妊娠合并糖尿病与妊娠期高血压疾病的相关性：北京地区15家医院整群分层抽样研究

Correlation of hypertensive disorders and diabetes mellitus in pregnancy：a random sampling study in Beijing area

目的研究北京地区孕产妇妊娠合并糖尿病和妊娠期高血压疾病的患病情况及二者的相关性。方法采用整群分层抽样方法随机抽取2013年6月至11月北京地区的15家医院共15194例分娩孕产妇，研究妊娠合并糖尿病和妊娠期高血压疾病的患病率；将总人群分为非糖尿病组、妊娠期糖尿病组和孕前糖尿病组，比较三组妊娠期高血压疾病、子痫前期、重度子痫前期的患病率；将总人群分为慢性高血压组和未合并慢性高血压组，比较两组妊娠期糖尿病和孕前糖尿病的患病率。采用Logistic回归分析研究妊娠期糖尿病和妊娠期高血压疾病的危险因素。结果北京地区孕产妇妊娠期糖尿病的患病率为19.7%（2986/15194），孕前糖尿病的患病率为1.4%（208/15194）。妊娠期高血压疾病的患病率为4.4%（672/15194），其中子痫前期为2.7%（417/15194），包括重度子痫前期1.8%（279/15194），慢性高血压的患病率为2.3%（350/15194）。孕前体质指数（OR：1.09,95%CI 1.08~1.10）、年龄（1.03,1.02~1.04）和慢性高血压（1.57,1.23~2.00）为妊娠期糖尿病的危险因素；孕前体质指数（1.22,1.15~1.29）、孕期体重增长（1.08,1.05~1.12）、妊娠期糖尿病（1.90,1.20~3.01）和孕前糖尿病（4.44,1.50~13.21）为妊娠期高血压疾病的危险因素。结论妊娠合并糖尿病和妊娠期高血压疾病有相关性，妊娠合并糖尿病是妊娠期高血压疾病的危险因素，慢性高血压为妊娠期糖尿病的危险因素，孕前高体质指数是二者共同的危险因素。

Objective To assess the prevalence and association of hypertensive disorders and diabetes mellitus in pregnancy. Methods Fifteen hospitals in Beijing were randomly sampled from June 2013 to November 2013 and 15 194 deliveries were evaluated. Overall prevalence of maternal hypertensive disorders and diabetes mellitus in pregnancy were assessed. Prevalence of hypertensive disorders of pregnancy, preeclampsia and severe preeclampsia were compared among non？diabetes, gestational diabetes,nbsp;and pre？gestational diabetes groups, as well as the prevalence of gestational diabetes between chronic hypertension and non？chronic hypertension groups. Logistic regression analysis was used to explore the association between risk factors and hypertensive disorders and diabetes mellitus. Risk factors included in the model were chronic hypertension, diabetes, age, parity, education status, family income, pre？gestational body mass index and gestational weight gain. Results The prevalence of hypertensive disorders, preeclampsia, severe preeclampsia and chronic hypertension was 4.4%（672/15 194）, 2.7%（417/15 194）, 1.8% （279/15 194） and 2.3%（350/15 194）, respectively.The prevalence of gestational diabetes and pre？gestational diabetes was 19.7%（2 986/15 194）and 1.4%（208/15 194）. When dividing the population into non？diabetic group, gestational diabetic group and pre？gestational diabetic group, the incidence of hypertensive disorders of pregnancy increased accordingly （3.8%（454/12 000）, 6.2%（185/2 986）, 15.9%（33/208）,χ2=96.8, P〈0.05）, as well as the incidence of preeclampsia （2.4%（291/12 000）, 3.7%（111/2 986）, 7.2%（15/208）,χ2=34.3, P〈0.05） and severe preeclampsia （1.5%（184/12 000）, 2.5%（75/2 986）, 2.9%（6/208）,χ2=14.9,P〈0.05）. The incidence of gestational diabetes （31.4%（110/350） vs 19.4%（2 876/14 844）,χ2=42.1, P〈0.05） and pre？gestational diabetes （7.1%（25/350） vs 1.2%（183/14 844）, χ2=113.2, P〈0.05） in the chronic hypertensive group were higher than those in the non？hypertensive group. Maternal body mass index before pregnancy （OR：1.22, 95%CI 1.15-1.29）, gestational weight gain （1.08, 1.05-1.12）, maternal complications of gestational diabetes （1.90, 1.20-3.01） and pre？gestational diabetes （4.44, 1.50-13.21） were identified as risk factors for hypertensive disorders . Significant risk factors for gestational diabetes were maternal body mass index （BMI） before pregnancy （1.09, 1.08-1.10）, age （1.03, 1.02-1.04） and maternal complication of chronic hypertension （1.57, 1.23-2.00）. Conclusion Hypertensive disorders of pregnancy and diabetes mellitus in pregnancy are closely correlated to each other. Pre？gestational diabetes and gestational diabetes are risk factors for hypertensive disorders of pregnancy. Chronic hypertension is a risk factor for gestational diabetes.Pre？gestational body mass index is the common risk factor for both diseases.