妇女妊娠早期红细胞参数与妊娠期糖尿病关联队列研究

Association between red blood cell parameters during early pregnancy and risk of gestational diabetes: a retrospective cohort study

目的探讨妇女妊娠早期红细胞参数与妊娠期糖尿病(gestational diabetes mellitus,GDM)发生的关联,为GDM的早期筛查提供科学依据。方法以2013年1月1日至2017年12月31日期间在北京市通州区妇幼保健院产检且住院分娩且符合纳入标准的25044名单胎孕妇为研究对象,基于医院电子信息系统收集孕妇孕早期红细胞参数等相关资料。根据四分位数法,将孕妇的红细胞计数(RBC),血红蛋白(Hb),血细胞比容(HCT)分为四组。通过以医院为基础的回顾性队列研究比较不同孕早期红细胞参数水平妇女GDM发生率的差异,并通过多因素logistic回归分析在控制了其他混杂因素后,分析孕早期红细胞参数与GDM的关联。结果研究对象的GDM患病率为23.32%(5840/25044)。随着孕早期Hb、RBC、HCT的四分位数组别的增高,GDM发生率均逐渐升高(P<0.001)。在控制了年龄、文化程度、巨大儿分娩史、糖尿病家族史、初孕、初产、孕前BMI因素的影响后,孕早期Hb、RBC、HCT参数均是孕妇发生GDM的独立危险因素。其中,Hb≥P75组、RBC≥P75组、HCT≥P75组发生GDM的风险分别是相应参数<P25组孕妇的1.61倍(ORa=1.61,95%CI=1.46~1.77)、1.62倍(ORa=1.62,95%CI=1.47~1.78)、1.46倍(ORa=1.46,95%CI=1.33~1.61)。结论孕早期Hb、RBC、HCT参数均是孕妇发生GDM的独立危险因素,可考虑将红细胞参数水平作为孕早期筛查GDM高风险人群的筛查指标之一。

Objective To explore the relationship between red blood cell parameters in early pregnancy and gestational diabetes mellitus(GDM), and to provide evidences for early screening of GDM. Methods A hospital-based retrospective cohort study was conducted among 25 044 singleton pregnant women hospitalized in a maternal and child health care hospital in Beijing during the period from January 2013 through December 2017. From the hospital′s electronic information system, we extracted the data on the pregnant women’s red blood cell count(RBC), hemoglobin(Hb), and hematocrit(HCT)detected in their first trimester and other relevant information. Then we assigned the pregnant women into four groups according to the quartile values of red blood cell parameters and the GDM of the women in different groups were compared.Multivariate logistic regression analysis was adopted to assess the associations of the red blood cell parameters with the incidence of GDM. Results The incidence of GDM was 23.32%(5 840/25 044) in the pregnant women. With the increment of Hb, RBC, and HCT quartile values in early pregnancy, the incidence of GDM increased gradually(P < 0.001 for all).Multivariate logistic regression analysis revealed that the Hb, RBC, and HCT value were independent risk factors of GDM after adjusting for age, education, history of macrosomia, family history of diabetes, first pregnancy, primipara, and prepregnancy body mass index(BMI). The pregnant women with higher values of the red blood parameters(≥ 75% quartile)were at significantly increased risk of GDM compared to those with lower values(< 25% quartile), with the odds ratio(95%confidence interval) of 1.61(1.46-1.77) for Hb, 1.62(1.47-1.78) for RBC, and 1.46(1.33-1.61) for HCT, respectively.Conclusion The levels of Hb, RBC and HCT in early pregnancy are independent risk factors for GDM and these parameters are of potential application to the early screening of pregnant women at higher GDM risk.