摘要
目的探讨妊娠期糖尿病(GDM)共病抑郁对孕期糖代谢功能及新生儿形态结局的影响。方法于2015年3月至2018年6月,在合肥市第一人民医院、安徽医科大学第一附属医院和安徽省妇幼保健院三家医院招募孕符合标准的18~28周孕妇,共纳入4380名研究对象,其中收集到3827名孕妇新生儿的出生结局信息。采用自制问卷《合肥市孕产妇健康问卷》和爱丁堡产后抑郁量表获得基本人口学特征及抑郁情绪状态。在孕24~28周行75 g糖耐量实验诊断GDM,产妇分娩后从医院病历收集分娩结局信息。采用协方差分析不同GDM和抑郁状态孕妇糖代谢指标及新生儿结局指标的差异。以不同GDM和抑郁状态分组(无GDM且无抑郁、单病抑郁、单病GDM及GDM共病抑郁者)为自变量,以是否为大于胎龄儿为因变量,采用多因素logistic回归模型分析两者之间的关联,并分析GDM和抑郁的交互作用。结果4380名孕妇年龄为(28.8±4.2)岁,孕18~28周和孕32~36周的抑郁检出率分别为12.1%(526/4380)和12.3%(536/4367);孕24~28周GDM的检出率为19.5%(852/4380)。GDM共病抑郁者服糖后1 h血糖水平和曲线下面积高于无GDM且无抑郁者(P<0.05)和单病GDM者(P<0.05)。调整孕妇分娩年龄、教育程度、家庭主要经济收入、孕前体重指数、产次、体力活动次数、孕期增重等因素后,与无GDM且无抑郁者相比,单病抑郁、单病GDM和GDM共病抑郁者发生LGA的RR(95%CI)分别为1.31(0.89~1.91)、1.51(1.14~2.00)和2.43(1.29~4.57);进一步分析发现,抑郁状态的GDM孕妇与新生儿LGA的关联[RR(95%CI):2.12(1.01~4.49)]比无抑郁状态GDM孕妇与新生儿LGA的关联[RR(95%CI):1.50(1.12~1.99)]的更强(P交互<0.05)。结论孕妇GDM共病抑郁会损伤糖代谢功能,增加新生儿LGA发生风险。
Objective To estimate the effect of comorbid gestational diabetes mellitus(GDM)and depression on glucose metabolism and neonatal morphology.Methods From March 2015 to October 2018,recruited 18 to 28 weeks pregnant women who met the criteria in the Hefei First People′s Hospital or First Affiliated Hospital of Anhui Medical University or Anhui Maternal and Child Health Hospital,including a total of 4380 study subjects,of which the birth outcome information of 3827 newborns were collected.The self‑made questionnaire"Maternal Health Questionnaire for Hefei City"and Edinburgh Postpartum Depression Scale were used to obtain basic demographic characteristics and emotional state of depression.Data from the 75‑g oral‑glucose‑tolerance test were obtained at 24-28 weeks of gestation.After delivery,delivery outcome information were collected from the hospital medical records.Covariance analysis was used to analyze the differences in glucose metabolism indicators and neonatal outcome indicators in pregnant women with different GDM and depression status.Multiple logistic regression model was used to analyze the correlation between GDM and depression,with different groups of GDM and depression status(no GDM and depression,simple depression,simple GDM,comorbid GDM and depression)as independent variables and whether they were large for gestational age as dependent variables.The interaction between GDM and depression was also analyzed.Results The 4380 pregnant women were(28.8±4.2)years old.The incidence of GDM was 19.5%(852/4380),and the detection rates of depression in the second and third trimesters were 12.1%(526/4380)and 12.3%(536/4367).PG‑1h and AUC in the comorbid GDM and depression group were significantly higher than those in the group with no GDM and depression(P<0.05)and the single GDM group(P<0.05).After adjusting for factors such as the childbirth age,education level,family′s main economic income,BMI before pregnancy,parity,number of physical activities,and weight gain during pregnancy,compared with the group with no GDM and depression,the RR(95%CI)of LGA occurred in the single depression group,the single GDM group and the comorbid group were 1.31(0.89-1.91),1.51(1.14-2.00)and 2.43(1.29-4.57),respectively.Further analysis showed that the association between GDM pregnant women with depression and newborn LGA[RR(95%CI):2.12(1.01-4.49)]was stronger than that between GDM pregnant women without depression and newborn LGA[RR(95%CI):1.50(1.12-1.99)],the P interaction value was<0.05.Conclusion The status of comorbid GDM and depression can impair glucose metabolism and increase the risk of LGA.
作者
焦雪纯
肖敏
高宗侠
解钧
刘洋
尹万军
吴钰
陶瑞雪
朱鹏
Jiao Xuechun;Xiao Min;Gao Zongxia;Xie Jun;Liu Yang;Yin Wanjun;Wu Yu;Tao Ruixue;Zhu Peng(Department of Maternal,Child&Adolescent Health,School of Public Health,Anhui Medical University,Key Laboratory of Health Education of Birth Population,Anhui Key Laboratory of Population Health and Aristogenics Hefei 230032,China;Department of Obstetrics and Gynecology,the First People′s Hospital of Hefei City,Hefei 230031,China;The First Clinical Medical College,Anhui Medical University,Hefei 230032,China)
出处
《中华预防医学杂志》
CAS
CSCD
北大核心
2020年第9期968-973,共6页
Chinese Journal of Preventive Medicine
基金
国家自然科学基金(81872631、81472991)
安徽省高校优秀青年人才基金(gxyqZD2018025)
安徽省学术和技术带头人后备人选科研资助项目(2017H141)
合肥市卫计委应用医学研究(hwk2018zd002)
安徽医科大学临床医学(“5+3”一体化)专业“早期接触科研”训练计划(2019‐ZQKY‐86)。
关键词
妊娠
糖尿病
抑郁
新生儿筛查
Pregnancy
Diabetes mellitus
Depression
Neonatal screening
