孕早期睡眠状况对妊娠期糖尿病影响的前瞻性研究

中文关键词:  睡眠 妊娠期糖尿病 前瞻性研究

中文摘要:

      目的 调查分析孕妇孕早期睡眠状况，探讨其对妊娠期糖尿病（GDM）的影响。方法 选取成都市区妇幼医疗机构产前门诊542例孕早期妇女为研究对象进行前瞻性研究，通过问卷调查收集孕妇孕早期睡眠时间、失眠、孕前体质量及其基本信息，于24～28孕周进行糖耐量筛查试验（OGTT），根据中国妊娠合并糖尿病诊治指南（2014）诊断GDM，并测量体质量。采用多因素非条件logistic回归方法分析孕妇孕早期睡眠状况对GDM发生率的影响。结果 孕早期睡眠不足组、睡眠正常组、睡眠过多组人数分别为16例（2.95%）、268例（49.45%）和258例（47.60%），GDM发病率分别为62.50%（10/16）、25.75%(69/268)、22.09%(57/258)，三组比较差异有统计学意义（χ²=11.280，P<0.05)；睡眠不足组GDM发病率较睡眠正常组和睡眠过多组高，差异均有统计学意义（χ²值分别为8.410和11.218,均P<0.017）。孕早期失眠组（137例，占25.28%）和非失眠组GDM发病率分别为32.12% 和22.72%，两组比较差异有统计学意义（χ²=4.813，P<0.05）。调整可能混杂因素后〔孕妇年龄、文化程度、孕前体质量指数（BMI）、孕早中期增重、孕妇2型糖尿病家族史、孕次、产次、吸烟、饮酒、锻炼、就业〕，多因素非条件logistic回归分析显示：孕妇孕早期睡眠不足是GDM发生的独立危险因素，比值比（95%可信区间）为7.38(2.25~24.17)，未观察到孕早期失眠对GDM的影响。结论 孕妇孕早期睡眠状况与GDM发生密切相关，孕早期睡眠不足是GDM发生的危险因素，失眠对GDM的影响有待研究。

英文摘要:

      Objective To investigate the influence of sleep status in early pregnant women on the occurrence of gestational diabetes mellitus (GDM). Methods In this prospective study, 542 pregnant women in early pregnancy were selected as subjects. The sleep time, insomnia, pre-gestational body mass and basic information of the subjects were collected by the trained investigators through questionnaire. At the 24^th to 28^th pregnant week, the body mass of each subject was measured and oral glucose tolerance test (OGTT) was conducted. The diagnosis of GDM was followed the guidelines of diagnose and treatment of gestational diabetes mellitus in China (2014). A non-conditional logistic regression method was adopted to analyze the correlation between sleep status of early pregnant women and the occurrence of GDM. Results The numbers of subjects in sleep deficiency group, sleep sufficiency group and sleep excessive group were 16 (2.95%), 268 (49.45%) and 258 (47.60%), respectively. The incidences of GDM for sleep deficiency group, sleep sufficient group, and sleep excessive group were 62.50%(10/16), 25.75%(69/268) and 22.09% (57/258), respectively, the difference was statistically significant (χ²=11.280，P<0.05). Compared with either sleep sufficiency or sleep excessive group, sleep deficiency group had higher GDM occurrence rate with statistically significant (χ²=8.410, 11.218, P<0.017). Insomnia subjects in early pregnancy were 137 (25.28%). The incidences of GDM in insomnia group and normal group were 32.12% and 22.72% respectively, the difference was statistically significant (χ²=4.813，P<0.05). After adjusting the confounding factors 〔age, education, pre-pregnant body mass index (BMI), gained body mass in early and medium pregnancy, family history of type-2 diabetes, gravidity, parity, smoke, drink, exercise and occupation〕, non-conditional logistic regression results show that sleep deficiency for early pregnant women was an independent risk factor for the occurrence of GDM 〔odds ratio (OR)=7.38, 95% confidence interval (CI): 2.25-24.17〕. However, the association between insomnia and the occurrence of GDM was not found. Conclusion Sleep deficiency in early pregnancy may be a risk factor for the occurrence of GDM.