妊娠期糖尿病孕妇产后2年糖代谢转归失败风险因素分析

Analysis of the risk factors of conversion failure of abnormal glucose metabolism of women with gestational diabetes mellitus 2 years after delivery

目的:探究妊娠期糖尿病(GDM)孕妇产后2年内糖代谢转归情况及转归失败风险因素。方法:纳入2018年1月-2019年1月本院分娩且孕期诊断为妊娠期糖尿病GDM的120例产妇,产后随访2年,在产后2、6、12、18、24个月时检测空腹血糖(FPG)或75g葡萄糖耐量试验,以糖尿病(DM)为终点事件,Kaplan-Meier曲线绘制产后2年DM发病情况。分产后糖代谢正常组和异常组,分析产后糖代谢转归失败因素。结果:109例完成随访,产后2年内糖代谢异常42.2%,其中DM 17.4%,葡萄糖耐量受损18.4%,空腹血糖受损6.4%,产后2、6、12、18、24个月的DM累积发病率(7.3%、10.1%、11.0%、12.8%、17.4%)逐渐增加。糖代谢异常组孕前、孕期及产后体质指数≥28kg/m^(2)、腰臀比>0.85占比均高于正常组,孕期糖代谢指标均高于正常组,GDM诊断孕周小于正常组(均P<0.05),孕期及产后血脂代谢指标两组无差异(P>0.05)。logistic回归分析,肥胖、GDM诊断孕周早、产后-孕期FPG和2h PG差值大是GDM产后2年糖代谢转归失败危险因素(P<0.05)。结论:GDM孕妇产后糖尿病发病率随产后时间增加而升高,肥胖、GDM诊断孕周早、产后-孕期FPG和2h PG差值大是糖代谢转归失败风险因素。

Objective:To explore the situation and the risk factors of conversion failure of abnormal glucose metabolism of women with gestational diabetes mellitus(GDM)within 2 years after delivery.Methods:A total of 120 women who had been diagnosed as GDM during pregnancy from January 2018 to January 2019 were selected as study objects,and were followed up for 2 years.The fasting plasma glucose level of these women was detected and 75g Oral glucose tolerance test of the women was performed in 2,6,12,18,and 24 months after delivery.Based on the postpartum diabetes mellitus(DM)occurrence as the end point event,Kaplan-Meier curve was drawn to study the postpartum DM situation of the women within 2 years after delivery.The women were divided two groups according to their status of postpartum glycometabolism,which included the women with normal glycometabolism in group A and the women with abnormal glycometabolism in group B.The risk factors of conversion failure of abnormal glucose metabolism of these women were analyzed.Results:Among 109 women who had completed the followed up,42.2%of them had abnormal glucosemetabolism within 2 years after delivery,which included 17.4%women with DM,18.4%women with impaired glucose tolerance,and 6.4%women with impaired fasting glucose.The cumulative incidence of DM of the women in 2,6,12,18,and 24 months after delivery were 7.3%,10.1%,11.0%,12.8%,17.4%,respectively,which were gradually increased.The proportions of the women with body mass index≥28kg/m^(2) and the women with the ratio of waist to hip>0.85 in group A before pregnancy,during pregnancy,and after delivery were significantly higher than those in group A,the gestational weeks of the women when GDM diagnosis in group B was significantly less than that in group A(all P<0.05).There was no significant difference in the blood lipid metabolism index of the women during pregnancy or after delivery between the two groups(P>0.05).Logistic regression analysis showed that obesity,early gestational weeks when GDM diagnosis,and more different in the values of FPG and 2h PG from pregnancy to delivery were the risk factors of conversion failure of abnormal glucose metabolism of the women with GDM(P<0.05).Conclusion:The incidence of postpartum DM of the women with GDM increases gradually with the postpartum time prolonged.Obesity,early gestational weeks when GDM diagnosis,and more different in the values of FPG and 2h PG from pregnancy to delivery are the risk factors of conversion failure of abnormal glucose metabolism of the women with GDM.