| Objective To investigate the prevalence of prediabetes and type 2 diabetes mellitus（T2DM）,and cumulative incidence rate during 3.3 years of follow-up in 40 to75 year old women in Lanzhou area.To explore the relationship between reproductive factors（gestation,parturition,abortion,lactation,menarche age,menopause age and reproductive age）and the risk of prediabetes and T2 DM in women.Methods Based on some data from the " REACTION " study in Lanzhou,a random cluster sampling survey was carried out in May 2011 to investigate the epidemiology of residents aged 40 to 75 in tianqingjiayuan community,Zhangguang community and Wuquanshan community in Lanzhou.A follow-up survey was carried out from 2014 to 2016.A total of 5804 women bring into this study.Reproductive history and menstrual history were determined by questionnaire.The study population was divided into normal glucose tolerance group,impaired glucose regulation group and T2 DM group according to different glucose metabolism status.The general clinical characteristics were analyzed and the differences of reproductive related factors such as gestation,parturition and menarche age in different glucose metabolism groups were compared.Logistic regression analysis be applied to explore the correlation between reproductive factors（such as gestation,parturition,menarche age）and the risk of T2 DM in women.Median follow-up 3.3 years after,COX risk regression model be applied to explore the relevance between reproductive related factors and the risk of IGR and T2 DM in NGT population,as well as the risk of T2 DM in IGR population.Results（1）At baseline,the prevalence of IGR was 28.7%（1666/5804）and T2DM was 20.2%（1175/5804）.Gestation and parturition were positively correlated with FPG and2h-PG,and lactation was negatively correlated with FPG and 2h-PG（P<0.05）;However,abortion,menarche age,menopause age and reproductive age were not correlated with FPG and 2h-PG;The prevalence of T2DM in women increased with the increase of gestation and parturition.Especially when the number of pregnancies exceeded 3 and the number of parities reached 3,the risk of T2DM in women increased by 1.6 times,especially when the number of parities reached 4,the risk of T2DM increased by 2 times（P<0.05）;The risk of T2DM in lactating women was 30%lower than that in non lactating women;Estrogen related indexes（menarche age,menopause age,reproductive age）had no correlation with the risk of T2DM in women,and abortion did not affect the risk of T2DM in women（P>0.05）.（2）Follow up NGT the cumulative incidence rate of IGR was 26%（769/2963）.The incidence of IGR increased with the increase of gestation and parturition times.Compared with the gestation and parturition less then 1,the incidence rate of IGR increased significantly when the gestation and parturition times exceeded 2.Especially the incidence of gestation was more prominent（gestation: 22.6%,23.9%,26.8%,30%,parturition: 21.8%,30.9%,34.8%,34.8%,P < 0.05）.Compared with the number of pregnancies and parities less than 1,the risk of IGR increased with the increase of the number of pregnancies and parities.When the number of pregnancies and parities exceeded 3,the risk increased by 1.5 times（gestation:HR = 1.45,95% CI:1.11-1.71,P= 0.010;parturition:HR = 1.50,95% CI:1.09-1.83,P = 0.005）;Despite there was no correlation in the incidence of IGR among menarche age,menopausal age and reproductive age,we found that the age of menarche was too late and the incidence rate of IGR was higher（P > 0.05）.There was no correlation between abortion and the risk of IGR（P > 0.05）;The incidence rate of IGR in lactating women was significantly lower（25.6%Vs27.5%）,and lactation reduced the risk of IGR by about 30%（HR=0.72,95%CI:0.46-0.98,P=0.002）.Abortion,menarche age,menopause age and reproductive age did not affect the risk of IGR in NGT women（P > 0.05）.（3）Follow up NGT the cumulative incidence rate of T2DM in females was 7%（208/2963）.With the increase of gestation and parturition times,the cumulative incidence rate of T2DM increased significantly（gestation:5.5%,5.6%,7.1%,9.9%;parturition:5.7%,7.6%,11.1%,13.1%,P<0.05）.The cumulative incidence rate of T2DM in lactating women was significantly lower than that in non lactating women（6.8%Vs8.0%,P<0.05）.There was no significant difference in cumulative incidence rate of T2DM among women with menarche age,menopause age,reproductive age and abortion.（P>0.05）.The incidence risk of T2DM increased significantly in women with higher gestation and parturition times.Especially when the gestation and parturition times were more than 3 times,the incidence risk of T2DM increased by 1.6times compared with less then 1,and the impact of parturition times on female T2DM was more obvious（gestation:HR=1.60,95%CI:1.01-2.45,P=0.000;parturition:HR=1.65,95%CI:1.11-2.43,P=0.005）.Lactation is a better protective factor for female T2DM.The risk of T2DM in lactating women is reduced by 30%（HR=0.70,95%CI:0.46-0.96,P=0.001）.Abortion did not affect the incidence of female T2DM,and the cumulative level of estrogen（menarche age,menopause age,reproductive age）was not correlated with female T2DM.（4）Follow up IGR the cumulative incidence rate of T2 DM was 9.8%（163/1666）,and there was no significant difference in incidence rate of T2 DM among IGR women among different gestation times and other reproductive factors.Reproductive factors such as gestation,parturition times and menarche age were not risk factors for T2 DM progression in IGR population（P > 0.05）.Conclusions（1）The prevalence and cumulative incidence rate of IGR and T2 DM in Lanzhou women are higher.The number of pregnancies and parities are the risk factors of IGR and T2 DM in women.With the increase of the number of pregnancies and parities,the risk of T2 DM increases significantly;Lactation is the protective factor of female IGR and T2 DM,which can reduce the risk of female T2 DM.（2）Whether gestation,parturition,abortion,lactation,or estrogen related indicators（menarche age,menopausal age,reproductive age）,are not risk factors for IGR women to develop T2 DM. |
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