孕前含糖饮料消费与妊娠期糖尿病风险的前瞻性队列研究
Prospective cohort study of pre-pregnancy sugar-sweetened beverage consumption and risk of gestational diabetes mellitus
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摘要:
背景 目前我国关于含糖饮料（SSB）消费与妊娠期糖尿病（GDM）关联的研究证据较为缺乏。
目的 探讨陕西省孕妇怀孕前SSB消费频率与GDM发生风险的关联，为采取控制孕妇血糖的针对性干预措施提供一定的科学依据。
方法 依托中国宝贝健康出生队列，招募2020年10月开始在陕西省5家医院首次参加产检的6~16周孕妇为研究对象。根据孕妇健康调查问卷收集其基本信息。采用半定量食物频率问卷收集孕妇怀孕前一年的碳酸饮料、果蔬汁饮料、咖啡饮料和奶茶饮料的消费频率，相加得到SSB消费频率。按照SSB消费频率将孕妇分为3组，分别为<1份·周−1、1~4份·周−1和≥5份·周−1。通过在孕24—28周进行的口服葡萄糖耐量试验（OGTT）确认孕妇是否患GDM。采用二元logistic回归模型探究SSB消费与GDM发生风险之间的关联；采用多元线性回归分析SSB消费（增加1份·d−1）与OGTT服用糖水前的空腹血糖和服用后1 h、2 h血糖的关系。
结果 共纳入孕妇3 811例，其中，752例孕妇发生GDM，发生率为19.7%。SSB消费频率为<1份·周−1、1~4份·周−1和≥5份·周−1的孕妇GDM发生率分别为18.0%、21.1%和26.8%。调整孕妇年龄、孕前体重指数（BMI）、受教育程度、生育孩子个数、糖尿病家族史、吸烟、饮酒、体力活动水平和总能量摄入后，与SSB消费频率为<1份·周−1组相比，消费频率为1~4份·周−1组和≥5份·周−1组的孕妇GDM发生风险分别增加26%（OR=1.26，95%CI：1.05~1.50）和76%（OR=1.76，95%CI：1.31~2.38）。进一步分层分析发现，SSB消费与孕妇年龄、孕前BMI和是否生育过孩子等因素均无交互效应（
P 交互>0.05）。增加1份·d−1的SSB消费，GDM发生风险会增加94%（OR=1.94，95%CI：1.37~2.75），孕妇OGTT服用糖水后1 h和2 h血糖分别增加0.33 mmol·L−1和0.18 mmol·L−1（P <0.05），空腹血糖差异无统计学意义（P >0.05）。结论 怀孕前较高的SSB消费频率会增加孕妇GDM的发生风险。
Abstract:Background There is a lack of research evidence on the association between sugar-sweetened beverage (SSB) consumption and gestational diabetes mellitus (GDM) in China.
Objective To explore the association between frequency of SSB consumption before pregnancy and risk of GDM in pregnant women in Shaanxi Province, and to provide a scientific basis for targeted interventions to control maternal blood glucose.
Methods The recruitment to the China Birth Cohort study started in October 2020. Pregnant women at 6-16 weeks who had their first prenatal examination at five hospitals in Shaanxi Province were recruited. A maternal health questionnaire was used to collect basic information about pregnant women. A semi-quantitative food frequency questionnaire was used to collect the consumption of carbonated beverages, fruit and vegetable juice beverages, coffee beverages, and milk tea beverages in one year before pregnancy, which were summed to obtain the SSB consumption. Pregnant women were divided into three groups according to SSB consumption, namely <1 serving·week−1, 1-4 servings·week−1, and ≥5 servings·week−1. GDM was confirmed by oral glucose tolerance test (OGTT) between 24-28 weeks of gestation. A binary logistic regression model was applied to explore the association between SSB consumption and risk of GDM. Multiple linear regression was applied to investigate the associations between SSB consumption (per 1-serving·d−1 increase) and OGTT fasting plasma glucose, 1-hour glucose, and 2-hour glucose.
Results A total of 3811 pregnant women were finally enrolled in this study, of which 752 developed GDM, with an incidence rate of 19.7%. The incidence rates of GDM in pregnant women with SSB consumption frequency of <1 serving·week−1, 1-4 servings·week−1, and ≥5 servings·week−1 were 18.0%, 21.1%, and 26.8%, respectively. After adjusting for maternal age, pre-pregnancy body mass index (BMI), education, number of children born, family history of diabetes, smoking, alcohol consumption, physical activity level, and total energy intake, the risk of GDM increased by 26% (OR=1.26, 95%CI: 1.05, 1.50) in the 1-4 servings·week−1 group and by 76% (OR=1.76, 95%CI: 1.31, 2.38) in the ≥5 servings·week−1 group compared to the <1 serving·week−1 SSB consumption group, respectively. Further stratified analysis revealed no interaction effect (
P interaction>0.05) between SSB consumption and maternal age, pre-pregnancy BMI, or first labor or not. For each additional SSB consumption per day, the risk of GDM increased by 94% (OR=1.94, 95%CI: 1.37, 2.75); and the maternal OGTT 1-hour glucose and 2-hour glucose increased by 0.33 mmol·L−1 and 0.18 mmol·L−1, respectively (P <0.05), and no significant increase in fasting plasma glucose was found (P >0.05).Conclusion Higher SSB consumption before pregnancy increases the risk of GDM in pregnant women.
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