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中国循证儿科杂志

中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (1): 12-16.

• 论著 • 上一篇    下一篇

孕期膳食血糖生成指数变化与出生体重及母子胰岛素抵抗水平的关系

牛大彦1,张羿1,王丽萍2,杨文红3,赵倩1,穆锴1,严卫丽1   

  1. 1 复旦大学附属儿科医院临床流行病学研究室上海，201102；2  上海交通大学医学院附属国际和平妇幼保健院上海，200030；3 江苏省昆山市妇幼保健所昆山，215300
  • 收稿日期:2017-01-15 修回日期:2017-03-13 出版日期:2017-02-25 发布日期:2017-02-25
  • 通讯作者: 严卫丽

The association of the change of diet glycemic index during pregnancy with birth weight and insulin resistance level of pregnant women and their offsprings

NIU Da-yan1, ZHANG Yi1, WANG Li-ping2, YANG Wen-hong3, ZHAO Qian1, MU Kai1, YAN Wei-li1   

  1. 1 Department of Clinical Epidemiology, Children's Hospital of Fudan University, Shanghai 201102, China,; 2 Maternity and Child Health Center, International Peace Maternity & Child Health Hospital of China Welfare Institute, Shanghai 200030, China,; 3 Department of Genetic Counseling, Kunshan Maternity and Child Care Center, Kunshan 215300, China
  • Received:2017-01-15 Revised:2017-03-13 Online:2017-02-25 Published:2017-02-25
  • Contact: YAN Wei-li

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摘要：

目的：探讨超重孕妇孕期膳食血糖生成指数（GI）变化水平与新生儿出生体重及母子胰岛素抵抗水平的关系。方法：选择在江苏省昆山市妇幼保健所及上海市国际和平妇幼保健院参加产检的超重孕妇为研究对象。前瞻性收集孕妇初次产检及孕中期膳食资料，计算GI变化水平（ΔGI）。采用Pearson相关分析ΔGI与新生儿出生体重、孕晚期空腹胰岛素及脐血C肽之间的相关关系，利用多元回归校正混杂因素的影响,进一步分析ΔGI与三者之间的关系。将ΔGI分为4组（<25%、~50%、~75%和＞75%）, 出生体重分为巨大儿、正常体重儿、低出生体重儿3组，应用有序多分类Logistic 回归分析孕期ΔGI和出生体重各分组之间的关系。结果：本文共纳入392名超重孕妇，初诊和孕中期膳食GI平均水平分别为64.4±9.2和63.8±9.5，ΔGI为-0.6±12.7。孕晚期空腹胰岛素平均水平为11.6(7.4~15.8) μU·mL-1。新生儿平均出生体重（3489.7±519.6）g，巨大儿发生率14.4%，脐血C肽的平均水平为0.7(0.4~1.0) ng·mL-1。相关分析并未发现ΔGI与新生儿出生体重、孕晚期空腹胰岛素及脐血C肽之间的关系。多元线性逐步回归分析显示新生儿出生体重与ΔGI、孕期增重、新生儿性别、分娩孕周有关。有序多分类Logistic 回归分析显示，随着孕期ΔGI的增加，新生儿出生体重呈上升趋势（OR=1.54,95% CI:1.06~2.25）。多元回归分析并未发现ΔGI与孕晚期空腹胰岛素、脐血C肽之间的关系。结论：超重孕妇孕期膳食GI变化水平与新生儿出生体重显著相关，与母子胰岛素抵抗水平无关。

Abstract:

Objective: To explore the association of the change of diet glycemic index (GI) with birth weight and insulin resistance level of overweight pregnant women and their offsprings. Methods: Overweight pregnant women were recruited from Kunshan Maternity and Child Care Center and the International Peace Maternity & Child Health Hospital of China Welfare Institute. The 24 hour diet records in the first and second trimester were collected prospectively and the diet GI change during that period was calculated. Pearson correlation was used to analyze the correlation between thee diet GI change and serum insulin in the third trimester, birth weight and cord blood C peptide. And the association between them was further analyzed by multiple regression analysis. The diet GI change was divided into 4 groups （<25%, -50%, -75%, ＞75%）and birth weight into 3 categories as macrosomia, normal weight and low birth weight. Ordinal ploytomous Logistic regression was developed to analyze the association between diet GI groups and categories of birth weight.Results: A total of 392 overweight pregnant women were recruited and their diet GI in the first and second trimester was 64.4±9.2 and 63.8±9.5 respectively, with the change between them being -0.6±12.7. The average level of serum insulin in the third trimester, birth weight and cord blood C peptide were 11.6(7.4-15.8) uU·mL-1, （3 489.7±519.6）g and 0.7(0.4-1.0) ng·mL-1, respectively. There was no correlation between the diet GI change and serum insulin level in the third trimester, birth weight and cord blood C peptide. Birth weight was associated with the diet GI change, weight gain during the gestation, gestational age at delivery and gender of newborns in the multiple regression model. Categories of birth weight were significantly related to diet GI groups (OR=1.54, 95% CI: 1.06-2.25). No association was found between the diet GI change and either serum insulin in the third trimester or cord blood C peptide. Conclusion: The change of diet GI during the gestation was significantly associated with birth weight, but not with serum insulin level in the third trimester or cord blood C peptide.