妊娠早期黄体酮的使用对妊娠期糖尿病的影响

Effects of progesterone treatment on gestational diabetes mellitus in early pregnancy

目的探讨妊娠早期使用黄体酮对妊娠期糖尿病(GDM)发病率的影响。方法采用回顾性队列研究,选取妊娠早期被诊断为先兆流产的孕妇654例,其中接受黄体酮治疗的214例为给药组,未接受黄体酮治疗的440例作为对照组,比较2组间的GDM发生率和口服葡萄糖耐量试验结果异常率。构建logistic回归模型,分析黄体酮的使用对GDM的影响。结果给药组GDM发病率显著高于对照组(31.3%vs.16.4%,P<0.01),空腹血糖异常率与对照组无显著差异(12.1%vs.7.7%,P>0.05),服糖后1 h、2 h血糖异常率与对照组有显著差异(14.5%vs.6.8%,P<0.01;15.9%vs.7.5%,P<0.01)。多因素logistic回归分析显示妊娠早期使用黄体酮是GDM发生的危险因素(OR=2.300,95%CI:1.549~3.417,P<0.01)。结论妊娠早期使用黄体酮与GDM的发病率有相关性,且主要影响餐后血糖。

AIM To study the effects of progesterone treatment on the incidence of gestational diabetes mellitus(GDM)in early pregnancy.METHODS A retrospective cohort study of 654 pregnant women who were diagnosed as threatened abortion in early pregnancy was conducted,and 214 were treated with progesterone as treatment group and 440were not treated with progesterone as control group.The incidence of GDM and abnormal oral glucose tolerance test results between the two groups were compared,and a logistic regression model was constructed to analyze the effect of progesterone on GDM.RESULTS The incidence rate of GDM in the treatment group was significantly higher than that in the control group(31.3%vs.16.4%,P<0.01),the incidence of abnormal fasting blood glucose was not significantly different from that in the control group(12.1%vs.7.7%,P>0.05),and the incidence of abnormal blood glucose at 1 h or 2 h after taking glucose was significantly different from that in the control group(14.5%vs.6.8%,P<0.01;15.9%vs.7.5%,P<0.01).Multivariate logistic regression analysis showed that progesterone treatment in early pregnancy was a risk factor for GDM(OR=2.300,95%CI:1.549 to 3.417,P<0.01).CONCLUSION Progesterone treatment in early pregnancy is correlated with the incidence of GDM,and mainly affects postprandial blood glucose.