孕妇妊娠期糖尿病的危险因素分析

Study on risk factors in pregnant women with gestational diabetes mellitus

目的研究孕妇妊娠期糖尿病(GDM)发生的危险因素,为GDM的筛查及干预提供参考。方法收集2018年1~10月在马鞍山市人民医院及马鞍山市妇幼保健院进行产前检查的539例单活胎孕妇的临床资料。根据产次分为初产妇组(n=319)与二胎孕妇组(n=220),初产妇组分为正常组(n=93)与GDM组(n=226),二胎孕妇组分为正常组(n=62)与GDM组(n=158)。收集孕妇年龄、孕次、孕前身体质量指数(BMI)、当前BMI、空腹血糖(FPG)、铁蛋白、血红蛋白的资料并进行t检验,多因素logistic回归分析孕妇GDM发生的影响因素,应用受试者工作特征(ROC)曲线分析危险因素的预测价值。结果(1)与初产妇比较,二胎孕妇年龄、孕次、孕前BMI、当前BMI、FPG均高于初产妇,差异有统计学意义(P<0.05)。(2)在初产妇中,GDM组FPG高于正常组,差异有统计学意义(P<0.05);在二胎孕妇中,GDM组孕次、孕前BMI、FPG均高于正常组,差异有统计学意义(P<0.05)。(3)多因素logistic回归分析显示,FPG(OR=4.597,95%CI:3.344~6.319)及孕前BMI(OR=1.073,95%CI:1.001~1.150)水平的升高是孕妇GDM发生的危险因素(P<0.05)。(4)ROC曲线结果显示,在孕妇中FPG、孕前BMI预测GDM发生的曲线下面积为分别0.838、0.554,灵敏度为75.80%、90.10%,特异度为100%、20%。结论FPG及孕前BMI水平的升高是本地区孕妇GDM发生的危险因素,并且FPG对GDM的发生具有良好的预测能力。

Objective To study the risk factors of gestational diabetes mellitus(GDM)so as to provide reference for the screening and intervention of it.Methods The clinical data of 539 singleton pregnant women who underwent prenatal check-up in Maanshan People’s Hospital and Maanshan Maternal and Child Health Care Hospital from January to October 2018 were collected.The included pregnant women were divided into the primipara group(n=319)and thesecond pregnant womengroup(n=220).The primipara group was subdivided into normal group(n=93)and GDM group(n=226),and thesecond pregnant womengroup was subdivided into normal group(n=62)and GDM group(n=158).Age,times of pregnancy,pre-pregnancy body mass index(BMI),current BMI,fasting plasma glucose(FPG),serum ferritin and hemoglobin of the pregnant women were collected and analyzed by ttest.Multivariate logistic regression was used to analyze the influencing factors of GDM in pregnant women.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of risk factors.Results(1)Compared with primipara women,the age,times of pregnancy,pre-pregnancy BMI,current BMI and FPG of the second pregnant women were all higher than those of primiparas,and the differences were statistically significant(P<0.05).(2)Among the primipara women,FPG in GDM group was higher than that in normal group,and the difference was statistically significant(P<0.05).Amongthe second pregnant women,times of pregnancy,pre-pregnancy BMI and FPG in GDM group were all higher than those in normal group,and the differences were statistically significant(P<0.05).(3)Multivariate logistic regression analysis showed that FPG(OR=4.597,95%CI:3.344~6.319)and pre-pregnancy BMI(OR=1.073,95%CI:1.001~1.150)were risk factorsof GDM.(4)ROC curve showed that the area under the curve of FPG and pre-pregnancy BMIwas 0.838 and 0.554,the sensitivitywas 75.80% and 90.10%,the specificitywas 100% and 20%,respectively.Conclusions FPG and pre-pregnancy BMI are risk factors of GDM,and FPG has a good predictive ability for the occurrence of GDM.