妊娠期糖代谢异常相关因素的研究

A prospective study of risk factors in pregnant women with abnormal glucose metabolism

目的探讨妊娠期糖尿病(GDM)及妊娠期糖耐量低减(GIGT)发病的高危因素。方法采用前瞻性对照研究的方法,对2004年2月至8月,在北京大学第一医院妇产科门诊行产前检查诊断的糖代谢异常孕妇[其中GDM85例(GDM组)、GIGT63例(GIGT组)]和125例糖代谢正常孕妇(对照组)的临床资料进行单因素及多因素logistic回归分析,探讨各因素对GDM和GIGT发病的影响。结果(1)GDM组及GIGT组孕妇平均年龄、孕前体重指数、确诊前孕妇平均每周体重增长均明显高于对照组(P<0.05)。(2)GDM组及GIGT组孕妇每日主食及水果摄入量也明显高于对照组(P<0.05),而且GDM组与GIGT组比较,差异有统计学意义(P<0.05)。(3)GDM组、GIGT组及对照组糖尿病遗传家族史发生率分别为42.4%、36.5%及19.2%;孕前月经不调发生率分别为16.5%、23.8%及6.4%;多囊卵巢综合征(PCOS)发生率分别为5.9%、3.2%及0;妊娠期外阴阴道念珠菌病(VVC)发生率分别为15.3%、17.4%及7.2%。GDM组及GIGT组以上各指标与对照组比较,差异均有统计学意义(P<0.05)。(4)多因素logistic回归分析显示,孕妇年龄、月经不调、孕前体重指数、确诊前孕妇平均体重增加、自然流产史、VVC均为妊娠期糖代谢异常的高危因素。结论孕妇年龄、月经不调、自然流产史、孕前肥胖、孕期体重增加过快、VVC,为GDM和GIGT发病的独立高危因素。PCOS、糖尿病家族遗传史对GDM发病有一定影响,但不是独立高危因素。

Objective To evaluate the risk factors for gestational diabetes mellitus（GDM） and gestational impaired glucose tolerance （GIGT）. Methods A prospective case-control study was performed in 85 women with GDM, 63 cases with GIGT and 125 cases as control recruited from Feb 2004 to Aug 2004 in Peking University First Hospital. Univariate analysis and multivariate logistic regression were used to identify risk factors of GDM and GIGT. Results （ 1 ） The mean age, and body mass index （ BMI ） before pregnancy and larger maternal weight gains during pregnancy were significantly different between GDM/GIGT and control group （ P 〈0. 05）. （2）More intakes of fruits and carbohydrate per day increased the incidence of GDM and GIGT （ P 〈 0. 05 ）. （ 3 ） There was a higher proportion of women with family history of diabetes among the GDM （42. 2% ） and GIGT （36. 5% ） compared with control group （19. 2% ）. Irregular menses （ 16.5% ,23.8% ） , and polycystic ovary syndrome （PCOS） （5.9% , 3.2% ） were more prevalent in the GDM,GIGT groups versus control subjects （6. 4%, 0）. The incidence of vulvovaginal candidiasis （VVC） was significantly higher in pregnant women with GDM and GIGT （ 15.3% and 17. 4% ） than in control group （7. 2% ）. （4） Muhivariate logistic regression showed that age, irregular menses, BMI before pregnancy, history of spontaneous abortion, educational level and VVC all were independent factors for GDM or GIGT. Conclusions Maternal age, irregular menses, obesity before gestation, rapid weight gains during pregnancy, history of spontaneous abortion as well as VVC are independent risk factors for GDM or GIGT. PCOS and family history of diabetes increase the incidence of GDM and GIGT but these are not independent risk factors for GDM and GIGT.