A Prospective Study On The Relationship Between Women’s Health Behavior Patterns In The First Trimester And The Risk Of Gestational Diabetes Mellitus Based On The Latent Class Analysis

ObjectiveIdentifying the health behavior patterns of women in the first trimester by latent class analysis,and exploring the association between different health behavior patterns of women in the first trimester and the risk of gestational diabetes mellitus(GDM).MethodsUsing an epidemiological prospective cohort study,women in the first trimester of pregnancy who were registered in the obstetrics clinic of a hospital in Shenzhen from October 2021 to October 2022 were included as research objects.The sociodemographic data,clinical data and health behavior data were followed up until 24-28 weeks of pregnancy to obtain the OGTT results of the subjects.Latent class analysis(LCA)was used to identify the health behavior patterns of women in the first trimester.The Cox proportional hazards regression model was used to analyze the association between different health behavior patterns of women in the first trimester and GDM.Results1.Based on the nine health behaviors of women in the first trimester,there are four health behavior patterns identified by LCA in women in the first trimester,including the "behavioral health"(81.3%),the "lack of activity and social participation and poor eating habits"(10.8%),the "low sleep quality and poor psychological adjustment"(3.4%),and the "alcohol tobacco exposure and irregular folate intake"(4.5%).2.The four health behavior patterns of women in the first trimester were used as the dependent variables,and the statistically significant sociodemographic data and clinical data in the univariate analysis were used as the independent variables.The "behavioral health" as the reference group,a multinomial logistic regression analysis was performed.This study found that age > 30 years old(OR=0.33,95%CI: 0.18 ～ 0.59),urban household registration(OR=0.62,95%CI: 0.41 ～ 0.92),non-migrant population(OR=0.62,95%CI: 0.42 ～ 0.94),spouse with a bachelor’s degree or above(OR=0.54,95%CI: 0.32 ～ 0.79),monthly family income≥40,000(OR=0.33,95%CI: 0.13 ～ 0.78),scientific and educational personnel(OR=0.32,95%CI: 0.11 ～ 0.53)and pregnant women 2 pregnant(OR=0.58,95%CI: 0.37 ～ 0.78)reduced risk of belonging to the "lack of activity and social participation and poor eating habits" pattern.Pregnant women who are married(OR=0.30,95%CI: 0.13 ～ 0.42),have a bachelor’s degree or above(OR=0.26,95%CI: 0.11 ～ 0.42)were less likely to belong to the "low sleep quality and poor psychological adjustment".Pregnant women whose occupation type is business(OR=0.39,95%CI: 0.18 ～ 0.58)were less likely to belong to the "alcohol and tobacco exposure and irregular folic acid intake"(P<0.05).3.The incidence rate of GDM was 20.94% in this study.In terms of sociodemographic factors,27.50% of pregnant women aged > 30 years of age developed GDM,and 73.20% of pregnant women whose pre-pregnancy BMI was overweight and obese developed GDM;in terms of health behaviors,the incidence of GDM among pregnant women whose physical activity did not meet the standard was 21.52%,the incidence of GDM in pregnant women with bad eating habits was 23.39%(P<0.05).4.The four health behavior patterns of women in the first trimester as independent variables,GDM,fasting blood glucose before OGTT,OGTT1 h blood glucose and OGTT 2h blood glucose as dependent variables,the variables with statistical significance in the results of GDM univariate analysis(age,pre-pregnancy BMI)as covariates,and the gestational week at which GDM was diagnosed as the survival time,the Cox proportional hazards regression model was used for analysis.This study found that women with the "lack of activity and social participation and poor eating habits" in the first trimester had a 1.83-fold increased risk of GDM and a2.88-fold increased risk of fasting blood glucose before OGTT ≥ 5.1mmol/l in the second trimester;after adjusting for covariates,compared with the "behavioral health",the risk of GDM in pregnant women with "lack of activity and social participation and poor eating habits" increased by 1.89 times,and the risk of fasting blood glucose before OGTT ≥5.1mmol/l in the second trimester increased by 3.07 times(P<0.05).5.Based on different age subgroups and pre-pregnancy BMI subgroups,the analysis of women’s health behavior patterns found that only pregnant women age >30 years old and pre-pregnancy BMI within the normal range had the “relatively healthy behavior”.The Cox proportional hazards regression model found that,the risk of fasting blood glucose ≥5.1mmol/L in early pregnancy women aged 25-30 with the “lack of activity and social participation and poor eating habits” increased by 1.30 times,and pre-pregnancy BMI was among overweight and obesity and the risk of fasting blood glucose ≥5.1mmol/L in early pregnancy women with the“alcohol and tobacco exposure and irregular folic acid intake” increased by about 6 times(P<0.05).ConclusionPregnant women mainly have four different health behavior patterns in the first trimester,among which the "lack of activity and social participation and poor eating habits" has a significant correlation with GDM.Precise intervention strategies should be implemented according to the health behavior patterns of pregnant women to achieve early prevention and early treatment,so as to improve the management efficiency of pregnancy complications and reduce the medical burden on the country and families.