糖尿病高危孕妇妊娠早期血糖筛查情况及影响因素分析

Blood Glucose Screening and Its Influencing Factors in First Trimester of Pregnant Women at High Risk of Diabetes Mellitus

背景妊娠合并糖尿病的发病率不断增加,尤其是糖尿病高危孕妇,早期筛查、早期预防至关重要,而目前妊娠早期糖尿病筛查方法和诊断标准仍不统一。目的了解糖尿病高危孕妇妊娠早期的血糖情况,并分析相关高危因素对早期高血糖的影响。方法收集2017年7月-2018年12月在首都医科大学大兴教学医院产科门诊建档的糖尿病高危孕妇的资料,于妊娠14周之前采用75 g口服葡萄糖耐量试验(OGTT)进行糖尿病筛查。结果妊娠早期进行糖尿病筛查的糖尿病高危孕妇共596例,其中正常血糖(NGT)组374例(62.75%),糖调节受损(IGR)组190例(31.88%),孕前糖尿病(PGDM)组32例(5.37%)。IGR组中4例(2.11%)仅空腹血糖(FPG)升高,177例(93.16%)仅2 h血浆葡萄糖(2 hPG)升高,9例(4.73%)FPG和2 hPG均升高;PGDM组中6例(18.75%)仅FPG升高,24例(75.00%)仅2 hPG升高,2例(6.25%)FPG和2 hPG均升高。三组糖尿病高危孕妇的年龄、身高、体质量、妊娠前体质指数(BMI)、妊娠次数、分娩次数、颈围、腰围、一级亲属患有糖尿病比例、既往妊娠期糖尿病(GDM)病史比例、高血压比例比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄[OR=1.087,95%CI(1.043,1.132)]、颈围[OR=1.126,95%CI(1.049,1.207)]、一级亲属患有糖尿病[OR=1.763,95%CI(1.209,2.572)]是糖尿病高危孕妇IGR的独立影响因素(P<0.05);年龄[OR=1.131,95%CI(1.040,1.230)]、腰围[OR=1.063,95%CI(1.030,1.099)]、既往GDM病史[OR=5.260,95%CI(1.641,16.864)]、高血压[OR=6.246,95%CI(1.336,29.188)]是糖尿病高危孕妇PGDM的独立影响因素(P<0.05)。结论糖尿病高危孕妇妊娠早期IGR及PGDM发生率较高;妊娠早期单纯采用FPG进行血糖筛查会导致较高的IGR及PGDM漏诊率;高龄、颈围增粗、一级亲属患有糖尿病是IGR的危险因素,高龄、腰围增粗、既往GDM病史、高血压是PGDM的危险因素。

Background The incidence of gestational diabetes mellitus is increasing,especially among pregnant women at high risk of diabetes mellitus.Early screening and early prevention are very important.However,at present,the methods and diagnostic criteria of early gestational diabetes mellitus screening are still not uniform.Objective To study the blood glucose of high-risk pregnant women with diabetes mellitus in early pregnancy and to analyze the effect of related high-risk factors on early hyperglycemia.Methods Collect the data of high-risk pregnant women with diabetes who were enrolled in the maternity clinic of Daxing Teaching Hospital of Capital Medical University from July 2017 to December 2018,and oral glucose tolerance test( OGTT) was used for diabetes screening before 14 weeks of gestation.Results A total of 596 pregnant women with high-risk diabetes were screened for blood glucose in the first trimester of pregnancy,including 374 cases (62.75%) with normal blood glucose,190 cases( 31.88%) with impaired glucose regulation( IGR)and 32 cases( 5.37%) with pre-gestational diabetes mellitus( PGDM). In the IGR group,4 cases (2.11%) only had elevated fasting plasma glucose (FPG) level,177 cases (93.16%) only had higher 2 hours plasma glucose(2 hPG) level,9 cases (4.73%) had elevated FPG and OGTT 2 hPG level.In the PGDM group,6 cases (18.75%) only had elevated FPG,24 cases (75.00%) had only elevated OGTT 2 hPG level,2 cases (6.25%) had elevated FPG and OGTT 2 hPG.There were significant differences in age,height,weight,body mass index (BMI) before pregnancy,number of pregnancy,number of births,neck circumference,waist circumference,proportions of first-degree relatives with diabetes mellitus,previous gestational diabetes mellitus (GDM) history and hypertension among three groups (P<0.05).The results of multivariate Logistic regression showed that age 〔OR=1.087,95%CI(1.043,1.132)〕,neck circumference 〔OR=1.126,95%CI(1.049,1.207)〕 and first-degree relatives with diabetes 〔OR=1.763,95%CI(1.209, 2.572)〕 were independent influencing factors of IGR (P<0.05);age 〔OR=1.131,95%CI(1.040,1.230)〕, waist circumference 〔OR=1.063,95%CI(1.030,1.099)〕,GDM history 〔OR=5.260,95%CI(1.641,16.864)〕 and hypertension 〔OR=6.246,95%CI(1.336,29.188)〕 were independent influencing factors of PGDM (P<0.05). Conclusion The incidence of IGR and PGDM in the early pregnancy in high-risk diabetic women is high,and glucose screening only with FPG in early pregnancy would lead to a higher rate of missed diagnosis of IGR and PGDM.Advanced age, neck circumference enlargement,and first-degree relatives with diabetes are independent determinants of IGR.Advanced age, waist circumference enlargement,hypertension,and GDM history are independent determinants of PGDM.