妊娠期糖尿病高龄孕妇并发子痫前期的相关因素分析

Correlation analysis between advanced pregnant women with gestational diabetes mellitus and different types of preeclampsia

目的探讨妊娠期糖尿病(GDM)单胎妊娠高龄孕妇并发3种类型子痫前期(PE)(PE、早发型PE及重度PE)的相关因素。方法选择2018年1至12月在四川大学华西第二医院就诊的600例单胎妊娠高龄(≥35~39岁)孕妇纳入高龄组,年龄为(36.4±1.2)岁,其中GDM孕妇为200例,非GDM孕妇为400例。再按照与高龄组GDM与非GDM孕妇1∶1选取同期在本院就诊的600例单胎妊娠超高龄(≥40岁)孕妇纳入超高龄组,年龄为(40.9±1.2)岁,其中GDM孕妇为200例,非GDM孕妇为400例。本研究设定的可能影响孕妇发生PE的相关因素包括GDM、是否初产妇、人体质量指数(BMI)、文化程度、居住地及辅助生殖技术(ART)史,探讨这6种因素影响单胎妊娠高龄孕妇并发3种类型PE(PE、早发型PE及重度PE)的风险。采用t检验对年龄等进行组间比较,采用χ2检验对各组受试者中并发3种类型PE所占比例进行分析。对于2组孕妇并发3种类型PE影响因素的多因素非条件logistic回归模型进行分析。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。结果①高龄组和超高龄组中,GDM孕妇发生PE、早发型PE、重度PE所占比例均高于非GDM孕妇,其中高龄组GDM孕妇与非GDM孕妇并发PE者所占比例比较,差异有统计学意义(P<0.05)。超高龄组GDM孕妇与非GDM孕妇并发早发型PE、重度PE所占比例比较,差异亦有统计学意义(P<0.05)。②多因素非条件logistic回归分析结果显示,GDM是导致高龄组孕妇发生PE(OR=2.232,95%CI:1.080~4.613,P=0.030)的危险因素。GDM是导致超高龄组孕妇发生早发型PE(OR=3.456,95%CI:1.238~9.650,P=0.018)和重度PE(OR=2.236,95%CI:1.057~4.729,P=0.035)的危险因素。③控制混杂因素后,多因素非条件logistic回归分析结果显示,在高龄组中,GDM孕妇发生PE风险是非GDM孕妇的1.934倍(OR=1.934,95%CI:1.029~4.115,P=0.047);BMI≥24 kg/m2是导致高龄组GDM孕妇发生PE(OR=2.931,95%CI:1.332~6.449,P=0.008),早发型PE(OR=2.977,95%CI:1.105~8.019,P=0.031)和重度PE(OR=2.638,95%CI:1.093~6.365,P=0.031)的危险因素;居住地在乡村是导致其发生PE(OR=2.831,95%CI:1.042~7.686,P=0.041)和重度PE(OR=3.232,95%CI:1.088~9.603,P=0.035)的危险因素;文化程度高是高龄孕妇发生PE(OR=0.231,95%CI:0.071~0.749,P=0.015)和重度PE(OR=0.179,95%CI:0.048~0.673,P=0.011)的保护因素。在超高龄组中,GDM孕妇发生早发型PE、重度PE的风险,分别为非GDM孕妇的3.187倍(OR=3.187,95%CI:1.109~9.153,P=0.031)与2.3倍(OR=2.351,95%CI:1.043~5.302,P=0.039);BMI≥24 kg/m2是导致其发生PE(OR=2.654,95%CI:1.417~4.971,P=0.002)和重度PE(OR=3.418,95%CI:1.515~7.710,P=0.003)的危险因素;居住地在郊县是导致其发生PE(OR=2.374,95%CI:1.089~5.171,P=0.030)和重度PE(OR=5.303,95%CI:2.074~13.565,P<0.001)的危险因素;文化程度高是超高龄孕妇发生PE(OR=0.347,95%CI:0.135~0.892,P=0.028)和重度PE(OR=0.164,95%CI:0.047~0.574,P=0.005)的保护因素。结论GDM高龄孕妇的PE发病风险较非GDM高龄孕妇显著增高,GDM超高龄孕妇的早发型PE和重度PE发病风险较非GDM超高龄孕妇显著增加。BMI≥24 kg/m2、文化程度低、居住地在郊县和乡村,均是导致高龄及超高龄孕妇3种类型PE发生的危险因素。

Objective To investigate the correlation between advanced gestational diabetes mellitus(GDM)and different types of preeclampsia(PE),and to improve the clinical management of advanced GDM pregnant women.Methods From January to December 2018,600 elderly pregnant women[(36.4±1.2)years old]admitted to West China Second University Hospital,Sichuan University were included into elderly group,including 200 GDM and 400 non-GDM pregnant women.According to 1∶1 ratio,600 ultra-elderly pregnant women(200 GDM and 400 non-GDM pregnant women)who visited the same hospital during the same period were enrolled into ultra-elderly group,with the age of(40.9±1.2)years old.Independent-samples t test was used to compare the age between two groups,and the proportion of different types of PE was analyzed by chi-square test.Univariate and multivariate logistic regression models were used to analyze the relationship between GDM elderly pregnant women and different types of PE.This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.Results①The proportions of PE,early-onset PE and severe PE in GDM pregnant women were higher than those in non-GDM pregnant women in both elderly group and ultra-elderly group.Among them,the proportion of GDM pregnant women complicated with PE in the elderly group was higher than that of non-GDM pregnant women,with statistically significant(P<0.05).The proportion of early-onset PE and severe PE in GDM pregnant women in the ultra-elderly group were higher than those of non-GDM pregnant women,with statistically significant(P<0.05).②Univariate logistic regression analysis showed that GDM was a risk factor for PE of elderly group(OR=2.232,95%CI:1.080-4.613,P=0.030).As for ultra-elderly age group,GDM was a risk factor for early-onset PE(OR=3.456,95%CI:1.238-9.650,P=0.018)and severe PE(OR=2.236,95%CI:1.057-4.729,P=0.035).③After controlling for confounding factors,multivariate unconditional logistic regression analysis showed that the risk of PE in GDM pregnant women was 1.934 times than that in non-GDM pregnant women(OR=1.934,95%CI:1.029-4.115,P=0.047).In addition,BMI≥24 kg/m2 was a risk factor for PE(OR=2.931,95%CI:1.332-6.449,P=0.008),early-onset PE(OR=2.977,95%CI:1.105-8.019,P=0.031)and severe PE(OR=2.638,95%CI:1.093-6.365,P=0.031).Living in rural areas was a risk factor for PE(OR=2.831,95%CI:1.042-7.686,P=0.041)and severe PE(OR=3.232,95%CI:1.088-9.603,P=0.035).High education level was a protective factor for PE(OR=0.231,95%CI:0.071-0.749,P=0.015)and severe PE(OR=0.179,95%CI:0.048-0.673,P=0.011).In ultra-elderly group,the risk of early-onset PE and severe PE of pregnant women with GDM increased by 3.187 times(OR=3.187,95%CI:1.109-9.153,P=0.031)and 2.351 times(OR=2.351,95%CI:1.043-5.302,P=0.039),respectively,compared with those without GDM.In addition,BMI≥24 kg/m2 was a risk factor for PE(OR=2.654,95%CI:1.417-4.971,P=0.002)and severe PE(OR=3.418,95%CI:1.515-7.710,P=0.003).Living in suburban counties was a risk factor for PE(OR=2.374,95%CI:1.089-5.171,P=0.030)and severe PE(OR=5.303,95%CI:2.074-13.565,P<0.001).High education level was a protective factor for PE(OR=0.347,95%CI:0.135-0.892,P=0.028)and severe PE(OR=0.164,95%CI:0.047-0.574,P=0.005).Conclusions Elderly GDM pregnant women increase the risk of PE,while ultra-elderly GDM increases the risk of early onset and severe preeclampsia.Overweight and obesity,low education level and living in rural areas of suburban counties are different risk factors of preeclampsia.