母親妊娠糖尿病與孩童青春期發育之相關性研究

Associations Between Maternal Gestational Diabetes and Pubertal Growth in Offspring

許文瑋(Wen-Wei Hsu)

指導教授 ： 陳保中

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2021年)

https://doi.org/10.6342/NTU202103156

摘要

研究目標
本研究欲探討罹患妊娠糖尿病(Gestational diabetes mellitus, GDM)的母親，其子代是否會較早進入青春期。
研究方法
本研究為一世代追蹤研究，於2010年至2012年收案，對象為此期間曾在台大醫院產檢之孕婦，藉由病歷回溯方式記錄其口服葡萄糖耐量試驗值以及是否有妊娠糖尿病之診斷。接著於2018年追蹤其子代之健康情形，排除多胞胎妊娠，共有484名孩童接受回訪，內容包括問卷、身體檢查及骨齡X光拍攝。主要觀察結果為骨齡與實際年齡之相差值，其他觀測值包括女童胸部發育、男童睪丸發育以及陰莖長度。統計方法為t檢定及卡方檢定，另多元迴歸分析對於母親初經年齡、家庭年收入、出生週數及孩童受訪年齡進行校正。
結果
484名受訪孩童中，有43名母親在懷孕時確診妊娠糖尿病，另441名為對照組。女童中，GDM組(n=19)及對照組(n=205)的骨齡與實際年齡平均差距無顯著差異(0.6 vs. 0.1年, p=0.141)，然而若以不同診斷標準做分組，在一階段診斷方法(75g口服葡萄糖耐量試驗)中，GDM組女童的骨齡有較超前(0.65 vs. 0.14年，p=0.033)，經過迴歸分析之後，GDM組女童的骨齡依然顯示較超前的發育(0.47年，95%信賴區間0.01-0.94年)。而胸部發育大於坦納氏第一期的比例，GDM組與對照組無顯著差異(10.5 vs. 7.8%, p=0.655)，在分層分析及多元羅吉斯迴歸之後亦無達到顯著差異。
GDM組男童(n=24) 與對照組(n=236)的骨齡與實際年齡平均差距無顯著差異(0 vs. 0.1年，p=0.751)，其睪丸大小(2.2 vs. 2.1 ml, p=0.520)及陰莖長度(35.9 vs.39.6 mm p=0.073)在兩組皆無顯著差異。根據不同的GDM診斷條件進行分組，或是多元迴歸分析的結果，男童在各種青春期發育指標上，兩組皆無顯著差異。
結論
相較於沒有妊娠糖尿病的婦女，曾患妊娠糖尿病的媽媽，其當次產下的女性子代在七至九歲時(青春期前期)骨齡會較超前約半年，但乳房的發育以及男性子代的青春期發展，在兩組間沒有顯著統計差異。

關鍵字

妊娠糖尿病 ； 口服葡萄糖耐量試驗 ； 性早熟 ； 骨齡 ； 坦納氏期

並列摘要

Objective
This study aims to determine the association of maternal gestational diabetes mellitus (GDM) and pubertal growth of offspring.
Methods
This is a prospective cohort study that enrolled 1,008 women who received antenatal care at National Taiwan University Hospital from 2010 to 2012. The diagnosis of gestational diabetes mellitus was determined by self-report and verified by chart review of oral glucose tolerance test result. In 2018, 484 children received follow-up questionnaire, physical examination, and bone age study. The primary outcome was the difference between bone age and chronological age. Secondary outcomes included Tanner stage for breast and testes, and the penile length for male offspring. Differences in the outcomes between offspring of mothers with gestational diabetes mellitus and control subjects were examined using Student’s t test, chi-square test. We also used multivariate linear and logistic regression models to adjust for maternal age at menarche, household income, gestational week at birth and offspring age at follow-up.
Results
There were 43 children born form GDM mother, and 441 in the control group. In girls, there was no statistical difference in the bone age advancement (0.6 vs. 0.1 year, p=0.141) in the GDM (n=19) and control group (n=205). In the subgroup analysis, GDM group showed more advanced bone age compared to control group (0.65 vs. 0.14 year, p=0.033) under one-step diagnostic criteria. After adjusting for potential confounding factors, the result still showed more advanced bone age in the GDM group (0.47 year, 95% CI=0.01-0.94 year). For breast development more than Tanner stage 1, both groups showed similar rate (10.5 vs. 7.8%, p=0.655).
For boys, the GDM group (n=24) showed no advancement in the bone age (0 vs. 0.1 year, p=0.751) compared with the control group (n=236). The testes size (2.2 vs. 2.1 ml, p=0.520) and penile length (35.9 vs.39.6 cm, p=0.073) also showed no statistical difference. At subgroup analysis according to the different GDM diagnostic criteria, the result also revealed no difference, nor was the multivariate linear regression.
Conclusion
Compared to the control group, girls with mothers diagnosed with GDM showed more advanced bone age at the age of 7~9 (mostly prepubertal stage). However, the Tanner stage of breast and the pubertal growth of boys were not statistically different in the two groups.

並列關鍵字

Gestational diabetes mellitus ； oral glucose tolerance test ； precocious puberty ； bone age ； Tanner stage

參考文獻

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