妊娠早期空腹血糖对妊娠期糖尿病的影响

Influence of fasting glucose in early pregnancy on gestational diabetes mellitus

目的探讨妊娠早期空腹血糖对妊娠期糖尿病的影响。方法采取整群随机抽样的方法，抽取2014年10月7日-2015年4月3013在昆山市玉山镇社区卫生服务中心、张浦社区卫生服务中心进行首次产检（孕13周以内）的975例孕妇为调查对象。收集孕妇的年龄、文化程度等信息，测量初次检查的身高、体重、收缩压、舒张压等，检测孕早期空腹血糖、糖化血红蛋白等，随访至24-28周并收集75g葡萄糖耐量试验（OGTT）的筛查结果。采用单因素和多因素分析方法，分析孕早期空腹血糖对妊娠期糖尿病的影响。结果本次研究发现，妊娠期糖尿病的发病率为21．85％。根据孕早期空腹血糖四分位数（4．40、4．75、5．05mmol／L）由低到高将研究对象分为四组，发现随着孕早期空腹血糖的升高，GDM的发生率呈上升趋势（趋势性检验χ2=48．96，P〈0．01）。以最低分位作为对照组，调整年龄、孕早期收缩压、孕早期舒张压、孕早期体质指数等因素后，发现孕早期空腹血糖的第3分位和第4分位均可以增加妊娠期糖尿病的发生风险[OR（95％CI）=2．87（1．74-4．74）、4．18（2．56～6．82）]，并存在明显的剂量反应关系（趋势性检验χ2=42．12，P〈0．01）。结论较高的孕早期空腹血糖可增加妊娠期糖尿病的发病风险，并存在着剂量反应关系。

Objective To analyze the influence of fasting plasma glucose （FPG） in early pregnancy on gestational diabetes mellitus （GDM）. Methods From October 7, 2014 to April 30, 2015, 975 pregnant women who took the first trimester examination within 13 weeks of pregnancy in Yushan Town Community Health Service Center or Zhangpu Community Health Service Center In Kunshan City were recruited by cluster random sampling. Maternal information like age and education was collected. Height, weight, systolic blood pressure （SBP） ,diastolie blood pressure （DBP） , FPG and hemoglobin Ale and hemoglobin （HB） were detected in the first trimester examination. They were followed up for 24-28 weeks and oral glucose tolerance test （OGTT） was conducted. The influence of FPG in early pregnancy on GDM was analyzed by univariate and multivariate analysis. Results The incidence of GDM in this region was 21.85%. The paritcipants were divided into four groups based on the FPG quartiles （4.40 mmol/L, 4.75 mmol/L, 5.05 mmol/L） in early pregnancy. The incidence of GDM increased with the rise of FPG in early pregnancy （Xtrend = 48.96,P〈0.01）. When multiple factors including maternal age, body mass index, SBP, DBP, HB and FPG detected in the first trimester examination were adjusted, having the lowest quantile of FPG （ ≤4.40 mmol/L）as the control, the third （〉4.75-5.05） and the forth quartile （〉5.05） could both increase the risk of GDM, with the adjusted 0Rs（95%C1） of 2.87（1.74-4.74） and 4.18 （2.56-6.82）, respectively. Moreover, there presented a dose-response relationship between fasting glucose in early pregnancy and gestational diabetes mellitus（X2trond=48.96,P〈0.01）. Conclusion High fasting plasma glucose in early pregnancy can increase the risk of gestational diabetes mellitus in a dose-response manner,