Circulation:妊娠期糖尿病或增加孕妇心脏病风险!

2021-02-09 MedSci原创 MedSci原创

妊娠期糖尿病或导致孕妇中年患心脏病

全世界17%~20%的女性怀孕时会出现糖尿病,妊娠糖尿病(GDM)只出现在怀孕期间,随着孕期结束病症通常会消失。但是大量临床数据显示,即使多数GDM患者糖代谢于产后恢复正常,但患者产后患2型糖尿病的风险大大升高,胎儿早产或流产几率增加,一般还会伴随其它并发症

近日,美国CARDIA(青壮年冠状动脉风险发展)研究团队在Circulation上发表题为Diabetes during pregnancy is tied to heart trouble later in life的研究论文。通过分析患者数据,研究小组发现妊娠期糖尿病会增加女性在中年罹患心脏病的风险

在本研究中,研究人员在25年内统计调查了来自多个地区的上千名参与者,这些女性都经历过至少一个孕期,研究人员在25年间对这些女性进行随访,同时观察记录了她们的冠状动脉钙化情况(CAC)。(CAC是一种血管硬化指标,可用于预示患心脏病的可能性)

1985-1986年至2010-2011年,实验流程图

在这些分娩过的女性中,有139名患有妊娠糖尿病,994名不患有该病。记录结果显示,前者即使产后血糖水平恢复正常,但仍大约有1/4的患者产生并发症(34人),后者后期发生冠状动脉钙化的比例则只有15%149人)。

患病组(妊娠期糖尿病)与对照组女性发生管状动脉钙化的比例

研究结果表明妊娠糖尿病与心脏病风险之间存在关联,但尚未证明两者之间存在明确的因果关系。研究人员表示,妊娠期糖尿病可能会导致血管发生变化,通过胰岛素抵抗、胰岛素分泌受损等各种机制促进动脉粥样硬化斑块形成,从而导致心血管疾病。

来自亚利桑那大学医学院图森分校的心脏病专家Khadijah Breathett指出:尽管这种疾病关联性令人沮丧,但是大多数妊娠糖尿病妇女并未发展为冠状动脉钙化,这一点十分令人宽慰。

患病组(妊娠期糖尿病)与对照组女性不发生管状动脉钙化的概率

总而言之,妊娠期糖尿病患者产生心脏病的概率比未患病者大得多,对母婴的影响都极为深远,所以在孕期控制血糖尤为重要,患过妊娠糖尿病的女性应在产后更加关注自己的心脏健康

原始出处:

E.P. Gunderson et al. Gestational diabetes history and glucose tolerance after pregnancy associated with coronary artery calcium in women during midlife. The CARDIA Study. Circulation. Published online February 1, 2021. doi: 10.1161/CIRCULATIONAHA.120.047320

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