影响初孕妇妊娠糖尿病和产后糖尿病发病的因素

Effect factors of gestational diabetes mellitus and postpartum diabetes mellitus in primigravidas

目的:探讨影响初孕妇妊娠糖尿病和产后糖尿病发病的因素。方法:2035例符合标准的初孕妇,由产科医师进行问卷调查,完成产前检查的同时记录随访结果。主要终检标准:发生产后糖尿病。影响妊娠糖尿病事件的因素用Logistic回归分析、组间产后糖尿病发生率比较用Kaplan-Meier曲线表示,并作对数秩检验。结果:2035例初孕妇平均年龄27.9岁,妊娠糖尿病146例,妊娠糖尿病发病率7.2%。孕前体重指数(RR=6.4,P=0.000)及孕妇母亲2型糖尿病史(RR=4.5,P=0.000)是妊娠糖尿病的危险因素(Logistic回归分析:χ2=272.1,ν=5,P=0.000)。2035例平均随访3.6年,产后糖尿病63例,产后糖尿病发病率3.1%,平均年产后糖尿病发病率0.9%。妊娠糖尿病组产后糖尿病发生率明显高于非妊娠糖尿病组产后糖尿病发生率(对数秩检验:统计量=101.7,ν=1,P=0.0000)。肥胖组产后糖尿病发生率最高,超重组产后糖尿病发生率居中,体重正常组产后糖尿病发生率最低(对数秩检验:整体比较,统计量=150.1,ν=2,P=0.0000。组间比较,正常组vs超重组,统计量=36.8,P=0.0000;正常组vs肥胖组,统计量=175.0,P=0.0000;超重组vs肥胖组,统计量=22.5,P=0.0000)。结论:母亲2型糖尿病史是初孕妇妊娠糖尿病的危险因素,妊娠糖尿病亦是产后糖尿病的危险因素,而孕前体重指数高既是初孕妇妊娠糖尿病的危险因素,又是产后糖尿病的危险因素。

Objective：To explore the effect factors of gestational diabetes mellitus and postpartum diabetes mellitus in primigravidas.Methods：2 035 primigravidas were selected and investigated by obstetricians, and the results of follow up were recorded; the main final standard was postpartum diabetes mellitus; the effect factors of gestational diabetes mellitus were analyzed by logistic regression analysis, the comparison of incidence of postpartum diabetes mellitus was showed by Kaplan-Meier curve, then log rank sum test was conducted.Results：The average age of 2 035 primigravidas was 27.9 years,146 primigravidas were found with gestational diabetes mellitus, the incidence was 7.2%.Pre-pregnant BMI （RR= 4.5, P=0.000） and primigravidas with mothers suffered from type 2 diabetes mellitus （RR= 4.5, P=0.000） were risk factors of gestational diabetes mellitus （logistic regression analysis： χ2=272.1, ν=5, P=0.000）; the follow up time was 3.6 years on average, 63 primigravidas were found with postpartum diabetes mellitus, the incidence was 3.1%, the annual incidence of postpartum diabetes mellitus was 0.9% on average; the incidence of postpartum diabetes mellitus in gestational diabetes mellitus group was significantly higher than that in non-gestational diabetes mellitus group （log rank sum test： statistics=101.7, ν=1, P=0.000 0）; the incidence of postpartum diabetes mellitus in obesity group was the highest, the second and third were overweight group and normal weight group （log rank sum test： statistics=150.1, ν=2, P=0.000 0）; comparison between groups： normal weight group vs overweight group （statistics=36.8, P=0.000 0）; normal weight group vs obesity group （statistics=175.0, P=0.000 0）; overweight group vs obesity group （statistics=22.5, P=0.000 0）.Conclusion：The risk factor of gestational diabetes mellitus is primigravidas with mothers suffered from type 2 diabetes mellitus, gestational diabetes mellitus is a risk factor of postpartum diabetes mellitus, while high pre-pregnant BMI is a risk factor of gestational diabetes mellitus and postpartum diabetes mellitus in primigravidas.