【作者】 李慧；

【导师】 王友洁；

【作者基本信息】 华中科技大学 ， 流行病与卫生统计学， 2018， 硕士

【摘要】 第一部分月经初潮年龄与妊娠期糖尿病的相关性研究目的:妊娠期糖尿病对母亲和子代的健康造成短期和长期的不利影响。已有研究发现月经初潮年龄较早与2型糖尿病的风险相关,但与妊娠期糖尿病关系的研究却很少,且局限于西方国家。本研究旨在探讨在中国人群中月经初潮年龄与妊娠期糖尿病风险的关系。方法:研究对象来源于武汉健康宝贝出生队列研究。本次分析排除有孕前糖尿病史的孕妇6人和月经初潮年龄信息缺失的孕妇163人,最终共纳入11142名孕妇作为研究对象。通过面对面的问卷调查收集孕妇的基本情况和行为与生活方式的资料;查阅孕妇保健手册和病历记录收集妊娠和分娩的信息。月经初潮年龄的信息是通过问卷调查获得,根据月经初潮年龄将研究对象分5个年龄组(≤11岁、12岁、13岁、14岁、以及≥15岁)。妊娠期糖尿病的信息来自病历记录。统计分析采用SAS 9.4软件。妊娠期糖尿病组和非妊娠期糖尿病组间的计量资料差异比较用t检验,计数资料差异比较用χ2检验。控制可能的混杂因素(年龄、文化程度、工作状态、孕前饮酒、孕前吸烟、孕期被动吸烟、孕期体育锻炼、产次、妊娠期高血压疾病、以及孕前BMI),采用logistic回归分析分别计算月经初潮年龄与妊娠期糖尿病关系的比值比(odds ratio,OR)和95%可信区间(confidence interval,CI)。按照分娩年龄(<28岁或≥28岁)、孕前BMI(<24kg/m~2或≥24kg/m~2)、文化程度(高中及以下或大学及以上)、产次(初产或经产)、以及妊娠期高血压疾病(是或否)进行分层分析,并采用Wald检验计算交互作用。结果:共有11142名孕妇纳入本研究,905(8.1%)名孕妇患有妊娠期糖尿病。研究对象的平均月经初潮年龄为13.2±1.2岁,平均分娩年龄为28.2±3.7岁。在调整可能的混杂因素后,月经初潮年龄为≤11岁、12岁、13岁、14岁、以及≥15岁组的孕妇其妊娠期糖尿病的患病率(95%CI)分别为10.7%(95%CI:8.3%~13.0%)、8.4%(95%CI:7.3%~9.4%)、7.6%(95%CI:6.8%~8.4%)、7.5%(95%CI:6.5%~8.6%)、以及9.1%(95%CI:7.5%~10.7%)。多因素logistic回归分析的结果显示,月经初潮年龄较早(≤11岁)的孕妇其妊娠期糖尿病的患病风险是月经初潮年龄为13岁的孕妇的1.47倍(OR=1.47,95%CI:1.10~1.95)。分层分析的结果显示,月经初潮年龄与分娩年龄对妊娠期糖尿病的患病风险有交互作用(P=0.044),即月经初潮年龄较早与妊娠期糖尿病的关系在分娩年龄<28岁组中(OR=2.15,95%CI:1.30~3.56)较在分娩年龄≥28岁组中更显著(OR=1.25,95%CI:0.89~1.77)。结论:本研究的结果表明月经初潮年龄较早是妊娠糖尿病的危险因素,提示应该将月经初潮年龄较早的孕妇作为高危人群重点监测,并采取早期的干预措施,以期降低妊娠糖尿病的发生。第二部分月经初潮年龄与妊娠期高血压疾病的相关性研究目的:妊娠期高血压疾病是导致孕产妇死亡的主要原因。月经初潮年龄较早与非孕期妇女高血压疾病风险的关系尚存在争议,但与妊娠期高血压疾病的关系还未有报道。本研究旨在探讨在中国人群中月经初潮年龄对妊娠期高血压疾病风险的影响。方法:基于武汉健康宝贝出生队列研究的数据,本研究排除月经初潮年龄信息缺失的孕妇163人,纳入11148名孕妇作为研究对象。通过面对面的问卷调查收集孕妇的基本情况和行为与生活方式的资料;查阅孕妇保健手册和病历记录收集妊娠和分娩的信息。月经初潮年龄的信息来自问卷调查,依据月经初潮年龄将研究对象分为5个年龄组(≤11岁、12岁、13岁、14岁、以及≥15岁)。妊娠期高血压疾病的信息来自病历记录。统计分析采用SAS 9.4软件。妊娠期高血压疾病组和非妊娠期高血压疾病组间的计量资料差异比较用t检验,计数资料差异比较用χ2检验。控制可能的混杂因素(年龄、文化程度、工作状态、孕前饮酒、孕前吸烟、孕期被动吸烟、孕期体育锻炼、产次、妊娠期糖尿病、以及孕前BMI),采用logistic回归分析分别计算月经初潮年龄与妊娠期高血压疾病关系的比值比(odds ratio,OR)和95%可信区间(confidence interval,CI)。按照分娩年龄(<28岁或≥28岁)、孕前BMI(<24kg/m2或≥24kg/m2)、文化程度(高中及以下或大学及以上)、产次(初产或经产)、以及妊娠期糖尿病(是或否)进行分层分析,并采用Wald检验计算交互作用。结果:在纳入的11148名孕妇中,355(3.2%)名孕妇患有妊娠期高血压疾病。研究对象的平均月经初潮年龄为13.2±1.2岁,平均分娩年龄为28.2±3.7岁。在控制可能的混杂因素后,月经初潮年龄为≤11岁、12岁、13岁、14岁、以及≥15岁组的孕妇其妊娠期高血压疾病的患病率(95%CI)分别为3.1%(95%CI:1.8%~4.3%)、3.0%(95%CI:2.4%~3.6%)、3.3%(95%CI:2.8%~3.9%)、3.4%(95%CI:2.7%~4.2%)、以及2.4%(95%CI:1.5%~3.3%)。多因素logistic回归分析的结果显示,与月经初潮年龄为13岁相比,月经初潮年龄较早(≤11岁)与妊娠期高血压疾病的患病风险无统计学关联(OR=0.92,95%CI:0.58~1.47)。分层分析的结果显示,月经初潮年龄与分娩年龄、孕前BMI、文化程度、产次、以及妊娠糖尿病对妊娠期高血压疾病的风险没有交互作用(P>0.05)。结论:本研究的结果表明月经初潮年龄较早与妊娠期高血压疾病的关系不存在统计学关联,但鉴于存在的研究缺陷,可能导致出现阴性结果,需要更多的人群研究来阐明这两者之间的关系。更多还原

【Abstract】 Part 1 Association between age at menarche and risk of gestational diabetes mellitus Objective:Gestational diabetes mellitus has adverse short-and long-term influence on both maternal and neonatal health.Early menarche has been reported to be associated with an increased risk of type 2 diabetes,but little is known about the association of age at menarche with risk of gestational diabetes mellitus.The aim of this study was to examine the association between age at menarche and risk of gestational diabetes mellitus among Chinese women.Methods:Data were from the Wuhan Healthy Baby Cohort study.For the present analysis,the women excluded were those with a history of diabetes(n=6),and no available information on age at menarche(n=163),leaving 11142 pregnant women for inclusion in the final analysis.Data were collected from face-to-face interviews,maternity health handbook or medical records.Self-reported age at menarche were categorized into five age groups(≤11,12,13,14,and≥15 years).Information on gestational diabetes mellitus was obtained from medical records.All analyses were performed using SAS version 9.4 software.Numerical variables were compared using t test,and categorical variables were compared usingχ2test.Logistic regression models were used to estimate the odds ratio(OR)and 95%confidence interval(CI)for the association between age at menarche and gestational diabetes mellitus.Covariates for the adjusted models included age at delivery,level of education,employment status,alcohol consumption before pregnancy,smoking before pregnancy,passive smoking during pregnancy,physical activity during pregnancy,parity,hypertensive disorders of pregnancy,and pre-pregnancy BMI.Subgroup analyses were stratified by age at delivery(<28 or≥28 years),pre-pregnancy BMI(<24kg/m~2 or≥24kg/m~2),level of education(high school or below,college or above),parity(primiparous or multiparous),and hypertensive disorders of pregnancy(yes or no).The tests for interaction across subgroup were performed using Wald test.Results:Of the 11142 pregnant women,905(8.1%)were diagnosed with gestational diabetes mellitus.The mean age at menarche was 13.1±1.2 years,and the mean age at delivery was 28.2±3.7 years.The adjusted prevalence of gestational diabetes mellitus for menarche at ages≤11,12,13,14,and≥15 years were 10.7%(95%CI:8.3%~13.0%),8.4%(95%CI:7.3%~9.4%),7.6%(95%CI:6.8%~8.4%),7.5%(95%CI:6.5%~8.6%),and 9.1%(95%CI:7.5%~10.7%),respectively.Logistic regression analysis showed that compared with menarche at age 13 years,early menarche(≤11 years)was associated with an increased risk of gestational diabetes mellitus after adjusting for potential confounders(OR=1.47,95%CI:1.10~1.95).Subgroup analyses showed that the association between age at menarche and risk of gestational diabetes mellitus was more pronounced among women<28 years of age than women≥28 years of age(OR=2.15,95%CI:1.30~3.56 vs.OR=1.25,95%CI:0.89~1.77;P for interaction=0.044).Conclusions:Our findings suggested that early menarche was a risk factor for gestational diabetes mellitus.This findings could help obstetricians and midwives to identify women at higher risk of gestational diabetes mellitus.These women would benefit from early preventative strategiesPart 2 Association between age at menarche and risk of hypertensive disorders of pregnancyObjective: Hypertensive disorders of pregnancy is one of the leading cause of maternal mortality.Early menarche has been reported to be associated with hypertension in non-pregnant women with controversial finding,but evidence of its association with hypertensive disorders of pregnancy is lacking.The aim of this study was to examine the association of age at menarche with risk of hypertensive disorders of pregnancy among Chinese women.Methods: Data were from the Wuhan Healthy Baby Cohort study.For the present analysis,the women excluded were those with no available information on age at menarche(n=163),leaving 11148 pregnant women for inclusion in the final analysis.Data were collected from face-to-face interviews,maternity health handbook or medical records.Self-reported age at menarche were categorized into five age groups(≤11,12,13,14,and ≥15 years).Information on hypertensive disorders of pregnancy was obtained from medical records.All analyses were performed using SAS version 9.4 software.Numerical variables were compared using t test,and categorical variables were compared using χ2 test.Logistic regression models were used to estimate the odds ratio(OR)and 95% confidence interval(CI)for the association between age at menarche and hypertensive disorders of pregnancy.Covariates for the adjusted models included age at delivery,level of education,employment status,alcohol consumption before pregnancy,smoking before pregnancy,passive smoking during pregnancy,physical activity during pregnancy,parity,gestational diabetes mellitus,and pre-pregnancy BMI.Subgroup analyses were stratified by age at delivery(<28 or ≥28 years),pre-pregnancy BMI(<24kg/m2 or ≥24kg/m2),level of education(high school or below,college or above),parity(primiparous or multiparous),and gestational diabetes mellitus(yes or no).The tests for interaction across subgroup were performed using Wald test.Results: Of the 11148 pregnant women,355(3.2%)were diagnosed with hypertensive disorders of pregnancy.The mean age at menarche was 13.1±1.2 years,and the mean age at delivery was 28.2±3.7 years.The adjusted prevalence of hypertensive disorders of pregnancy for menarche at ages ≤11,12,13,14,and ≥15 years were 3.1%(95%CI:1.8%~4.3%),3.0%(95%CI:2.4%~3.6%),3.3%(95%CI:2.8% ~ 3.9%),3.4%(95%CI : 2.7% ~ 4.2%),and 2.4%(95%CI : 1.5% ~ 3.3%),respectively.Logistic regression analysis showed that compared with menarche at age13 years,early menarche(≤11 years)was not associated with risk of hypertensive disorders of pregnancy after adjusting for potential confounders(OR=0.92,95%CI: 0.58~1.47).Subgroup analyses showed that there were on interactions between age at menarche and age at delivery,pre-pregnancy BMI,level of education,parity,or gestational diabetes mellitus on risk of hypertensive disorders of pregnancyConclusions: The finding of our study suggested that early menarche was not associated with risk of hypertensive disorders of pregnancy.However,due to the existence of research limitations,and further population studies are needed to clarify the relationship between them.更多还原