ارتباط شاخص ترکیبی دور کمر - تری‌گلیسیرید سه ماهه اول بارداری با بروز دیابت بارداری

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استادیار بهداشت باروری، مرکز تحقیقات دیابت، پژوهشکده سلامت، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

2 رزیدنت گروه داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

3 استادیار گروه داخلی، مرکز تحقیقات دیابت، پژوهشکده سلامت، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

4 استادیار گروه داخلی، دانشکده پزشکی، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

5 مربی گروه آمار و اپیدمیولوژی، دانشکده بهداشت، دانشگاه علوم پزشکی جندی شاپور اهواز، اهواز، ایران.

چکیده

مقدمه: دیابت بارداری، قوی­ ترین عامل پیش ­بینی کننده دیابت در آینده می ­باشد. مطالعه حاضر با هدف تعیین ارزش شاخص ترکیبی دور کمر - تری‌گلیسیرید سه ماهه اول بارداری در پیش­بینی بروز دیابت بارداری انجام شد.
روش‌کار: در این مطالعه مورد شاهدی که با استفاده از داده­ های طرح کوهورت آینده‌نگر پیامدهای دیابت بارداری طراحی شد، از بین 9630 مادر غربالگری شده در طرح کوهورت، داده‌های 260 زن مبتلا به دیابت بارداری و 260 زن سالم باردار از نظر شاخص‌های بالینی، بیوشیمیایی و دموگرافیک مورد مقایسه قرار گرفتند. برای تعریف دیابت بارداری از معیار کارگروه بین‌المللی دیابت و بارداری استفاده شد. دور کمر و میزان تری­ گلیسیرید تمام مادران در سه ماهه اول بارداری اندازه‌گیری شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 23) و آزمون‌های کای دو، تی مستقل رگرسیون تک‌متغیره و چندمتغیره انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته­ها: بر اساس نتایج رگرسیون لجستیک، بروز دیابت بارداری با تری‌گلیسیرید بالای 150 میلی‌گرم بر دسی‌لیتر ارتباط معنی‌داری نداشت (04/2-52/0: CI؛ 95%، 03/1=OR، 91/0=p). دور کمر بالای 85 سانتی‌متر با افزایش خطر بروز دیابت بارداری همراه بود (53/2-17/1: CI؛ 95%، 72/1=OR، 0005/0=p). خطر ابتلاء در مادرانی که دور کمر بیشتر از 85 سانتی‌متر و تری­ گلیسیرید بیشتر از 150 میلی‌گرم بر دسی لیتر داشتند، بیش از دو شاخص مورد نظر به تنهایی بود (03/6-71/1: CI؛ 95%، 21/3=OR، 0001/0>p).
نتیجه ­گیری: شاخص ترکیبی تری­ گلیسیرید و دور کمر زنان باردار در سه ماهه اول بارداری، شاخص نسبتاً مناسبی جهت پیش ­بینی ابتلاء به دیابت بارداری می­ باشد. 

کلیدواژه‌ها

عنوان مقاله [English]

The relationship between combined index of triglyceride-waist circumference in the first trimester and incidence of gestational diabetes

نویسندگان [English]

  • Sedigheh Nouhjah 1
  • Roya Varzandeh 2
  • Leila Moradi 3
  • Ferdos Zaman 4
  • Zahra Farhangian 4
  • Seyed Mahmoud Latifi 5
1 Assistant Professor, Department of Reproductive Health, Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
2 Resident, Department of Internal Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
3 Assistant Professor, Department of Internal Medicine, Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
4 Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
5 Instructor, Department of Statistics and Epidemiology, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
چکیده [English]

Introduction: Gestational diabetes is the strongest predictor of diabetes in the future. This study was performed aimed to determine the association between the Hypertriglyceridemic waist phenotype of first trimester and the incidence of gestational diabetes.
Methods: This case-control study was designed using the data of gestational diabetes outcomes cohort study. Among 9630 screened mothers in cohort study, 260 women with GDM and 260 healthy pregnant women were compared in terms of clinical, biochemical, and demographic indicators. Gestational diabetes (GDM) was defined by the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria. Waist circumference and triglyceride levels of all mothers were measured in the first trimester of pregnancy. Data were analyzed by SPSS software (version 23) and Chi-square tests, independent t, univariate and multivariate regression. P<0.05 was considered statistically significant.
Results: According to Logistic regression results, the incidence of gestational diabetes was not significantly associated with triglycerides above 150 mg/dL (OR = 1.03 (0.95% CI: 0.52-2.04, P= 0.91)). Waist circumference above 85 cm was associated with a higher risk of developing GDM (OR = 1.72 (0.95% CI: 1.17-2.53, P = 0.005)). The risk of GDM occurrence in mothers with a waist circumference of more than 85 cm and a triglyceride greater than 150 mg /dL was more than the two indicators alone (OR = 3.21 (0.95% CI: 1.71-6.03, P<0.001).
Conclusion: The combined index of triglyceride and waist circumference of pregnant women in the first trimester of pregnancy is a relatively good indicator for predicting gestational diabetes.

کلیدواژه‌ها [English]

  • Gestational Diabetes
  • Hypertriglyceridemic Waist
  • Screening

مراجع

  1. Akhlaghi F, Moeindarbari S, Najaf Najafi M. The Relationship between Number of Pregnancy Cares with Maternal and Neonatal Complications in Mothers with Gestational Diabetes. Iran J Obstet Gynecol Infertil 2021; 24(4):10-15.
  2. Wu Y, Ding Y, Tanaka Y, Zhang W. Risk factors contributing to type 2 diabetes and recent advances in the treatment and prevention. International journal of medical sciences 2014; 11(11):1185.
  3. Jeanette W, Bertil E, Hans AJ. Most women with previous gestational diabetes mellitus have impaired glucose metabolism after a decade. International journal of molecular sciences 2018; 19(12):3724.
  4. McIntyre HD, Kapur A, Divakar H, Hod M. Gestational diabetes mellitus—innovative approach to prediction, diagnosis, management, and prevention of future NCD—mother and offspring. Frontiers in endocrinology 2020; 11:614533.
  5. Nouhjah S, Shahbazian H, Latifi SM, Malamiri RA, Ghodrati N. Body mass index growth trajectories from birth through 24 months in Iranian infants of mothers with gestational diabetes mellitus. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2019; 13(1):408-12.
  6. Nouhjah S, Shahbazian H, Jahanfar S, Shahbazian N, Jahanshahi A, Cheraghian B, et al. Early postpartum lipid profile in women with and without gestational diabetes mellitus: results of a prospective cohort study. Iran Red Crescent Med J 2017; 19.
  7. Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of gestational diabetes mellitus in eastern and southeastern Asia: a systematic review and meta-analysis. Journal of diabetes research 2018; 2018.
  8. Dolatian M, Mahmoodi Z, Mohammadi Nasrabadi F. Gestational diabetes and its relationship with social determinants of health according to world health organization model: Systematic review. Iran J Obstet Gynecol Infertil 2017; 19(40):6-18.
  9. Shahbazian H, Nouhjah S, Shahbazian N, Jahanfar S, Latifi SM, Aleali A, et al. Gestational diabetes mellitus in an Iranian pregnant population using IADPSG criteria: Incidence, contributing factors and outcomes. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2016; 10(4):242-6.
  10. Koivunen S, Viljakainen M, Männistö T, Gissler M, Pouta A, Kaaja R, et al. Pregnancy outcomes according to the definition of gestational diabetes. PLoS One 2020; 15(3):e0229496.
  11. Kapur A, McIntyre HD, Divakar H, Di Renzo GC, Kihara AB, McAuliffe F, et al. Towards a global consensus on GDM diagnosis: Light at the end of the tunnel?. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2020; 149(3):257-61.
  12. Rani PR, Begum J. Screening and diagnosis of gestational diabetes mellitus, where do we stand. Journal of clinical and diagnostic research: JCDR 2016; 10(4):QE01.
  13. Li-Zhen L, Yun X, Xiao-Dong Z, Shu-Bin H, Zi-Lian W, Sandra DA, et al. Evaluation of guidelines on the screening and diagnosis of gestational diabetes mellitus: systematic review. BMJ open 2019; 9(5):e023014.
  14. Jamieson EL, Spry EP, Kirke AB, Atkinson DN, Marley JV. Real-world gestational diabetes screening: problems with the oral glucose tolerance test in rural and remote Australia. International Journal of Environmental Research and Public Health 2019; 16(22):4488.
  15. Agarwal MM, Punnose J, Dhatt GS. Gestational diabetes: problems associated with the oral glucose tolerance test. Diabetes research and clinical practice 2004; 63(1):73-4.
  16. Kouhkan A, Khamseh ME, Moini A, Pirjani R, Arabipoor A, Zolfaghari Z, et al. Diagnostic accuracy of body mass index and fasting glucose for the prediction of gestational diabetes mellitus after assisted reproductive technology. International Journal of Fertility & Sterility 2019; 13(1):32-7.
  17. Farina A, Eklund E, Bernabini D, Paladino M, Righetti F, Monti G, et al. A first-trimester biomarker panel for predicting the development of gestational diabetes. Reproductive sciences 2017; 24(6):954-9.
  18. Rasekhjahromi A, Paymard Z, Kalani N. The relationship between serum vitamin D levels and gestational diabetes: A case-control study. Iran J Obstet Gynecol Infertil 2022; 25(8):33-41.
  19. Klein S, Allison DB, Heymsfield SB, Kelley DE, Leibel RL, Nonas C, et al. Waist circumference and cardiometabolic risk: a consensus statement from shaping America's health: Association for Weight Management and Obesity Prevention; NAASO, the Obesity Society; the American Society for Nutrition; and the American Diabetes Association. The American journal of clinical nutrition 2007; 85(5):1197-1202.
  20. Assmann G, Guerra R, Fox G, Cullen P, Schulte H, Willett D, et al. Harmonizing the definition of the metabolic syndrome: comparison of the criteria of the Adult Treatment Panel III and the International Diabetes Federation in United States American and European populations. The American journal of cardiology 2007; 99(4):541-8.
  21. LeBlanc S, Coulombe F, Bertrand OF, Bibeau K, Pibarot P, Marette A, et al. Hypertriglyceridemic waist: a simple marker of high‐risk atherosclerosis features associated with excess visceral adiposity/ectopic fat. Journal of the American Heart Association 2018; 7(8):e008139.
  22. Lemieux I, Pascot A, Couillard C, Lamarche B, Tchernof A, Alméras N, et al. Hypertriglyceridemic waist: a marker of the atherogenic metabolic triad (hyperinsulinemia; hyperapolipoprotein B; small, dense LDL) in men?. Circulation 2000; 102(2):179-84.
  23. Ren Y, Zhang M, Zhao J, Wang C, Luo X, Zhang J, et al. Association of the hypertriglyceridemic waist phenotype and type 2 diabetes mellitus among adults in China. Journal of diabetes investigation 2016; 7(5):689-94.
  24. Samadi S, Bozorgmanesh M, Khalili D, Momenan A, Sheikholeslami F, Azizi F, et al. Hypertriglyceridemic waist: the point of divergence for prediction of CVD vs. mortality: Tehran Lipid and Glucose Study. International journal of cardiology 2013; 165(2):260-5.
  25. Carr DB, Utzschneider KM, Hull RL, Tong J, Wallace TM, Kodama K, et al. Gestational diabetes mellitus increases the risk of cardiovascular disease in women with a family history of type 2 diabetes. Diabetes care 2006; 29(9):2078-83.
  26. Xia C, Li R, Zhang S, Gong L, Ren W, Wang Z, et al. Lipid accumulation product is a powerful index for recognizing insulin resistance in non-diabetic individuals. European journal of clinical nutrition 2012; 66(9):1035-8.
  27. Setareh A, Mitra MG, Sedigheh B, Shoaleh S, Vahid Y, Siroos S. Maternal plasma lipid concentrations in first trimester of pregnancy and risk of severe pre-eclampsia. Pak J Med Sci 2009; 25(4):563-7.
  28. De J, Mukhopadhyay A, Saha PK. Study of serum lipid profile in pregnancy induced hypertension. Indian Journal of Clinical Biochemistry 2006; 21(2):165-8.
  29. Gunderson EP, Quesenberry Jr CP, Jacobs Jr DR, Feng J, Lewis CE, Sidney S. Longitudinal study of prepregnancy cardiometabolic risk factors and subsequent risk of gestational diabetes mellitus: the CARDIA study. American journal of epidemiology 2010; 172(10):1131-43.
  30. Nouhjah S, Shahbazian H, Shahbazian N, Jahanshahi A, Jahanfar S, Cheraghian B. Incidence and contributing factors of persistent hyperglycemia at 6–12 weeks postpartum in Iranian women with gestational diabetes: results from LAGA Cohort Study. Journal of diabetes research 2017; 2017.
  31. Nouhjah S, Shahbazian H, Jahanfar S, Shahbazian N, Jahanshahi A, Cheraghian B, et al. Early postpartum lipid profile in women with and without gestational diabetes mellitus: results of a prospective cohort study. Iran Red Crescent Med J 2017; 19.
  32. Zaman F, Nouhjah S, Shahbazian H, Shahbazian N, Latifi SM, Jahanshahi A. Risk factors of gestational diabetes mellitus using results of a prospective population-based study in Iranian pregnant women. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2018; 12(5):721-5.
  33. Rashidi H, Kalantari K, Shahbazian H, Nouhjah S. The relationship between fasting plasma glucose in the first trimester of pregnancy and the incidence of gestational diabetes in Iran. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2021; 15(4):102193.
  34. Gunderson EP, Matias SL, Hurston SR, Dewey KG, Ferrara A, Quesenberry CP, et al. Study of Women, Infant Feeding, and Type 2 diabetes mellitus after GDM pregnancy (SWIFT), a prospective cohort study: methodology and design. BMC Public Health 2011; 11(1):1-5.
  35. Derakhshan A, Sardarinia M, Khalili D, Momenan AA, Azizi F, Hadaegh F. Sex specific incidence rates of type 2 diabetes and its risk factors over 9 years of follow-up: Tehran Lipid and Glucose Study. PloS one 2014; 9(7):e102563.
  36. American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2020. Diabetes care 2020; 43(Supplement_1):S14-31.
  37. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Human kinetics books; 1988.
  38. Lemieux I, Poirier P, Bergeron J, Alméras N, Lamarche B, Cantin B, et al. Hypertriglyceridemic waist: a useful screening phenotype in preventive cardiology?. Canadian Journal of Cardiology 2007; 23:23B-31B.
  39. Bhavadharini B, Uma R, Saravanan P, Mohan V. Screening and diagnosis of gestational diabetes mellitus–relevance to low and middle income countries. Clinical diabetes and endocrinology 2016; 2(1):1-8.
  40. Yao D, Chang Q, Wu QJ, Gao SY, Zhao H, Liu YS, et al. Relationship between maternal central obesity and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of cohort studies. Journal of diabetes research 2020; 2020.
  41. Jia XJ, Wang JX, Bai LW, Hua TS, Han ZH, Lu Q. The relationship between hypertriglyceridemic waist circumference phenotype and gestational diabetes mellitus. Gynecological Endocrinology 2021; 37(4):328-31.
  42. ArjmandiFar M, Ziaei S. Relationship between Serum Lipids in 13-23 Weeks of Pregnancy and Abnormal Glucose Challenge Test. J Adv Med Biomed Res 2013; 21(86):65-75.
  43. Nolan CJ, Riley SF, Sheedy MT, Walstab JE, Beischer NA. Maternal serum triglyceride, glucose tolerance, and neonatal birth weight ratio in pregnancy: a study within a racially heterogeneous population. Diabetes care 1995; 18(12):1550-6.
  44. Montelongo A, Lasunción MA, Pallardo LF, Herrera E. Longitudinal study of plasma lipoproteins and hormones during pregnancy in normal and diabetic women. Diabetes 1992; 41(12):1651-9.
  45. Zheng T, Ye W, Wang X, Li X, Zhang J, Little J, et al. A simple model to predict risk of gestational diabetes mellitus from 8 to 20 weeks of gestation in Chinese women. BMC pregnancy and childbirth 2019; 19(1):1-10.
  46. Padmapriya N, Bernard JY, Liang S, Loy SL, Cai S, Zhe IS, et al. Associations of physical activity and sedentary behavior during pregnancy with gestational diabetes mellitus among Asian women in Singapore. BMC pregnancy and childbirth 2017; 17(1):364.
  47. Maged AM, Moety GA, Mostafa WA, Hamed DA. Comparative study between different biomarkers for early prediction of gestational diabetes mellitus. The Journal of Maternal-Fetal & Neonatal Medicine 2014; 27(11):1108-12.
  48. Wang J, Lv B, Chen X, Pan Y, Chen K, Zhang Y, et al. An early model to predict the risk of gestational diabetes mellitus in the absence of blood examination indexes: application in primary health care centres. BMC Pregnancy and Childbirth 2021; 21(1):1-8.
  49. Farrar D, Simmonds M, Griffin S, Duarte A, Lawlor DA, Sculpher M, et al. The identification and treatment of women with hyperglycaemia in pregnancy: an analysis of individual participant data, systematic reviews, meta-analyses and an economic evaluation. Health technology assessment 2016; 20(86):1-348.
  50. Shahriari A, Khooshideh M, Shahriari M. Validity of Hemoglobin A1C before 20 weeks of gestation for prediction of gestational diabetes mellitus. Iran J Obstet Gynecol Infertil 2020; 23(10):1-8.
  51. Amini S, Jafarirad S, Mohseni H, Ehsani H, Hejazi L, Feghhi N. Comparison of food intake and body mass index before pregnancy between women with spontaneous abortion and women with successful pregnancy. Iran J Obstet Gynecol Infertil 2017; 20(10):35-42.
  52. Amini S, Mohseni H, Kalantar M, Amani R. Nutrition in caring for pregnant women during the COVID-19 pandemic in low-income countries. Nutrition Today 2021; 56(2):80-4.
مجله زنان، مامایی و نازایی ایران
دوره 26، شماره 1
فروردین 1402
صفحه 28-39

فایل ها

هم رسانی

ارجاع به این مقاله

آمار