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

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;张羿;王丽萍;杨文红;赵倩;穆锴;严卫丽
【摘要】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 th em 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％ C I: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.%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(△GI).采用Pearson相关分析△GI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△GI与三者之间的关系.将△GI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△GI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,△GI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△GI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
△GI、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△GI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△GI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.【期刊名称】《中国循证儿科杂志》
【年(卷),期】2017(012)001
【总页数】5页(P12-16)
【关键词】超重孕妇;血糖生成指数;出生体重;胰岛素抵抗
【作者】牛大彦;张羿;王丽萍;杨文红;赵倩;穆锴;严卫丽
【作者单位】复旦大学附属儿科医院临床流行病学研究室上海,201102;复旦大学附属儿科医院临床流行病学研究室上海,201102;上海交通大学医学院附属国际和平妇幼保健院上海,200030;江苏省昆山市妇幼保健所昆山,215300;复旦大学附属儿科医院临床流行病学研究室上海,201102;复旦大学附属儿科医院临床流行病学研究室上海,201102;复旦大学附属儿科医院临床流行病学研究室上海,201102【正文语种】中文
孕期环境因素对后代新生儿期、儿童期乃至成人后的肥胖以及相关代谢性疾病的发生有着重要影响[1]。

孕期超重可以显著增加巨大儿的发生风险，也可增加儿童期乃至成人期肥胖和2型糖尿病的发病风险[2～4]。

孕妇血液葡萄糖作为胎儿宫内发育的主要能量来源，与胎儿的生长发育息息相关。

膳食血糖生成指数(GI)是反映膳食中碳水化合物对餐后血糖影响程度的重要指标。

研究显示低GI膳食可以有效降低妊娠糖尿病(GDM)患者的餐后血糖，改善妊娠结局[5,6]。

目前，有关孕期膳食GI和新生儿出生体重的研究有限，且多为膳食干预研究，受干预人群和干预效果
的影响，研究结论并不一致[7,8]。

本研究旨在了解孕期膳食GI对孕妇及新生儿的影响，为超重孕妇母子的健康管理提供依据。

本文显示ΔGI与孕晚期空腹胰岛素、脐血C肽并无关联。

虽然多项研究显示低GI 膳食可以显著降低餐后血糖[5,29]，但膳食GI与母子胰岛素抵抗之间的关系却一直不明确。

有研究[29]显示高糖血症孕妇采用低GI膳食1个月后，空腹血糖下降(0.20±0.07)mmol·L-1，糖化血红蛋白和空腹胰岛素并未发生变化。

澳大利亚一项在确诊为GDM的孕妇中探讨低GI膳食的影响，接受低GI膳食指导组的GI由孕29周时的49降低到孕36周时的47，接受高纤维素中等GI膳食组GI由最初的52变为53，两组空腹胰岛素和糖化血红蛋白没有差异[8]，这一结论与另两项[7,22]在GDM高危孕妇、健康孕妇中的研究结论相似。

一项关于超重/肥胖孕妇研究中，孕期分别进行低GI膳食和低脂膳食后，未发现两组之间的空腹胰岛素和糖化血红蛋白的差异[19]。

目前有关新生儿胰岛素抵抗的研究较少，一项针对有巨大儿妊娠史的孕妇的干预研究发现孕期GI轻度下降(GI由孕早期的57.3下降到孕晚期56)并不影响脐血C肽的水平[30]。

本研究结果显示超重孕妇初次产检膳食GI约为64.4，孕中期膳食GI约为63.8，ΔGI为0.6，ΔGI与新生儿的出生体重有关，校正其他混杂因素后GI每上升1个单位，出生体重增加5.7 g。

ΔGI与孕晚期胰岛素及脐血C肽水平并无显著联系。