妊娠前体重指数和胎次对妊娠糖尿病发病的影响观察

Influence of pre-pregnancy body mass index and parity on the incidence of gestational diabetes mellitus.

目的观察妊娠前体重指数和胎次对妊娠糖尿病发病的影响。方法采用回顾性研究方法,选取2018年11月至2019年11月复旦大学附属妇产科医院孕产期保健孕妇131例,依据妊娠糖尿病发生情况分为发生组(n=112)和未发生组(n=19)。采用多因素Logistic回归分析评价妊娠糖尿病发病的影响因素,比较不同体重指数、胎次孕妇的血糖水平,比较两组患者的分娩方式、孕期体重增长量、分娩体重和羊水指数。结果发生组孕妇的年龄、体重指数、胎次、文化程度均显著高于未发生组,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,妊娠糖尿病发病的影响因素包括年龄、体重指数、胎次,差异具有统计学意义(P<0.05)。偏瘦、正常、超重、肥胖孕妇的空腹血糖、餐后1 h血糖、餐后2 h血糖水平均逐渐升高,差异均具有统计学意义(P<0.05)。第一胎孕妇的空腹血糖、餐后1 h血糖、餐后2 h血糖水平均显著低于第二胎及以上,差异均具有统计学意义(P<0.05)。发生组孕妇的阴道分娩率[58.9%(66/112)]显著低于未发生组[78.9%(15/19)],剖宫产率[34.8%(39/112)]显著高于未发生组[15.8%(3/19)],差异均具有统计学意义(P<0.05)。发生组孕妇的体重指数、孕期体重增长量、分娩体重、羊水指数均显著高于未发生组[(23.1±3.7)kg/m 2 vs.(20.1±3.6)kg/m 2、(19.0±3.7)kg vs.(16.6±2.9)kg、(71.4±9.4)kg vs.(68.6±7.5)kg、(125.9±21.1)mm vs.(108.8±19.9)mm],差异均有统计学意义(P<0.05)。结论妊娠前体重指数和胎次均是妊娠糖尿病发病的影响因素,妊娠前体重指数越高、胎次越多,妊娠糖尿病发病率越高。

Objective To observe the influence of prepregnancy body mass index and parity on the incidence of gestational diabetes mellitus.Methods 131 cases of pregnant women in Obstetrics and Gynecology Hospital Affiliated Fudan University from November 2018 to November 2019 were selected retrospectively.According to the occurrence of gestational diabetes,they were divided into two groups:occurrence group(n=112)and non-occurrence group(n=19).The influencing factors of gestational diabetes were evaluated by multivariate logistic regression analysis.The blood glucose levels of pregnant women with different body mass index and parity were compared.The delivery modes,weight gain during pregnancy,delivery weights and amniotic fluid indexes of the two groups were compared.Results The age,body mass index,parity and education level of pregnant women of the occurrence group were significantly higher than those of the non-occurrence group,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that the influencing factors of gestational diabetes included age,body mass index and parity(P<0.05).The fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose of lean,normal,overweight and obese pregnant women increased gradually,the differences were statistically significant(P<0.05).The fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose of the first pregnant women were significantly lower than those of the second pregnant women,the differences were statistically significant(P<0.05).The vaginal delivery rate of the occurrence group[58.9%(66/112)]was significantly lower than that of the non-occurrence group[78.9%(15/19)],and the cesarean section rate[34.8%(39/112)]was significantly higher than that of the non occurrence group[15.8%(3/19)],the differences were statistically significant(P<0.05).The body mass index,weight gain during pregnancy,birth weight,amniotic fluid index of the occurrence group were significantly higher than those of the non occurrence group[(23.1±3.7)kg/m 2 vs.(20.1±3.6)kg/m 2,(19.0±3.7)kg vs.(16.6±2.9)kg,(71.4±9.4)kg vs.(68.6±7.5)kg,(125.9±21.1)mm vs.(108.8±19.9)mm],and the differences were statistically significant(P<0.05).Conclusion Pre-pregnancy body mass index and parity are the influencing factors of gestational diabetes,the higher the body mass index and the parity of pregnancy,the higher the incidence rate of gestational diabetes mellitus.