新诊断标准下妊娠期糖尿病高危因素研究

Risk Factors and Countermeasures of Gestational Diabetes Mellitus under the New Diagnostic Criteria

目的：调查新诊断标准下国内妊娠期糖尿病（Gestational diabetes mellitus GDM）的发病情况,分析影响GDM发生的高危因素,为新标准下国内GDM孕妇临床早期管理、诊断和干预提供理论依据。方法：对2011年1月至2011年9月我院接受产前建卡检查的所有孕妇1152例进行临床资料的收集及回顾性研究,排除孕前糖尿病患者16例,采用GDM诊断新标准进行＂一步法＂诊断,收集包括年龄、孕产次、体质指数（body mass index BMI）、糖尿病家族史、多囊卵巢综合征等13种影响GDM发生的危险因素,并综合分析。结果：新标准下GDM检出率为10.39%（118/1136）2）单因素分析结果发现年龄≥35岁（X2=10.2814,P=0.0013）、肥胖（孕前BMI≥28kg/m2（）X2=36.2384,P〈0.0001）、多囊卵巢综合征（X2=20.6725,P〈0.0001）、糖尿病家族史（X2=7.8783,P=0.0050）在GDM组与非GDM组有统计学差异,多因素逐步Logistic回归分析肥胖（OR=7.546 95%CI=2.356~20.129 P=0.0002）、多囊卵巢综合征（OR=6.342 95%CI=1.783~16.329,P=0.0019）、年龄（OR=3.021 95%CI=0.983~6.459 P=0.0108）、糖尿病家族史（OR=2.43895%CI=0.612~5.231 P=0.0256）为GDM的高危因素。结论：新标准下报告GDM检出率为10.39%。肥胖、多囊卵巢综合征、年龄、糖尿病家族史为影响GDM发生的高危因素。加强GDM筛查并对具有高危因素的妊娠期妇女早期诊断,早期干预、早期管理可改善妊娠结局,提高人口素质。

Objective： To investigate the incidence of domestic gestational diabetes mellitus（GDM） and the risk factors for GDM occurs under the new diagnostic criteria,and to provide a theoretical basis of early clinical management,diagnosis and intervention for domestic GDM women under the new standard.Methods： To collect 1152 cases of pregnant women having prenatal check in our hospital and their clinical data for retrospective study on June 2011 to September 2011.16 patients were excluded from pre-pregnancy diabetes mellitus.To use the new ＂one-step ＂diagnosis for GDM and to collect 13 kinds of effects GDM risk factors,including age,maternal time,body mass index（BMI）,family history of diabetes,polycystic ovary syndrome etc.,and have a comprehensive analysis.Results： 10.39%（118/1136） pregnant women were detected for GDM under the new standard.2） Univariate analysis showed that ≥ 35 years of age（X2 = 10.2814,P=0.0013）,obesity（pre-pregnancy BMI ≥ 28kg/m2）（X2=36.2384,P〈0.0001）,polycystic ovary syndrome（X^2=20.6725,P〈0.0001）,family history of diabetes（X^2=7.8783,P=0.0050） were significantly different between GDM group and non-GDM group.Multiple stepwise logistic regression analysis demonstrated that obesity（OR=7.546 95% CI = 2.356∽20.129 P=0.0002）,polycystic ovary syndrome（OR=6.342 95%CI=1.783 ∽ 16.329,P=0.0019）,the age（OR=3.021 95% CI=0.983~6.459 P=0.0108）,family history of diabetes（OR=2.438 95%CI=0.612∽5.231 P = 0.0256） were the risk factors for GDM.Conclusion： The detection rate of GDM was reported 10.39% under the new standard.Obesity,polycystic ovary syndrome,age,family history of diabetes affected GDM as risk factors.Strengthen the GDM screening and early diagnosis,early intervention,early management for pregnant women with risk factors for GDM could improve pregnancy outcomes and population quality.