妊娠期糖尿病不良妊娠结局相关危险因素分析

Analysis of related risk factors of adverse pregnancy outcomes of pregnant women with gestational diabetes mellitus

目的研究妊娠期糖尿病(GDM)患者不良妊娠结局发生的相关危险因素。方法选取2019年6月到2020年6月在西北妇女儿童医院产科住院分娩的GDM患者243例,根据妊娠结局分为不良妊娠结局组和正常妊娠结局组,采用单因素和多因素二分类Logistic回归模型分析GDM患者年龄、孕前BMI、糖尿病家族史、不良孕产史、糖尿病确诊孕周、文化程度及经济状况等一般资料以及孕中期口服葡萄糖耐量试验(OGTT)血糖指标结果与妊娠结局的相关性。结果 243例GDM患者中,不良妊娠结局的发生率为37.86%(92人)。多因素Logistic回归分析显示年龄≥35岁(OR=4.232,P=0.032)、孕前BMI≥25kg/m;(OR=3.673,P=0.008)是GDM患者发生不良妊娠结局的危险因素;OGTT三项指标均异常者不良妊娠结局发生显著增加(OR=3.887,P=0.014)。结论 GDM患者不良妊娠结局发生率较高,高龄(35岁及以上)、孕前超重肥胖(BMI≥25kg/m;)以及OGTT结果三项指标均异常者不良妊娠结局显著增加。临床上应予以早识别、早管理、早干预,并积极进行孕期血糖和体重控制。

Objective To analyze related risk factors of adverse pregnancy outcomes of pregnant women with gestational diabetes mellitus(GDM).Methods 243 pregnant women with GDM who delivered in Department of Obstetrics, Northwest Women and Children′s Hospital from June 2019 to June 2020 were selected as study subjects.According to pregnancy outcome, the pregnant women with GDM were divided into adverse pregnancy outcome group and normal pregnancy outcome group.General information of the pregnant women in the two groups such as age, pre-pregnancy body mass index(BMI),oral glucose tolerance test results in middle pregnancy, family history of diabetes mellitus, history of pregnancy, gestational age at diagnosis of diabetes mellitus, educational level, and economic status were collected with a questionnaire.And their adverse pregnancy outcomes were recorded after delivery.Univariate and multivariate binary logistic regression analyses were used to analyze possible factors that associated with perinatal adverse outcomes.Results Among 243 pregnant women with GDM,92(37.86%) pregnant women had adverse pregnancy outcomes.Multiple logistic regression analysis showed that advanced age(age ≥35 years)(OR=4.232,P=0.032),pre-pregnancy overweight and obesity(BMI≥25 kg/m;)(OR=3.673,P=0.008) were significantly associated with adverse perinatal outcomes of the pregnant women with GDM.Besides, GDM pregnant women with abnormal OGTT results in all three indexes had significantly increased risk of adverse perinatal outcomes(OR=3.887,P=0.014).Conclusion The incidence of adverse pregnancy outcomes in the pregnant women with GDM is higher.Advanced age, overweight or obesity before pregnancy, severely abnormal OGTT results(all three indexes are abnormal simultaneously) would increase the risk of adverse pregnancy outcomes in pregnant women with GDM.Clinicians should pay special attention to these group of pregnant women to improve their pregnancy outcomes.