Effect of the treatment of gestational diabetes on the offspring’s childhood obesity
-
摘要:
目的 评估妊娠期糖尿病的治疗对其后代儿童时期肥胖症发病情况的影响。 方法 选取入院生产的137名患有妊娠期糖尿病的妇女，对接受治疗与未接受治疗的孕妇后代进行追踪研究，研究指标包括身高、体质量、血压、腰围、空腹血糖、空腹胰岛素、甘油三酯含量和高密度脂蛋白及胆固醇的含量。 结果 治疗组与未治疗组的后代体质量指数>P95（肥胖）的例数分别占总人数的8.8%和9.5%（P=0.79），体质量指数>P85（超重）的例数占总人数的16.8%和19.7%（P=0.65）。其中治疗组与未治疗组的体质量指数、空腹血糖值、甘油三酯含量、高密度脂蛋白含量、血压值、胰岛素抵抗值之间差异并无统计学意义（P>0.05）。但治疗组与未治疗组女性后代的空腹血糖和胰岛素抵抗值之间的差异有统计学意义（P=0.002，0.02）。 结论 尽管妊娠期糖尿病的治疗可以降低其女性后代的空腹血糖值，但总体而言并未降低儿童时期肥胖症的发生率。 Abstract:Objective To explore the effect of the treatment of gestational diabetes mellitus (GDM) on the offspring’s childhood obesity. Methods 137 women diagnosed with GDM in our hospital were enrolled, and there were similar baseline characteristics between the maternal follow treated and untreated groups. A follow-up study was carried on the offspring of the abovementioned women 5-6 years after their deliveries in our hospital. Height, weight, blood pressure, waist circumference, fasting glucose, fasting insulin, triglycerides, and HDL cholesterol of their offspring were measured. Results The frequency of BMI>P95 (8.8% and 9.5%,P=0.78) and BMI>P85 (16.8% and 19.7%,P=0.65) in their offspring was not significantly different in treated and untreated group. The difference of BMI z score, log waist circumference, log triglycerides, HDL cholesterol, blood pressure, or log HOMA-estimated insulin resistance (HOMA-IR) between treated and untreated group were not significant (P>0.05). However, the difference of fasting glucose and log HOMA-IR between the female offspring of each group was significant(P for interaction = 0.002 and 0.02, respectively) in female offspring. Conclusions Although the treatment of gestational diabetes can reduce the fasting glucose of the female offspring, the overall incident of childhood obesity has not been improved. -
Key words:
- gestational diabetes mellitus /
- fasting glucose /
- glucose tolerance /
- BMI
-
表 1 妊娠期糖尿病治疗组与未治疗组基本情况（Mean±SD）
指标 接受治疗组 未接受治疗组 P 怀孕年龄（岁） 29.3±3.7 28.9±4.6 0.31 BMI（kg/m2） 30.7±4.9 30.2±5.4 0.44 空腹血糖（mg/dL） 87.7±6.3 87.3±5.6 0.30 1 h OGTT（mg/dL） 182.7±23.3 183.9±19.1 0.13 2 h OGTT（mg/dL） 171.3±21.4 172.5±17.3 0.79 3 h OGTT（mg/dL） 132.2±28.1 133.7±31.6 0.15 
下载: 导出CSV
表 2 妊娠期糖尿病患者后代的追踪结果（Mean±SD）
指标 整体情况 男性后代 女性后代 治疗组 未治疗组 P 治疗组 未治疗组 P 治疗组 未治疗组 P BMI 0.33±0.02 0.36±0.01 0.83 0.36±0.01 0.35±0.02 0.84 0.31±0.03 0.37±0.02 0.34 空腹血糖（mg/dL） 80.32±8.33 88.65±6.22 <0.01 89.34±7.45 87.31±5.33 0.83 80.11±5.23 89.32±9.43 <0.01 HOMA-IR 0.97±0.04 1.19±0.06 <0.05 1.06±0.04 0.97±0.03 0.78 1.05±0.02 1.7±0.05 <0.05 甘油三酯（mg/dL） 58.82±3.22 57.48±5.88 0.83 57.89±4.23 54.87±3.56 0.62 60.05±5.34 60.15±4.23 0.89 高密度脂蛋白（mg/dL） 54.36±4.22 55.01±3.26 0.8 54.87±3.56 56.45±6.67 0.82 53.62±7.34 53.33±5.28 0.84 收缩压（mmHg） 101±8 100±11 0.91 99±6 101±8 0.82 99±6 99±5 0.92 舒张压（mmHg） 60±6 59±7 0.89 60±8 60±9 0.92 61±5 58±7 0.78
下载: 导出CSV
表 3 妊娠期糖尿病患者后代的追踪统计结果（n）
指标 整体情况 男性 女性 治疗组 未治疗组 相对危险度（RR） 治疗组 未治疗组 相对危险度（RR） 治疗组 未治疗组 相对危险度（RR） BMI≥P95 12 13 0.92 8 6 1.33 4 7 0.57 BMI≥P85 23 27 0.85 15 17 0.88 8 10 0.8 空腹血糖≥100 mg/dL 15 18 0.75 9 7 1.29 6 11 0.55 甘油三酯≥M100 mg/dL 11 15 0.73 6 5 1.2 5 10 0.50 高密度脂蛋白<40 mg/dL 24 22 1.09 14 8 1.75 10 12 0.83 高血压≥P95 15 13 1.15 9 8 1.13 6 5 1.20
下载: 导出CSV
-
[1] 张 娅, 徐先明. 妊娠期糖尿病病因学研究进展[J]. 中国实用妇科与产科杂志, 2013, 29(4): 299-302. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zgsyfkyckzz200706020 [2] Hillier TA, Pedula KL, Schmidt MM, et al. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia[J]. Diabetes Care, 2007, 30(9): 2287-92. doi: 10.2337/dc06-2361 [3] Brawerman GM, Dolinsky VW. Therapies for gestational diabetes and their implications for maternal and offspring health:Evidence from human and animal studies[J]. Pharmacol Res, 2018,5(2):11-6. [4] Shepherd E, Gomersall JC, Tieu J, et al. Combined diet and exercise interventions for preventing gestational diabetes mellitus[J]. Cochrane Database Syst Rev, 2017,11(4): 443-7. doi: 10.1002/14651858.CD010443.pub3/abstract [5] Wisnieski L, Kerver J, Holzman C, et al. Breastfeeding and risk of metabolic syndrome in children and adolescents:a systematic review[J]. J Hum Lact, 2017,19(8):38-47. doi: 10.1177/0890334417737038 [6] Chu SY, Callaghan WM, Kim SY, et al. Maternal obesity and risk of gestational diabetes mellitus[J]. Diabetes Care, 2007, 30(8): 2070-6. doi: 10.2337/dc06-2559a [7] Catalano PM, Farrell K, Thomas A, et al. Perinatal risk factors for childhood obesity and metabolic dysregulation[J]. Am J Clin Nutr, 2009, 90(5): 1303-13. doi: 10.3945/ajcn.2008.27416 [8] Sewell MF, Huston-Presley L, Super DM, et al. Increased neonatal fat mass,and not lean body mass is associated with maternal obesity[J]. Am J Obstet Gynecol, 2006,(195): 1100–3. https://www.sciencedirect.com/science/article/pii/S0002937806007381 [9] Al-Hamad D, Raman V. Metabolic syndrome in children and adolescents[J]. Transl Pediatr, 2017, 6(4): 397-407. doi: 10.21037/tp [10] Cunningham SA, Kramer MR, Narayan K. Incidence of childhood obesity in the United States[J]. N Engl J Med, 2014, 370(5): 403-11. doi: 10.1056/NEJMoa1309753 [11] Pham MT, Brubaker K, Pruett K, et al. Risk of childhood obesity in the toddler offspring of mothers with gestational diabetes[J]. Obstet Gynecol, 2013, 121(5): 976-82. doi: 10.1097/AOG.0b013e31828bf70d [12] Baptiste-Roberts K, Nicholson WK, Wang NY, et al. Gestational diabetes and subsequent growth patterns of offspring: the National Collaborative Perinatal Project[J]. Matern Child Health J, 2012, 16(1): 125-32. doi: 10.1007/s10995-011-0756-2 [13] Boney CM, Verma A, Tucker R, et al. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus[J]. Pediatrics, 2005, 115(3): e290-6. doi: 10.1542/peds.2004-1808 [14] Maryns AS, G. Page.Maternal and neonatal outcomes in a treated versus non-treated cohort of women with gestational diabetes mellitus according to the HAPO 5 and 4 criteria[J]. Facts Views Vis Obgyn, 2017, 9(3): 133-40. [15] Mitanchez D, Jacqueminet S, Nizard J, et al. Effect of maternal obesity on birthweight and neonatal fat mass:A prospective clinical trial[J].PLoS One, 2017, 12(7): e0181307-12. doi: 10.1371/journal.pone.0181307 [16] Mitanchez D, Chavatte-Palmer P. Review shows that maternal obesity induces serious adverse neonatal effects and is associated with childhood obesity in their offspring[J]. Acta Paediatr, 2018,29(8):142-9. [17] Dugas C, Perron J, Kearney M, et al. Postnatal prevention of childhood obesity in offspring prenatally exposed to gestational diabetes mellitus: where are we now[J]. Obes Facts, 2017, 10(4): 396-406. doi: 10.1159/000477407 [18] Fraser A, Tilling K, Macdonald-Wallis C, et al. Association of maternal weight gain in pregnancy with offspring obesity and metabolic and vascular traits in childhood[J]. Circulation, 2010, 121(23): 2557-64. doi: 10.1161/CIRCULATIONAHA.109.906081 [19] Keely EJ, Malcolm JC, Hadjiyannakis S, et al. Prevalence of metabolic markers of insulin resistance in offspring of gestational diabetes pregnancies[J]. Pediatr Diabetes, 2008, 9(1): 53-9. [20] Thangaratinam S, Rogozinska E, Jolly K, et al. Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence[J]. BMJ, 2012, 344(11): e2088-95. [21] Gillman MW, Oakey H, Baghurst PA, et al. Effect of treatment of gestational diabetes mellitus on obesity in the next Generation[J]. Diabetes Care, 2010, 33(5): 964-8. doi: 10.2337/dc09-1810 [22] Lingwood BE, Henry AM. d'emden MC,et al. Determinants of body fat in infants of women with gestational diabetes mellitus differ with fetal sex[J]. Diabetes Care,2011,19 (34): 2581-5. [23] Kim SY, England JL, Sharma JA, et al. Gestational diabetes mellitus and risk of childhood overweight and obesity in offspring:a systematic review[J]. Exp Diabetes Res, 2011,21(10): 541308-13. [24] Crume TL, Ogden L, West NA, et al. Association of exposure to diabetes in utero with adiposity and fat distribution in a multiethnic population of youth: the Exploring Perinatal Outcomes among Children (EPOCH) Study[J]. Diabetologia, 2011, 54(1): 87-92. doi: 10.1007/s00125-010-1925-3 -
点击查看大图
表(3)
计量
- 文章访问数: 1068
- HTML全文浏览量: 554
- PDF下载量: 2
- 被引次数: 0
