Abstract:

Background　China is the country with the highest prevalence of diabetes in the world.Therefore，it is necessary to explore the risk factors of diabetes.So far，no agreement has been reached on whether parity（number of live births） has a relationship with the incidence of diabetes in women or not.Objective　To explore the influence of parity on the risk of type 2 diabetes in women，providing fertility counseling for women of childbearing age.Methods　This study was conducted in 1 815 nondiabetic women aged ≥40 who met the criteria of this study.They were recruited from those who participated in the epidemiological survey of cancer risk in Chinese patients with type 2 diabetes mellitus in Luzhou，Sichuan from April to November 2011.According to self-reported parity，they were divided into 1-birth group（n=1 115），2-birth group（n=403），3-birth group（n=173），and 4 or more births group（n=124）．All groups received a follow-up from June to November 2016，during which the blood glucose levels were recorded and compared.Logistic regression analysis was used to explore the relationship of parity with type 2 diabetes.Results　Compared with baseline，during the follow-up period，all participants showed no significant changes in fasting plasma glucose（FPG） levels（P>0.05）；1-birth and 2-birth groups demonstrated lower 2-hour plasma glucose（2 hPG） levels after an oral glucose tolerance test（OGTT），but other two groups presented higher 2 hPG levels after OGTT（P<0.05）．The rates of developing type 2 diabetes in all the participants，1-birth group，2-birth group，3-birth group，and 4 or more births group were 9.15%（166/1 815），6.64%（74/1 115），9.68%（39/403），19.65%（34/173），and 15.32%（19/124），respectively.The 3-birth group showed a higher rate of developing type 2 diabetes compared with 1-birth group，and 2-birth group（P<0.05）．And the 4 or more births group presented a higher rate of developing type 2 diabetes than 1-birth group（P<0.05）．Multivariate Logistic regression analysis showed that compared with women having 1 birth，the risk of developing type 2 diabetes was almost the same in those having 2 births〔OR（95%CI）=1.216（0.797，1.856）〕，but it was 2.355 times in those having 3 births〔95%CI（1.474，3.761）〕，and was 1.860 times in those having 4 or more births〔95%CI（1.058，3.270）〕.Conclusion　Multi-parity may increase the risk of type 2 diabetes in women.To prophylactically reduce this risk，it is recommended that women have one or two children.

Key words:
Diabetes mellitus, Parity, Correlation, Prospective studies

摘要： 背景　我国是世界上糖尿病患病率最高的国家，探讨糖尿病发病的危险因素十分必要，但目前关于生育子女数量与糖尿病发病风险之间关系的研究尚存在争议。目的　探讨女性生育子女数量对糖尿病发病风险的影响，从而为育龄女性计划生育胎数提供参考依据。方法　从2011年4—11月参与“四川泸州地区2型糖尿病患者肿瘤发生风险的流行病学调查”的受试者中，筛选出符合本研究标准的≥40岁非糖尿病女性受试者1 815例。根据受试者自我报告的生育子女数量（活产总数），将其分为1胎组（n=1 115）、2胎组（n=403）、3胎组（n=173）、≥4胎组（n=124）。于2016年6—11月开展随访，比较4组受试者的血糖情况，采用Logistic回归分析探讨生育子女数量对受试者转变为糖尿病的影响。结果　5年后随访时，受试者的空腹血糖（FPG）与基线时无差异（P>0.05）；1胎组、2胎组的口服葡萄糖耐量试验2 h血糖（OGTT 2 hPG）低于基线时，3胎组、≥4胎组的OGTT 2 hPG高于基线时（P<0.05）。1 815例受试者共166例（9.15%）转变为糖尿病，4组受试者转变为糖尿病的比例分别为6.64%（74/1 115）、9.68%（39/403）、19.65%（34/173）、15.32%（19/124），3胎组高于1胎组、2胎组，≥4胎组高于1胎组（P<0.05）。多因素Logistic回归分析结果显示，生育2胎者转变为糖尿病的风险与生育1胎者无差异〔OR（95%CI）=1.216（0.797，1.856）〕，生育3胎者转变为糖尿病的风险是生育1胎者的2.355倍〔95%CI（1.474，3.761）〕，生育4胎者转变为糖尿病的风险是生育1胎者的1.860倍〔95%CI（1.058，3.270）〕。结论　多次分娩可能会增加女性的糖尿病发病风险，建议的女性生育子女数量为1~2胎，以预防性降低糖尿病的发病风险。

关键词: 糖尿病, 产次, 相关性, 前瞻性研究