早期个体化健康管理对高风险人群妊娠期糖尿病发病的影响

The impact of early personalized health management on the development of gestational diabetes mellitus in high-risk individuals

摘要

目的 探讨早期个体化健康管理对存在高危因素人群预防妊娠期糖尿病(GDM)的干预效果。方法 选取2021年12月至2022年9月在西安市中心医院产检的有妊娠期糖尿病高危因素的368例孕妇为研究对象.个体化健康管理措施从孕早期开始,直至妊娠24周至28周口服葡萄糖耐量试验(OGTT)结束.根据个体化健康管理措施不同分为干预组(个体化健康管理组)201例和对照组(常规管理组)167例.观察并比较两组孕妇体质量增长情况、75g OGTT结果、GDM发病率情况。结果 干预组OGTT检测空腹血糖低于对照组,差异有统计学意义(t=2.894,P<0.05);服糖后1h血糖、服糖后2h血糖对照组和干预组差异无统计学意义(P>0.05);干预组GDM发病率低于对照组,差异有统计学意义(11.94% vs. 19.76%,χ²=4.261,P<0.05);根据风险因素不同分层评估,在高遗传风险人群中,干预组GDM发病率低于对照组,差异有统计学意义(χ²=9.340,P<0.05);在非高遗传风险人群中,干预组和对照组差异无统计学意义(P>0.05);干预组孕妇分娩时体质量、孕期体质量增长均低于对照组,差异有统计学意义(t值分别为3.517、3.098,P<0.05);根据年龄不同分层评估,干预组和对照组不同年龄间GDM发生率差异均有统计学意义,其中35~<40岁组GDM发病率较高(χ²值分别为8.450、10.389,P<0.05);另外,30~<35岁组中,干预组的GDM发病率低于对照组,差异有统计学意义(χ²=6.187,P<0.05)。结论 从孕早期开始进行个体化健康管理,可以更好地控制孕期体质量增长,对存在GDM高危因素者预防效果明显增强,降低GDM发病率;高遗传风险人群接受个体化健康管理,对降低GDM发病率有积极的临床意义.

Abstract

Objective To investigate the intervention effects of early personalized health management on preventing gestational diabetes mellitus (GDM) in high-risk individuals. Methods A total of 368 pregnant women with high risk factors of GDM who underwent prenatal examinations at the Xi′an Central Hospital from December 2021 to September 2022 were selected as the study subjects. Personalized health management measures were implemented from early pregnancy until completion of the oral glucose tolerance test (OGTT) between 24 to 28 weeks of gestation. The participants were divided into an intervention group (personalized health management group) comprising 201 cases and a control group (routine management group) comprising 167 cases. The gestational weight gain, results of the 75g OGTT and incidence of GDM of the two groups were observed and compared. Results In the intervention group, fasting blood glucose levels during OGTT were lower than those in the control group, showing statistical significance (t=2.894, P<0.05). There were no statistically significant differences in blood glucose level in 1h and 2h of OGTT between the control and intervention groups (P>0.05). The intervention group exhibited a lower incidence of GDM compared to the control group, with statistically significant (11.94% vs. 19.76%, χ²=4.261, P<0.05). Stratified assessment based on different risk factors showed that in the high genetic risk population, the intervention group had a lower incidence of GDM compared to the control group, with statistically significant (χ²=9.340, P<0.05). In the low genetic risk population, there was no statistically significant difference between the intervention and control groups (P>0.05). Maternal weight at delivery and gestational weight gain were both lower in the intervention group compared to the control group, with statistically significant (t=3.517 and 3.098, respectively, P<0.05). Stratified assessment based on age showed statistically significant differences in the GDM incidence between the intervention group and the control groups across different age. The GDM incidence was higher in the 35-<40 age group (χ²=8.450, 10.389, P<0.05). Additionally, in the 30-<35 age group, the GDM incidence was lower in the intervention group compared to the control group, with statistically significant differences (χ²=6.187, P<0.05). Conclusion Initiating personalized health management from early pregnancy can better control gestational weight gain, significantly enhance preventive effects for individuals at high risk of GDM, and reduce the incidence of GDM. Providing personalized health management to individuals with high genetic risk has positive clinical significant for reducing the incidence of GDM.

关键词

妊娠期糖尿病 / 个体化 / 健康管理 / 预防

Key words

gestational diabetes mellitus / personalized / health management / prevention

参考文献

[1] Szmuilowicz ED, Josefson JL, Metzger BE. Gestational diabetes mellitus[J]. Endocrinol Metab Clin North Am, 2019, 48(3): 479-493.

[2] 韩娜, 刘珏, 金楚瑶, 等. 2013-2017年北京市通州区34637例孕妇妊娠期糖尿病流行情况及其影响因素研究[J]. 中华疾病控制杂志, 2019, 23(2): 156-161.

[3] Gao C, Sun X, Lu L, et al. Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta-analysis[J]. J Diabetes Investig, 2019, 10(1): 154-162.

[4] Bruno R, Petrella E, Bertarini V, et al. Adherence to a lifestyle programme in overweight/obese pregnant women and effect on gestational diabetes mellitus: a randomized controlled trial[J]. Matern Child Nutr, 2017, 13(3): e12333.

[5] 李占辉, 阮冀, 王晋萍, 等. 早期干预对妊娠期糖尿病管理的作用[J]. 中国妇幼健康研究, 2018, 29(10): 1280-1283.

[6] 张驰, 魏丽荣, 陈璎珞, 等. 探讨个体化营养管理与集体宣教讲课对妊娠期糖尿病患者的管理作用[J]. 中国妇产科临床杂志, 2022, 23(1): 60-62.

[7] Huang Q, Wang Y, Gu B, et al. Whether the risk of gestational diabetes mellitus is affected by TNF-α, IL-6, IL-10 or ADIPOQ polymorphisms: a meta-analysis[J]. Diabetol Metab Syndr, 2020, 12: 81.

[8] Liu J, Song G, Zhao G, et al. Association between TNF-α polymorphisms and gestational diabetes mellitus: a meta-analysis and trial sequential analysis[J]. Gynecol Endocrinol, 2021, 37(6): 506-510.

[9] Wei Q, Chen X, Chen H. Association of single nucleotide polymorphisms of the IL-6, IL-10, and TNF-α genes with susceptibility to gestational diabetes mellitus[J]. Genet Test Mol Biomarkers, 2020, 24(7): 390-398.

[10] Vounzoulaki E, Khunti K, Abner SC, et al. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis[J]. BMJ, 2020, 369: m1361.

[11] 中华医学会妇产科学分会产科学组, 中华医学会围产医学分会, 中国妇幼保健协会妊娠合并糖尿病专业委员会. 妊娠期高血糖诊治指南(2022)[第二部分][J]. 中华妇产科杂志, 2022, 57(2): 81-90.

[12] 王彬苏, 周秋明, 盛望望, 等. 中国妊娠期糖尿病危险因素及妊娠结局的调查分析[J]. 中国医刊, 2019, 54(9): 1014-1019.

[13] Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective[J]. Curr Diab Rep, 2016, 16(1): 7.

[14] Song C, Li J, Leng J, et al. Lifestyle intervention can reduce the risk of gestational diabetes: a meta-analysis of randomized controlled trials[J]. Obes Rev, 2016, 17(10): 960-969.

[15] Wang H, Jiang Y, Wiley J, et al. Effectiveness of smartphone-based lifestyle interventions on women with gestational diabetes: a systematic review and meta-analysis of randomized controlled trials[J]. Psychol Res Behav Manag, 2022, 15: 3541-3559.

[16] Wu Q, Chen Y M, Zhou M, et al. An early prediction model for gestational diabetes mellitus based on genetic variants and clinical characteristics in China[J]. Diabetol Metab Syndr, 2022, 24, 14(1): 15.

[17] 王彦林, 吕淑平. 高龄孕妇再生育子代出生缺陷健康风险[J]. 中国临床医生杂志, 2017, 45(6): 5-8.

[18] LI Y, Ren X, He L, et al. Maternal age and the risk of gestational diabetes mellitus: a systematic review and meta-analysis of over 120 million participants[J]. Diabetes Res Clin Pract, 2020, 162: 108044.

基金资助

陕西省自然科学基础研究计划(2023GYBSFG649)

西安市创新能力强基计划医学研究项目(21XYJ0021)

西安市中心医院科学技术项目(2022YB03)

西安市中心医院科学技术项目(2023QN02)

西安市中心医院科学技术项目(2023HG04)