2015-2016年厦门市再生育孕妇妊娠期糖尿病发病危险因素

Risk factors of gestational diabetes mellitus among the re-birth pregnant women in Xiamen City in 2015-2016

目的探讨再生育孕妇妊娠期糖尿病(gestational diabetes mellitus,GDM)发病的相关危险因素。方法于2015—2016年在厦门市妇幼保健院围产营养门诊,按照孕期保健手册的建卡编号随机选择393例GDM患者,并以年龄段为匹配因素进行1∶1配对,以393例糖耐量试验正常的孕妇作为对照组。收集妊娠前体质指数、文化程度、流产次数、产检时的孕周及体重、父母亲患糖尿病史、上一胎胎儿出生体重、有无妊娠期糖尿病史等资料,两组人群均为再生育孕妇。结果 (1)单因素分析显示:GDM组孕妇孕24周前体重增长高于对照组[(9.11±3.09)kg vs(7.54±2.95)kg,t=2.121,P=0.004],母亲患糖尿病的比例高于对照组(64/393 vs 38/393,χ~2=7.616,P=0.006),而对照组文化程度总体水平高于GDM组(Z=-4.060,P=0.001)。配对卡方分析显示,巨大儿分娩史(χ~2=14.297,P=0.001)、妊娠期糖尿病史(χ~2=12.938,P=0.001)及流产次数≥2次(χ~2=7.078,P=0.010)均是再生育孕妇发生GDM的危险因素。随着上一胎胎儿出生体重的增长,下一孕期GDM发病的风险也逐渐增加。当出生体重达到3.8 kg时,OR=3.467,该风险值达到强相关程度。(2)多因素Logistic回归分析显示:单因素分析中,差异有统计学意义的危险因子均是GDM发病的高危因素,其中孕24周前体重增长超过10 kg的影响最大(OR=1.875,P=0.001)。结论妊娠期糖尿病史、巨大儿分娩史、流产次数≥2次、妊娠24周前体重总增长超过10 kg、文化程度水平相对低、孕妇母亲患糖尿病史均是GDM发病的危险因素;对于上一胎胎儿出生体重达到3.8 kg以上的再生育孕妇,应被纳入GDM发病的高危人群。

Objective To discuss the risk factors of the gestational diabetes mellitus （GDM） among the re-birth pregnant women. Methods A total of 393 pregnant women with GDM were collected randomly according to the number of the antenatal care manual in the Maternal and Child Health Hospital in Xiamen City. Meanwhile, 393 pregnant women with normal glucose tolerance were chosen to be the control group matching with age of the GDM group. Their basic data would be analyzed, including the BMI before pregnancy, the degree of the education, the times of the abortion, the body weight gain during the pregnancy, their parental diabetes history, the birth weight of the last fetal, the history of GDM and so on. The two groups of people were re-birth pregnant women. Results Single factor analysis showed that among the GDM group, the total body weight gain before the 24th week （9.11 ± 3.09） kg and the proportion of their mothers with the DM （64/393） were both higher than the control group （7.54 ± 2.95 ） kg and （38/393）, however, the degree of the education was lower than the control group. Paired chi-square analysis showed that the history of macrosomia delivery （X2 = 14. 297, P = O. 001 ） , the history of GDM（x2 = 12. 938 ,P =0. 001 ） , and abortion history more than 2 times （X2 = 7. 078,P = 0. 010）were the risk factors of GDM for those women. Meanwhile, with the increasing of the fetal birth weight, the risk of being the GDM during the second pregnancy was also increasing. When the fetal birth weight reached 3.8 kg, OR = 5. 467, the risk value reached a strong correlation. Multiple factors Logistic regression analysis showed those factors of GDM also had statistically significant differences, especially the bodyweight Rain before the 24th week over 10 kg played the most important role during the pregnancy（OR = 1. 875, P =0. 001 ）. Conclusion The risk factors of the GDM for the re-birth pregnant women concluded the history of GDM, the history of macrosomia, the times of the abortion over twice, the bodyweight gain before the 24th week over 10 kg, the low degree of the education, the pregnant women＇ s mother had the DM. For those pregnant women with fetal birth weight above 3.8 kg, they should be included in the high risk population of GDM during the next pregnancy.