基于多中心数据分析妊娠糖尿病危险因素及对妊娠结局的影响

Analysis of risk factors of gestational diabetes mellitus and its influence on pregnancy outcome based on multicenter data

目的借助多中心的临床数据分析妊娠糖尿病(GDM)的危险因素并探讨其对妊娠结局的影响。方法选择重庆市3所医院产科2012年2月—2019年3月的孕妇病历5 038例,根据糖尿病诊断标准筛查GDM,分析影响GDM发生的危险因素,比较GDM组和非GDM组孕妇妊娠结局的差异。结果不同年龄、孕前体型、孕期增体质量、产次、妊娠次数、剖宫产史孕妇的GDM患病率差异均有统计学意义(P<0.05)。经Logistic回归分析发现,年龄≥35岁、孕前超质量和肥胖、孕期增体质量过少、妊娠次数2~4次和多于5次、有剖宫产史是孕妇发生GDM的危险因素。此外,GDM组孕妇的妊娠期高血压疾病、水肿、胎膜早破、早产、剖宫产、巨大儿的发生率均显著高于非GDM组(P<0.05)。结论年龄≥35岁、孕前超质量和肥胖、孕期增体质量过少等均为GDM发生的危险因素,且GDM孕妇的不良妊娠结局发生率较高。因此对于GDM孕妇,需早期进行血糖筛查,定期产检并有效控制血糖水平,对高危因素进行早期防控,才能够获得良好的母婴结局。

Objective To analyze the risk factors of gestational diabetes mellitus(GDM) using multicenter clinical data and explore its influence on pregnancy outcome. Methods A total of 5 038 cases of pregnant women from February 2012 to March 2019 in 3 obstetric hospitals in Chongqing were selected, according to the diagnostic criteria for diabetes screening for GDM, to analyze the risk factors of GDM and compare the difference of pregnancy outcome between GDM group and non GDM group. Results The differences between GDM group and non-GDM group in age, body mass index before pregnancy, weight gain during pregnancy, parity, number of pregnancies and previous cesarean section history were statistically significant(P<0.05). Logistic regression analysis showed that age≥35 years old, overweight and obesity before pregnancy, low weight gain during pregnancy, 2~4 times and ≥5 times of pregnancy, and previous cesarean section history were risk factors for GDM. The incidence of hypertensive disorder complicating pregnancy, edema, premature rupture of membranes, premature delivery, cesarean section and macrosomia in GDM group were significantly higher than those in non-GDM group(P<0.05). Conclusion Age≥35 years old, overweight and obesity before pregnancy, too little weight gain during pregnancy are all risk factors for GDM, and the incidence of adverse pregnancy outcomes for GDM pregnant women is relatively high. Therefore, for GDM pregnant women, early blood glucose screening, regular prenatal examination and effective control of blood glucose level, and early prevention and control of high-risk factors are necessary to obtain good maternal and infant outcomes.