PLoS Med：先兆子痫是糖尿病发病危险因素

　　加拿大一项研究表明，对于无妊娠期糖尿病（GDM）、有先兆子痫（PEC）和（或）妊娠期高血压（GH）的女性，在随访至产后16.5年时，其糖尿病发生风险增加了2倍。与仅有GDM者相比，同时患有GDM、PEC和（或）GH者的糖尿病发生风险显著增加。该论文4月16日在线发表于《公共科学图书馆·医学》（PLoS Med）杂志。

　　该回顾性研究纳入1994年4月至2008年3月期间在加拿大安大略省分娩的女性超过100万名。结果为，PEC组、GH组和对照组的糖尿病发病率分别为6.47/1000人-年、5.26/1000人-年、2.81/1000人-年。多变量分析显示，PEC[风险比（HR）=2.08]和GH（HR=1.95）均为发生糖尿病的危险因素。仅有GDM的女性分娩后发生糖尿病的风险增加；GDM+PEC组及GDM+GH组女性，分娩后发生糖尿病风险进一步增加。

与糖尿病相关的拓展阅读：

• Diabetes Care：ADA和ENDO发布低血糖和糖尿病共识报告
• FDA拟重新审议GSK糖尿病药物文迪雅的安全性
• Diabetes Res Clin Pract：台北双和医院林俊佃等发现第一时相胰岛素分泌是2型糖尿病的触发因素
• Diabetes Care：低碳饮食对妊娠期糖尿病无效
• J Med Life：1型糖尿病合并抑郁者转归较差 更多信息请点击：有关糖尿病更多资讯

Preeclampsia as a Risk Factor for Diabetes: A Population-Based Cohort Study
Background
Women with preeclampsia (PEC) and gestational hypertension (GH) exhibit insulin resistance during pregnancy, independent of obesity and glucose intolerance. Our aim was to determine whether women with PEC or GH during pregnancy have an increased risk of developing diabetes after pregnancy, and whether the presence of PEC/GH in addition to gestational diabetes (GDM) increases the risk of future (postpartum) diabetes.
Methods and Findings
We performed a population-based, retrospective cohort study for 1,010,068 pregnant women who delivered in Ontario, Canada between April 1994 and March 2008. Women were categorized as having PEC alone (n = 22,933), GH alone (n = 27,605), GDM alone (n = 30,852), GDM+PEC (n = 1,476), GDM+GH (n = 2,100), or none of these conditions (n = 925,102). Our main outcome was a new diagnosis of diabetes postpartum in the following years, up until March 2011, based on new records in the Ontario Diabetes Database. The incidence rate of diabetes per 1,000 person-years was 6.47 for women with PEC and 5.26 for GH compared with 2.81 in women with neither of these conditions. In the multivariable analysis, both PEC alone (hazard ratio [HR] = 2.08; 95% CI 1.97–2.19) and GH alone (HR = 1.95; 95% CI 1.83–2.07) were risk factors for subsequent diabetes. Women with GDM alone were at elevated risk of developing diabetes postpartum (HR = 12.77; 95% CI 12.44–13.10); however, the co–presence of PEC or GH in addition to GDM further elevated this risk (HR = 15.75; 95% CI 14.52–17.07, and HR = 18.49; 95% CI 17.12–19.96, respectively). Data on obesity were not available.
Conclusions
Women with PEC/GH have a 2-fold increased risk of developing diabetes when followed up to 16.5 years after pregnancy, even in the absence of GDM. The presence of PEC/GH in the setting of GDM also raised the risk of diabetes significantly beyond that seen with GDM alone. A history of PEC/GH during pregnancy should alert clinicians to the need for preventative counseling and more vigilant screening for diabetes.