北京平谷地区妊娠糖尿病发病危险因素及生产结局分析

Risk factors and outcomes of gestational diabetes mellitus in Pinggu district in Beijing

目的探讨北京平谷地区GDM发病率并分析其危险因素。方法前瞻性选取2016年10月至2017年3月于北京市平谷区医院进行产前检查并分娩的974例孕妇,排除孕前糖尿病后诊断GDM患者184例(GDM组),同期非GDM孕妇790例(N-GDM组)。比较两组年龄、孕前BMI、孕期BMI增幅、谷丙转氨酶、BP、DM家族史,探讨GDM的危险因素;比较两组妊娠、分娩期并发症的差异。结果平谷地区GDM发病率高达18.9%(184/974)。GDM组孕妇年龄中位数高于N-GDM组[31(28,35)vs 29(27,32)岁,Z=-4.719,P<0.01],GDM组孕前BMI中位数高于N-GDM组[24.2(22.2,26.2)vs 22.0(19.9,24.8)kg/m^(2),Z=-6.351,P<0.01],GDM组剖宫产率明显高于N-GDM组[60.9%(112/184)vs 42.7%(337/790),χ^(2)=19.29,P<0.01]。GDM、N-GDM组孕妇早产率[1.6%(3/184)vs 3.3%(26/790)]、妊娠期高血压病患病率[2.7%(5/184)vs 2.5%(20/790)]、巨大儿[4.3%(8/184)vs 6.5%(51/790)]比较,差异无统计学意义(P>0.2)。结论平谷地区GDM发病率较高,高龄、孕前超重及肥胖与GDM发生增加相关,应进一步加强对孕龄女性孕前体重管理,减少GDM发生;对GDM患者综合管理,避免不良妊娠结局发生。

Objective To investigate the prevalence and risk factors of gestational diabetes mellitus(GDM)in Pinggu District.Methods This prospective study enrolled 974 pregnant women who did prenatal examination and delivery in Pinggu District Hospital of Beijing between October 2016 to March2017.Subjects diagnosed with diabetes mellitus before pregnancy were excluded.All the participants were divided into two groups:GDM group(n=184)and pregnant women without diabetes(N-GDM group,n=790).Age,BMI before pregnancy,BMI increase during pregnancy,alanine aminotransferase,blood pressure,family history of diabetes were compared between the two groups,and the risk factors of GDM were explored.Chi-square test was used to compare pregnancy and delivery complications between the two groups.Results The prevalence of GDM was as high as 18.9%(184/974)in Pinggu District.The median age of pregnant women was significantly higher in GDM group than in non GDM group[31(28,35)vs29(27,32),Z=-4.719,P<0.001].The pre-pregnancy BMI was significantly higher in GDM group than in N-GDM group[24.2(22.2,26.2)vs 22.0(19.9,24.8)kg/m^(2),Z=-6.351,P<0.001].The cesarean section rate was significantly higher in GDM group than in N-GDM group[60.9%(112/184)vs 42.7%(337/790),χ^(2)=19.29,P<0.001].Preterm delivery rate[1.6%(3/184)vs 3.3%(26/790),χ^(2)=1.425,P>0.2],hypertensive disorder during pregnancy[2.7%(5/184)vs 2.5%(20/790),χ^(2)=0.021,P>0.2],and macrosomia rate[4.3%(8/184)vs 6.5%(51/790),χ^(2)=1.211,P>0.2]were not significantly different between GDM and N-GDM group.Conclusion The prevalence of GDM was high in Pinggu district.Old age,pre-pregnancy overweight and obesity were related to the increase of GDM prevalence.Pre-pregnancy weight management should be further strengthened to reduce the incidence of GDM.Comprehensive management of GDM should be adopted to avoid the occurrence of adverse pregnancy outcomes.