经产妇发生妊娠期糖尿病的危险因素研究

Risk factors for gestational diabetes mellitus among multiparae

目的·探究经产妇发生妊娠期糖尿病(gestational diabetes mellitus,GDM)的危险因素。方法·选取2012年1月—2017年1月在国际和平妇幼保健院有连续2次分娩记录的经产妇。按照前次妊娠孕前年龄进行1:4配比,病例组116例,对照组464例。通过病史调取这些孕产妇的临床资料和口服糖耐量试验(oral glucose tolerance test,OGTT)、血脂等生化指标。通过多因素回归分析计算校正比值比(odds ratio,OR)和95%CI,找出经产妇发生GDM的危险因素。结果·相比对照组,病例组孕产妇2次妊娠孕前体质量指数(BMI)增加(校正OR=1.35,95%CI为1.07～1.69),前次妊娠OGTT 1 h血糖(校正OR=1.99,95%CI为1.55～2.55)和2 h血糖(校正OR=2.02,95%CI为1.51～2.70)越高,以及本次妊娠孕早期空腹血糖(校正OR=1.96,95%CI为1.16～3.32)、总胆固醇(校正OR=1.37,95%CI为1.06～1.77)和三酰甘油(校正OR=1.53,95%CI为1.10～2.14)越高,发生GDM的风险越大。结论·2次妊娠间BMI增加,以及血糖和血脂持续性增长是引起经产妇GDM发生的危险因素。

Objective·To investigate the risk factors for gestational diabetes mellitus(GDM)among multiparae.Methods·Women who had two consecutive pregnancies records in the International Peace Maternity and Child Health Hospital from January 2012 to January 2017 were included into this study.The case group(116 cases)and control group(464 cases)were matched at the ratio of 1:4 according to the pre-pregnancy age in index pregnancy.Clinical characteristics,biochemical parameters including oral glucose tolerance test(OGTT)and lipid profiles were took into consideration by virtue of their medical records.Multivariate Logistic regression analysis was used to compute the adjusted odds ratio(aOR)and 95%CI so as to identify the risk factors.Results·Compared with the control group,the case group was associated with greater body mass index(BMI)change between pregnancies(aOR=1.35,95%CI=1.07-1.69),greater postprandial 1 h glucose load(aOR=1.99,95%CI=1.55-2.55)and 2 h glucose load(aOR=2.02,95%CI=1.51-2.70)at OGTT in index pregnancy,and greater first-trimester fasting plasma glucose(aOR=1.96,95%CI=1.16-3.32),total cholesterol(aOR=1.37,95%CI=1.06-1.77)and triacylglycerol(aOR=1.53,95%CI=1.10-2.14)in subsequent pregnancy.Conclusion·The elevated BMI change between pregnancies,the abnormal glucose and lipid profiles persisting from index to subsequent pregnancy lead to the occurrence of GDM.