孕早期血红蛋白水平与妊娠期糖尿病的关系研究：基于出生人口队列

闫明鑫; 赵豆豆; 宛惠玲; 赵欢; 单莉; 裴磊磊; 米阳; 屈鹏飞

doi:10.16462/j.cnki.zhjbkz.2023.01.011

孕早期血红蛋白水平与妊娠期糖尿病的关系研究：基于出生人口队列

doi: 10.16462/j.cnki.zhjbkz.2023.01.011

闫明鑫^{1, 2},
赵豆豆^{1, 2},
宛惠玲¹,
赵欢¹,
单莉¹,
裴磊磊²,
米阳¹,
屈鹏飞^{1, 2, ,}

1.
710061 西安，西安交通大学医学部附属西北妇女儿童医院
2.
710061 西安，西安交通大学医学部公共卫生学院卫生统计教研室

基金项目:

国家重点研发计划 2016YFC1000101

国家自然科学基金 82103924

国家自然科学基金 72174167

西安市科技计划 20YXYJ0005(8)

详细信息

通讯作者:
屈鹏飞，E-mail: xinxi3057@163.com

中图分类号: R173
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出版历程
- 收稿日期: 2022-03-30
- 修回日期: 2022-06-29
- 网络出版日期: 2023-02-09
- 刊出日期: 2023-01-10

Relationship between hemoglobin level in early pregnancy and gestational diabetes mellitus: a birth cohort study

YAN Ming-xin^{1, 2},
ZHAO Dou-dou^{1, 2},
WAN Hui-ling¹,
ZHAO Huan¹,
SHAN Li¹,
PEI Lei-lei²,
MI Yang¹,
QU Peng-fei^{1, 2
, ,}

1.
Northwest Women and Children's Hospital Affiliated to Xi'an Jiaotong University, Xi'an 710061, China
2.
Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an 710061, China

Funds:

the National Key R & D Program of China 2016YFC1000101

National Natural Science Foundation of China 82103924

National Natural Science Foundation of China 72174167

Xi'an Science and Technology Plan Project 20YXYJ0005(8)

More Information

Corresponding author: QU Peng-fei, E-mail: xinxi3057@163.com

摘要

摘要: 目的探究中国西北地区孕妇孕早期血红蛋白水平与妊娠期糖尿病(gestational diabetes mellitus, GDM)的关系。方法连续纳入2018年7月-2019年7月加入西北妇女儿童医院出生人口队列的孕早期孕妇，调查其基本人口学特征、生活行为方式等资料，并对研究对象的孕早期血红蛋白水平、口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)结果进行随访。首先使用logistic回归分析模型分析孕早期血红蛋白水平对GDM的影响，进一步采用限制性三次立方样条来呈现血红蛋白水平与GDM的非线性关系。结果在调整了混杂因素后，孕早期高血红蛋白水平(血红蛋白≥135 g/L)增加了GDM的发生风险(OR=1.44，95% CI：1.13~1.83)；孕早期血红蛋白水平每升高10 g/L，FPG、OGTT 1h血糖、OGTT 2h血糖水平分别升高0.03 mmol/L(95% CI：0.01~0.05)、0.14 mmol/L(95% CI：0.07~0.21)、0.13 mmol/L(95% CI：0.08~0.19)；限制性立方样条结果显示，随着孕早期血红蛋白水平升高，GDM的发生风险逐渐升高。结论孕早期血红蛋白水平升高将增加GDM的发病风险，应积极对孕妇孕早期血红蛋白水平进行监测，促进母婴健康。
- 妊娠期糖尿病 /
- 孕早期 /
- 血红蛋白水平 /
- 口服葡萄糖耐量试验
Abstract: Objective To investigate the relationship between hemoglobin levels in early pregnancy and gestational diabetes mellitus (GDM) in pregnant women in northwest China. Methods In Northwest Women's and Children's Hospital from July 2018 to July 2019, women in early pregnancy were recruited to birth cohort. A questionnaire was used to collect their basic demographic characteristics and lifestyle behaviors, and to follow up the hemoglobin levels and oral glucose tolerance test (OGTT) in early pregnancy. The association of hemoglobin levels in early pregnancy with GDM was first explored using a logistic regression model, and the nonlinear relationship between hemoglobin levels and GDM was further investigated by restricted cubic splines. Results After adjusting for confounders, high hemoglobin levels (Hb ≥135 g/L) in early pregnancy increased the risk of GDM (OR=1.44, 95% CI: 1.13-1.83). For every 10g/L increase in hemoglobin levels in early pregnancy, FPG, OGTT 1h glucose, and OGTT 2h glucose levels increased by 0.03 mmol/L (95% CI: 0.01-0.05), 0.14 mmol/L (95% CI: 0.07-0.21), and 0.13 mmol/L (95% CI: 0.08-0.19), respectively. The results of the restricted cubic strip showed that the risk of GDM progressively increased with increasing hemoglobin levels in early pregnancy. Conclusions Elevated hemoglobin levels in early pregnancy will increase the risk of GDM. Women hemoglobin levels in early pregnancy should be actively monitored to promote maternal and infant health.
- Gestational diabetes mellitus /
- Early Pregnancy /
- Haemoglobin levels /
- Oral glucose tolerance test

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图 1 孕早期血红蛋白水平与GDM的关系

注：调整了年龄、受教育程度、家庭经济状况、孕前BMI、孕期增重、二手烟暴露、孕次、产次。

Figure 1. Relationship between hemoglobin levels and GDM in early pregnancy

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表 1 研究对象的一般特征(N=2 059)[n(%)]

Table 1. General characteristics of study subjects(N=2 059)[n(%)]

变量	血红蛋白水平(g/L)			F/χ²值	P值
变量	< 125(n=668)	125~ < 135(n=701)	≥135(n=690)	F/χ²值	P值
年龄(x±s, 岁)	29.38±3.99	29.45±3.38	29.40±3.25	0.073	0.929
育龄妇女受教育程度				2.683	0.262 ^a
高中及以下	104(15.57)	90(12.84)	98(14.18)
大专及本科	460(68.86)	489(69.76)	488(70.72)
研究生及以上	104(15.57)	122(17.40)	104(15.07)
家庭经济状况				2.932	0.231 ^a
贫穷(< 5万/家庭年收入)	85(12.72)	79(11.27)	87(12.61)
中等(5~ < 20万/家庭年收入)	448(67.07)	474(67.62)	483(70.00)
富裕(≥20万/家庭年收入)	135(20.21)	148(21.11)	120(17.39)
孕前BMI(kg/m²)				7.293	0.026 ^a
消瘦	161(24.10)	117(16.69)	104(15.07)
正常	440(65.87)	496(70.76)	451(65.36)
超重	67(10.03)	88(12.55)	135(19.57)
孕期增重(x±s, kg)	14.35±4.02	14.13±4.03	13.31±4.18	12.511	< 0.001
二手烟暴露				7.123	0.028
否	504(75.45)	522(74.47)	553(80.14)
是	164(24.55)	179(25.53)	137(19.86)
产史(次)				0.450	0.799 ^a
0	540(80.84)	571(81.46)	567(82.17)
1	121(18.11)	123(17.55)	119(17.25)
≥2	7(1.05)	7(0.99)	4(0.58)
人工流产				6.777	0.034
否	561(83.98)	563(80.31)	589(85.36)
是	107(16.02)	138(19.69)	101(14.64)
是否初次妊娠				4.693	0.096
否	299(44.76)	332(47.36)	287(41.59)
是	369(55.24)	369(52.64)	403(58.41)
RBC(x±s, ×10¹²/L)	3.98±0.35	4.30±1.39	4.56±0.26	80.212	< 0.001
HCT(x±s, %)	35.36±2.29	38.44±3.69	41.15±2.08	729.184	< 0.001
注：^a秩和检验。

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表 2 孕早期血红蛋白水平与GDM单因素分析(N=2 059)

Table 2. Univariate analysis of haemoglobin levels and GDM in early pregnancy (N=2 059)

指标	血红蛋白水平(g/L)			F/χ²值	P值
指标	< 125(n=668)	125~ < 135(n=701)	≥135(n=690)	F/χ²值	P值
GDM[n(%)]	167(25.00)	201(28.67)	225(32.61)	9.591	0.008
FPG(x±s, mmol/L)	4.80±0.45	4.84±0.47	4.87±0.47	3.806	0.022
OGTT 1h血糖(x±s, mmol/L)	7.50±1.70	7.64±1.75	7.88±1.86	7.471	0.001
OGTT 2h血糖(x±s, mmol/L)	6.73±1.30	6.77±1.26	6.98±1.40	6.370	0.002
FPG异常[n(%)]	117(18.93)	154(23.62)	176(27.46)	12.790	0.002
OGTT 1h异常[n(%)]	53(8.59)	64(9.83)	79(12.36)	5.060	0.080
OGTT 2h异常[n(%)]	56(9.06)	50(7.67)	79(12.34)	8.477	0.014

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表 3 孕早期血红蛋白水平与GDM多因素分析(N=2 059)

Table 3. Multifactorial analysis of haemoglobin levels and GDM in early pregnancy(N=2 059)

血红蛋白水平	GDM调整OR (95% CI)值	FPG调整β (95% CI)值	OGTT 1h血糖调整β (95% CI)值	OGTT 2h血糖调整β (95% CI)值
血红蛋白水平-每“10g/L”	1.11(1.01~1.22)	0.03(0.01~0.05)	0.14(0.07~0.21)	0.13(0.08~0.19)
血红蛋白水平(g/L)-分组
< 125	1.00	1.00	1.00	1.00
125~ < 135	1.21(0.95~1.54)	0.04(-0.01~0.09)	0.15(-0.04~0.34)	0.03(-0.11~0.17)
≥135	1.44(1.13~1.83)	0.07(0.02~0.12)	0.36(0.17~0.55)	0.23(0.09~0.37)
注：调整了年龄、受教育程度、家庭经济状况、孕前BMI、孕期增重、二手烟暴露、孕次、产次。

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