母亲妊娠期血糖处于较高水平发展轨迹可能增加子女学龄前屈光不正的发生风险

Association between maternal fasting glucose levels throughout pregnancy and preschoolers' refractive errors

妊娠期母体血糖水平与学龄前儿童屈光不正的关联

Author：Yufan Guo, Jixing Zhou, Jingru Lu, Linlin Zhu, Xuemei Hao, Shuangqin Yan, Juan Tong, Shuman Tao, Shaojun Xu, Fangbiao Tao and Kun Huang

Sourse：Journal of clinical endocrinology and metabolism

DOI: 10.1210/clinem/dgae247

Abstract

Purpose: We aimed to investigate the association between maternal fasting plasma glucose (FPG) trajectories during pregnancy and children's refractive errors at 6 years old.

Design：Based on the Ma'anshan Birth Cohort (MABC) in China, a total of 1987 mother-child pairs were included in this study.

Methods: Using the group-based trajectory model, trajectory fitting was performed on fasting blood glucose levels during the first, second, and third trimesters of pregnancy. Children's vision was measured at 6 years of age using the standard logarithmic visual acuity E-chart and cycloplegic refraction examination. Logistic regression models and multi-informant generalized estimating equations were used to analyze the association between maternal blood glucose level and 6-year-old children's visual acuity.

Results: Children born of mothers with high level FPG trajectory had a higher risk of developing refractive error [OR=1.46 (95% CI 1.08 1.97)], hypermetropia [OR=1.64 (95% CI 1.09, 2.46)] and astigmatism [OR=1.60 (95% CI 1.06, 2.41)] at age six compared to those with low level trajectory. Maternal blood glucose level in the first [β=-0.012 (95% CI -0.024, -0.001)] and the second [β=-0.016 (95% CI -0.025, -0.006)] trimesters was associated with 6 year children's distance vision value.

Conclusions: High level of fasting plasma glucose trajectories during pregnancy has been observed to be associated with 6-year-old children's refractive error, hypermetropia and astigmatism. The first and the second trimesters may be critical periods for the effects of maternal blood glucose on children's vision. The long-term effect of maternal glucose metabolism on children's visual development deserves further study.

Keywords: Astigmatism, critical period, fasting plasma glucose trajectory, gestational glucose level, hypermetropia, refractive error

摘要

目的 

研究妊娠期母亲空腹血浆葡萄糖（FPG）轨迹与6岁儿童屈光不正的关联。

设计

本研究基于马鞍山优生优育队列（MABC），共纳入1987对母子对。

方法

基于组基轨迹模型，根据孕早期、孕中期和孕晚期母亲FPG水平拟合血糖轨迹。儿童6岁时使用标准对数视力表和睫状体麻痹屈光检查进行视力测量。运用Logistics回归模型和多重信息广义估计方程（GEEs）分析妊娠期母体血糖水平与6岁儿童视力之间的关联。

结果

妊娠期母亲FPG处于高轨迹组与6岁儿童的总体屈光不正（OR=1.46，95%CI：1.08~1.98）、远视（OR=1.64，95% CI：1.09~2.46）和散光（OR=1.60，95%CI：1.06~2.41）的风险更高相关。多信息GEEs的分析结果表明，孕早期（β=-0.012，95% CI：-0.023~ -0.001）和孕中期（β=-0.018，95%CI：-0.029~ -0.008）母亲血糖水平与6岁儿童远视力呈负相关。

结论

妊娠期母亲“高水平”水平轨迹与6岁儿童总体屈光不正、远视和散光的风险增加相关，孕早期和孕中期可能是作用关键期。母体血糖代谢对儿童视觉发育的长期影响值得进一步研究。