本特征

Table 1. Basic characteristics of participants

人口学特征	合计(N=1 083)	非GDM (n=880)	GDM (n=203)	t/ χ²值	P值
年龄(岁)	30.11±4.90	29.65±4.74	32.13±5.08	6.63	< 0.001
高龄(≥35岁)	184 (16.99)	124 (14.09)	60 (29.56)	27.98	< 0.001
孕前BMI (kg/m²)	20.57±2.90	20.34±2.68	21.54±3.51	4.45	< 0.001
糖尿病家族病史	158 (14.79)	125 (14.32)	33 (16.50)	0.62	0.432
既往GDM病史				20.60	< 0.001
初产	411 (37.95)	349 (39.66)	62 (30.54)
无	621 (57.34)	501 (56.93)	120 (59.11)
有	51 (4.71)	30 (3.41)	21 (10.34)
孕期被动吸烟	795 (73.41)	239 (27.16)	49 (24.14)	0.77	0.380
孕期饮酒	38 (3.53)	32 (3.65)	6 (2.97)	0.22	0.635
能量摄入(kcal/d)	1 804.7 ± 503.2	1 799.8 ± 508.7	1 825.5 ± 481.0	0.64	0.525
注:定量资料用(x±s)表示, 定性资料用[n(%)]表示。

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表 2 GDM和非GDM孕妇的体力活动水平

Table 2. Physical activity levels of GDM and non-GDM pregnant women

体力活动	总体	非GDM	GDM	t/ χ²值	P值
每周中高等体力活动(min)	179.69±252.76	183.05±256.49	165.13±235.94	0.91	0.363
≥150 min	396 (36.57)	326 (37.05)	70 (34.48)	0.47	0.494
总体力活动(Met-min/w)	1 900.35±1 656.00	1 954.52±1 718.00	1 665.51±1 334.00	2.62	0.009
日常交通体力活动(Met-min/w)	584.81±618.83	597.05±643.33	521.09±495.55	1.85	0.065
日常生活体力活动(Met-min/w)	468.01±729.30	471.04±733.27	454.87±713.46	0.28	0.776
运动锻炼及休闲体力活动(Met-min/w)	454.21±590.09	465.79±607.90	403.97±503.91	1.51	0.131
静坐时间(h/d)	4.96±2.69	4.98±2.70	4.85±2.64	0.62	0.536
注:定量资料用(x±s)表示, 定性资料用[n(%)]表示。

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表 3 体力活动类型与孕中期血糖的关系

Table 3. The relationship between the type of physical activities and blood glucose in the second trimester of pregnancy

体力活动类型	OGTT-空腹血糖				OGTT-1 h血糖				OGTT-2 h血糖
体力活动类型	β	S_x	t值	P值	β	S_x	t值	P值	β	S_x	t值	P值
总体力活动(Met-min/w)	-0.02	0.01	-1.55	0.120	-0.10	0.06	-1.73	0.084	-0.10	0.04	-2.39	0.017
日常交通体力活动(Met-min/w)	-0.02	0.01	-1.27	0.203	0.01	0.06	0.14	0.885	-0.03	0.04	-0.74	0.459
日常生活体力活动(Met-min/w)	0.00	0.01	0.11	0.916	-0.09	0.06	-1.51	0.132	-0.06	0.05	-1.40	0.161
运动锻炼及休闲体力活动(Met-min/w)	0.00	0.01	-0.19	0.851	-0.11	0.06	-2.04	0.042	-0.05	0.04	-1.08	0.283
静坐时间(h/d)	0.00	0.01	-0.10	0.923	0.02	0.02	0.99	0.322	0.02	0.02	1.07	0.286
注:调整年龄、孕前BMI、全家平均月收入、糖尿病家族史、文化程度、是否被动吸烟、每天摄入能量(kcal/d)、调查年份。

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表 4 孕妇体力活动与GDM的关系

Table 4. The relationship between physical activities and GDM in pregnant women

体力活动类型^*	模型1			模型2
体力活动类型^*	OR (95% CI)值	P值	P_趋势值	OR (95% CI)值	P值	P_趋势值
总体力活动(Met-min/w)			0.172			0.060
Q1	1.00			1.00
Q2	1.06 (0.69~1.63)	0.791		1.07 (0.67~1.71)	0.773
Q3	1.13 (0.74~1.73)	0.572		1.15 (0.72~1.83)	0.566
Q4	0.77 (0.49~1.21)	0.256		0.66 (0.40~1.10)	0.110
日常交通体力活动(Met-min/w)			0.389			0.549
Q1	1.00			1.00
Q2	0.69 (0.44~1.09)	0.113		0.80 (0.49~1.32)	0.988
Q3	0.89 (0.60~1.33)	0.578		1.04 (0.67~1.61)	0.597
Q4	0.78(0.51~1.20)	0.252		0.83(0.51~1.33)	0.821
日常生活体力活动(Met-min/w)			0.768			0.606
Q1	1.00			1.00
Q2	0.75 (0.49~1.15)	0.184		0.90 (0.57~1.43)	0.651
Q3	0.65 (0.42~1.01)	0.058		0.61 (0.37~1.00)	0.051
Q4	0.93 (0.62~1.40)	0.727		0.84 (0.53~1.33)	0.446
运动锻炼及休闲体力活动(Met-min/w)			0.513			0.157
Q1	1.00			1.00
Q2	0.85 (0.55~1.31)	0.447		0.79 (0.49~1.27)	0.328
Q3	0.94 (0.62~1.43)	0.764		0. 96 (0.61~1.51)	0.856
Q4	0.84 (0.54~1.29)	0.414		0.68 (0.42~1.10)	0.116
静坐时间(h/d)			0.503			0.645
Q1	1.00			1.00
Q2	1.05 (0.69~1.61)	0.808		0.98 (0.61~1.55)	0.915
Q3	1.07 (0.69~1.67)	0.746		1.05 (0.64~1.70)	0.859
Q4	0.84 (0.53~1.31)	0.432		0.86 (0.52~1.42)	0.556
注:Q1~Q4分别表示四等分后对应的4个组。模型1:未调整; 模型2:调整年龄、孕前BMI、全家平均月收入、糖尿病家族史、文化程度、是否被动吸烟、每天摄入能量(kcal/d)、调查年份。

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