妊娠糖尿病的影响因素及围产期结局

The influencing factors and perinatal outcomes of gestational diabetes

目的分析妊娠糖尿病(gestational diabetes mellitus,GDM)的相关危险因素,并探讨GDM的围产期结局。方法本研究数据来源于中国孕产妇队列研究协和项目,共纳入孕妇3874例,根据75 g口服葡萄糖耐量试验结果,分为GDM组(494例)和正常组(3380例)。收集各组母婴的临床资料、围产结局和新生儿结局,并采用χ^(2)检验、秩和检验、Fisher确切概率法、单因素logistic回归分析模型和多因素logistic回归分析模型分析GDM发病的相关危险因素。结果GDM组早产、胎膜早破及大于胎龄儿的发生率大于正常组,差异均有统计学意义(均有P<0.05)。logistic回归分析模型分析结果显示:随着年龄的增加,发生GDM的风险也逐渐增加;南方地区(OR=1.719,95%CI:1.401~2.109,P<0.001)、孕期增重不足(OR=1.485,95%CI:1.164~1.893,P=0.001)及孕前超重(OR=1.634,95%CI:1.241~2.151,P<0.001)也是GDM发病的独立危险因素。结论高龄、南方地区、孕前超重及孕期增重不足是GDM的影响因素,应尽早识别相关危险因素并积极干预,从而降低不良妊娠结局的发生,改善母婴健康状况。

Objective To analyze the risk factors of gestational diabetes mellitus(GDM)and to explore the perinatal outcomes of GDM.Methods Data were derived from the Chinese Pregnant Women Cohort Study,and 3874 pregnant women were included.According to the results of 75 g oral glucose tolerance test,494 cases were in the GDM group,and 3380 cases were in the non-GDM group.The clinical characteristics,perinatal outcomes and neonatal outcomes of mothers and infants in each group were recorded,and the data were compared byχ^(2) test,Wilcoxon rank sum test,Fisher exact probability method and univariate logistic regression analysis.Results The incidence of premature delivery and premature rupture of membranes of GDM were higher than those in the normal group,with statistically significant differences(all P<0.05).The multivariate logistic regression showed that the risk of developing GDM increased with age.In addition,the southern region(OR=1.719,95%CI:1.401-2.109,P<0.001),insufficient weight gain during pregnancy(OR=1.485,95%CI:1.164-1.893,P=0.001)and preconception overweight(OR=1.634,95%CI:1.241-2.151,P<0.001)were independent risk factors of GDM.Conclusion Advanced age,southern region,overweight before pregnancy and insufficient weight gain during pregnancy are influencing factors of GDM.The related risk factors should be identified as soon as possible and actively intervened,in order to reduce the occurrence of adverse pregnancy outcomes and improve health status of mothers and infants.