妊娠期糖尿病危险因素研究及对妊娠结局的影响

The risk factors of gestational diabetes mellitus and its influence on pregnancy outcome

目的探讨妊娠期糖尿病发生的危险因素以及对妊娠结局的影响，为临床早期干预妊娠期糖尿病和改善妊娠结局提供指导。方法选取2014年1月至2016年1月本院住院分娩的159例妊娠期糖尿病产妇为观察组，并以同期随机选取的634例健康分娩产妇为对照组，采用Logistic回归分析妊娠期糖尿病的危险因素，并比较两组患者的妊娠结局。结果观察组患者中年龄≥35岁、孕前超重或肥胖、有不良孕产史、有糖尿病家族史、有高血压、合并有阴道念珠菌感染以及抗甲状腺过氧化物酶抗体（TPOAb）阳性的患者例数与对照组比较，差异有统计学意义（P〈0．05）。多因素Logistic回归分析结果显示，年龄≥35岁、孕前超重或肥胖、不良孕产史、有糖尿病家族史、TPOAb阳性是妊娠期糖尿病的独立危险因素，OR分别为2．441、2．889、1．486、4．879、1．323，差异有统计学意义（P〈0．05）。观察组胎膜早破、妊娠期高血压疾病、早产、羊水过多、剖宫产以及产后出血发生率高于对照组，差异有统计学意义（P〈0．05）；观察组巨大儿、胎儿窘迫以及新生儿轻度窒息发生率高于对照组，差异有统计学意义（P〈0．05），胎儿生长受限、新生儿畸形发生率与对照组比较差异无统计学意义（P〉0．05）。结论年龄≥35岁、孕前超重或者肥胖、不良孕产史、糖尿病家族史、甲状腺功能异常是妊娠期糖尿病的高危因素，且严重影响妊娠结局，临床因针对高危因素采取干预措施。

Objective To explore the risk factors of gestational diabetes mellitus and its influence on pregnancy outcome, and to provide guidance for early intervention of gestational diabetes to improve preg- nancy outcome in clinic. Methods Totally 159 patients with gestational diabetes mellitus in our hospital from January 2014 to January 2016 as observation group were collected, and at the same time, 634 healthy pregnancy women as control group were collected. The risk factors of gestational diabetes mellitus were analyzed by the Logistic regression analysis and comparison of pregnancy outcome between two groups was con- ducted. Results The patients in the observation group with age ≥ 35 years, overweight or obesity before pregnancy, adverse pregnancy history, family history of diabetes, hypertension and vaginal candida and thyroid peroxidase antibody （TPOAb） compared with the control group, the difference was statistically significant （P 〈 0. 05）. Multivariate logistic regression analysis showed that age ≥35 years, overweight or obesity before pregnancy, adverse pregnancy history, family history of diabetes, and positive TPOAb were the inde-pendent risk factors of gestational diabetes mellitus, OR was 2.441, 2. 889, 1.486, 4. 879, and 1. 323, respectively; the difference was statistically significant （P 〈 0. 05 ）. The incidence of premature rupture of membrane, pregnancy hypertensive disorder, premature birth, polyhydramnios, uterine-incision and post- partum hemorrhage in observation group were higher than those in control group, the difference was statisti- cally significant （P 〈 0. 05 ）. The incidence of giant baby, fetal distress and mild neonatal asphyxia were higher than those in control group, and the difference was statistically significant （ P 〈 0. 05 ）. No statistical significance in fetal growth restriction, neonatal malformations between two groups was found （ P 〉 0.05 ）.Conclusions Age ≥35 years, overweight or obesity before pregnancy, adverse pregnancy history, family history of diabetes, and thyroid dysfunction were the independent risk factors of gestational diabetes mellitus, and it has serious effect on pregnancy outcome, so that it should take measures to prevent the independent risk factors.