2016年河北省妊娠期糖尿病患病率和流行病学特点分析

Prevalence and Epidemiologic Characteristics of Gestational Diabetes Mellitus in Hebei Province,2016

目的了解2016年河北省妊娠期糖尿病(GDM)的患病率和流行病学特点。方法本研究数据来源于2016-01-01至2016-12-31河北省妇幼保健中心孕产妇监测信息管理系统(网络直报),该系统包括分布在河北省各地市的22个监测点(医院)。本研究统计2016年所有出院的分娩产妇的相关数据。分析2016年河北省GDM患病率以及流行病学特征,其中后者包括地区分布(城市分布、城乡分布)、医院级别分布、人群分布(年龄分布)、时间分布(季节分布)、高危因素[经产妇、多胎妊娠、贫血、妊娠期高血压疾病(HDP)、接受高等教育]情况。结果共有产妇64 931例,其中GDM患者3 460例,GDM患病率为5.33%。保定产妇GDM患病率为13.99%,张家口为0.06%。城市医院分娩的产妇GDM患病率(7.20%)高于乡镇医院(3.51%,P<0.05)。三级医院分娩的产妇GDM患病率高于二级医院、一级医院,二级医院分娩的产妇GDM患病率高于一级医院(P<0.05)。25~29、30~34、35~39、≥40岁产妇GDM患病率均高于≤24岁产妇,30~34、35~39、≥40岁产妇GDM患病率均高于25~29岁产妇,35~39、≥40岁产妇GDM患病率均高于30~34岁产妇(P<0.05)。随着孕产妇年龄的增长,GDM患病率增高(拟合方程式为y=0.390 5x-5.893,R^2=0.692 4)。产妇GDM患病率春季为5.71%,夏季为4.74%。GDM产妇HDP发生率、接受高等教育率高于非GDM产妇(P<0.05)。多因素Logistic回归分析结果显示,年龄、经产妇情况、贫血情况、HDP情况、受教育程度、医院级别、城乡分布、季节均为GDM的影响因素(P<0.05)。结论 2016年河北省GDM患病率处于我国中间水平,其患病特点有明显的地区、人群、时间差异。为此,针对不同地区应采取个性化预防措施,切实做好高危人群GDM的预防和干预工作,以提高围生期保健水平。

Objective To investigate the prevalence and epidemiological characteristics of gestational diabetes mellitus（GDM）in Hebei Province in 2016.Methods Data were collected from the Monitoring Information Management System for Pregnant and Parturient Women of Hebei Women and Children＇s Health Center（reported by 22 critical maternal surveillance hospitals in Hebei Province via an internet-based system）from January 1 to December 31,2016.The involved individuals were women discharged from these institutions after delivery in 2016.The prevalence of GDM in 2016 was analyzed.Moreover,epidemiological characteristics of GDM including regional distribution（urban distribution,urban and rural distribution）,level of hospitals,age group,onset time（season）,and the associated high-risk factors[pluriparity,multifetation,anemia,hypertensive disorders of pregnancy（HDP）,tertiary educational attainment]in 2016 were explored.Results 64 931 parturient women were included.The overall prevalence of GDM was 5.33%（3 460/64 931）.From a city-specific perspective,the prevalence of GDM in Baoding and Zhangjiakou was 13.99% and 0.06% respectively.In the view of the location of hospital for childbirth,the prevalence of GDM was higher in urban hospitals compared with rural hospitals（7.20% vs 3.51%,P〈0.05）.From the point of view of level of hospitals for childbirth,the prevalence of GDM increased successively in primary,secondary and tertiary hospitals（P〈0.05）.From the perspective of age group,of the 5 age groups（≤ 24,25-29,30-34,35-39,≥ 40）,age group of ≤ 24 possessed the lowest prevalence of GDM（P〈0.05）,age group of 25-29 had lower prevalence of GDM compared with other 3 older groups（P〈0.05）,and age group of 30-34 owned lower prevalence of GDM compared with other 2 older groups（P〈0.05）,indicating that the prevalence of GDM increased with maternal age（fitting equation：y=0.390 5 x-5.893,R-2=0.692 4）.In terms of onset season,the prevalence of GDM in spring and summer was 5.71% and 4.74% respectively.In addition,by demographic characteristics,higher proportions of women with GDM were found with HDP and tertiary educational attainment compared with those without（P〈0.05）.The results of multivariate Logistic regression analysis showed that age,pluriparity,anemia,HDP,education level,level of hospitals,urban and rural distribution,and season were all factors influencing the prevalence of GDM（P〈0.05）.Conclusion The prevalence of GDM in Hebei in 2016 was at an intermediate level of the national norms.Its epidemiological characteristics differed significantly by regions,age groups,and seasons.Therefore,in order to prevent the development of GDM in high-risk populations,raising the level of perinatal health care,targeted preventive interventions should be delivered by regions.