湘西地区妊娠期糖尿病影响因素分析

Investigation and analysis on high risk factors of gestational dia-betes mellitus in Xiangxi area

目的探讨湘西地区妊娠期糖尿病(GDM)发病高危影响因素。方法根据病例纳入和排除标准收集符合要求的湘西自治州人民医院2018-01-01-2018-12-31产检并分娩的641例孕妇病例资料,诊断为GDM的214例患者作为GDM组,余427例为非GDM组。采用调查表方式填写孕妇资料,采取单因素分析(计量资料用t检验,计数资料用Pearson检验、连续性校正χ^(2)检验或Fisher确切概率法)和Logistic回归对数据进行分析。结果单因素分析结果显示,孕妇母亲是否肥胖(χ^(2)=38.258,P<0.001)、有无不良孕产史(χ^(2)=13.677,P<0.001)、月经周期是否正常(χ^(2)=31.414,P<0.001)、有无GDM史(χ^(2)=30.315,P<0.001)、糖尿病家族史(χ^(2)=57.300,P<0.001)、孕期有无补充叶酸(χ^(2)=30.637,P<0.001)、孕前身体质量指数(BMI)≥24kg/m2(χ^(2)=28.731,P<0.001)、孕期体质量增加≥25kg(χ^(2)=5.101,P=0.024)、是否喜爱甜食(χ^(2)=6.174,P=0.013)、是否每天坚持走步运动(χ^(2)=20.162,P<0.001)与妊娠期糖尿病发病有关联。多因素Logistic回归分析结果显示,年龄(OR=1.098,95%CI为1.054~1.145)、孕妇母亲是否肥胖(OR=2.509,95%CI为1.642~3.835)、有无不良孕产史(OR=1.745,95%CI为1.034~2.943)、月经周期是否正常(OR=0.356,95%CI为0.219~0.579)、有无糖尿病家族史(OR=5.520,95%CI为3.129~9.740)、有无GDM史(OR=5.279,95%CI为1.946~14.422)、是否孕前BMI≥24kg/m2(OR=2.080,95%CI为1.361~3.179)、是否体质量增加≥25kg(OR=1.706,95%CI为0.672~4.330)、孕期是否补充叶酸(OR=0.313,95%CI为0.176~0.557)、是否喜爱甜食(OR=1.560,95%CI为1.045~2.330)和是否每天坚持走步运动(OR=0.499,95%CI为0.331~0.751)均为GDM发病的影响因素。结论湘西地区GDM发病的最大危险因素为糖尿病家族史和GDM史,而孕期补充叶酸和坚持走步运动能有效降低GDM的发病风险。

Objective To investigate the influencing factors of gestational diabetes mellitus(GDM)in Xiangxi area.Methods According to the inclusion and exclusion criteria,641 pregnant women who underwent prenatal examination and delivery in Xiangxi Autonomous Prefecture People’s Hospital from January 1 to December 31 in 2018 were collected.214 cases diagnosed as GDM group and the remaining 427 cases as non-GDM group.Pregnant women’s data were filled in by filling in the questionnaire,and univariate analysis(t-test for measurement data,Pearson test,continuity correctedχ^(2)test,or Fisher’s exact test for enumeration data)and Logistic regression were used to analyze the data.Results Univariate analysis results showed that maternal obesity(χ^(2)=38.258,P<0.001),history of adverse pregnancy(χ^(2)=13.677,P<0.001),normal menstrual cycle(χ^(2)=31.414,P<0.001),history of GDM(χ^(2)=30.315,P<0.001),family history of diabetes(χ^(2)=57.300,P<0.001),folic acid supplementation during pregnancy(χ^(2)=30.637,P<0.001),body mass index(BMI)≥24 kg/m2 before pregnancy(χ^(2)=28.731,P<0.001),weight gain≥25 kg during pregnancy(χ^(2)=5.101,P=0.024),preference for sweets(χ^(2)=6.174,P=0.013),and adherence to walking every day(χ^(2)=20.162,P<0.001)were associated with the incidence of gestational diabetes.Multivariate Logistic regression results showed that age(OR=1.098,95%CI:1.054-1.145),maternal obesity(OR=2.509,95%CI:1.642-3.835),presence or absence of adverse maternal history(OR=1.745,95%CI:1.034-2.943),normal menstrual cycle(OR=0.356,95%CI:0.219-0.579),and presence or absence of family history of diabetes(OR=5.520,95%CI:3.129-9.740),presence or absence of a history of GDM(OR=5.279,95%CI:1.946-14.422),presence or absence of pre-pregnancy BMI≥24 kg/m2(OR=2.080,95%CI:1.361-3.179),presence or absence of weight gain≥25 kg(OR=1.706,95%CI:0.672-4.330),folic acid supplementation during pregnancy(OR=0.313,95%CI:0.176-0.557),preference for sweets(OR=1.560,95%CI:1.045-2.330),and adherence to walking exercise per day(OR=0.499,95%CI:0.331-0.751)were all factors influencing the incidence of GDM.Conclusion The greatest risk factors of GDM in Xiangxi area are family history of diabetes and history of GDM,and folic acid supplementation during pregnancy and adherence to walking exercise can effectively reduce the risk of GDM.