妊娠期糖尿病妇女再次妊娠时糖尿病的发生状况及相关危险因素分析

Analysis of the occurrence and related risk factors of gestational diabetes mellitus in women with gestational diabetes mellitus during re-pregnancy

目的:探讨妊娠期糖尿病妇女再次妊娠时妊娠期糖尿病的发生状况及相关危险因素。方法:选择两次分娩,且前次妊娠为妊娠期糖尿病的产妇中,随机抽取100例作为研究对象。根据研究对象再次妊娠时的75 g口服葡萄糖耐量试验结果,血糖异常的孕妇作为血糖异常组,血糖正常的孕妇作为血糖正常组。采用单因素分析法比较2组孕妇的体质量指数、年龄、孕前体质量、胰岛功能、初次妊娠时血糖水平、初次妊娠时是否使用胰岛素、两次妊娠的间隔时间、初次妊娠时胰岛素抵抗指数。采用多因素logistic回归分析法分析妊娠期糖尿病妇女再次妊娠时妊娠期糖尿病发生的危险因素。结果:妊娠期糖尿病妇女再次妊娠时血糖异常的发生率为72.00%,单因素分析结果显示,血糖异常组再次妊娠前体质量、再次妊娠前体质量指数、初次妊娠时空腹胰岛素水平、初次妊娠时餐后1 h胰岛素水平、初次妊娠时胰岛素抵抗指数、初次妊娠时采用胰岛素治疗率均高于血糖正常组(P<0.05~P<0.01)。多因素logistic回归分析结果显示,再次妊娠前体质量>55 kg、再次妊娠前体质量指数>24 kg/m 2、初次妊娠时采用胰岛素治疗、初次妊娠时胰岛素抵抗指数>2.7可能是妊娠糖尿病妇女再次妊娠时发生妊娠糖尿病的危险因素(OR=2.184,12.147,7.767,7.448,P<0.05~P<0.01)。结论:妊娠期糖尿病妇女再次妊娠时妊娠期糖尿病发生率较高,妊娠前体质量过重、体质量指数过高、胰岛素抵抗、初次妊娠时采用胰岛素治疗是再次妊娠时发生妊娠期糖尿病的危险因素。

Objective:To investigate the occurrence and related risk factors of gestational diabetes mellitus in women with gestational diabetes during re-pregnancy.Methods:A total of 100 cases were randomly selected as the study subjects from women who had two consecutive deliveries,and had gestational diabetes mellitus in the first pregnancy.According to the results of 75 g oral glucose tolerance test at the time of the second pregnancy of the study subjects,pregnant women with abnormal blood glucose were set as the abnormal blood glucose group and those with normal blood glucose were set as the normal blood glucose group.Univariate analysis was used to compare body mass index,age,pre-pregnancy body mass,islet function,blood glucose level at first pregnancy,whether insulin was used at first pregnancy,interval between pregnancies,and insulin resistance index at first pregnancy between the two groups of pregnant women.Multivariate logistic regression analysis was used to analyze the risk factors for the development of gestational diabetes mellitus in women with gestational diabetes mellitus when they became pregnant again.Results:The prevalence of abnormal glucose in women with gestational diabetes mellitus at the time of second pregnancy was 72.00%.Univariate analysis showed that body mass before second pregnancy,body mass index before second pregnancy,fasting insulin level at first pregnancy,insulin level 1 h after meal at first pregnancy,insulin resistance index at first pregnancy and rate of insulin treatment at first pregnancy were higher in the abnormal glucose group than those in the normal glucose group,ant the differences were all statistically significant(P<0.05 to P<0.01).Multivariate logistic regression analysis showed that body mass>55 kg before re-pregnancy,body mass index>24 kg/m 2 before re-pregnancy,insulin therapy at first pregnancy,and insulin resistance index>2.7 at first pregnancy might be risk factors for the development of gestational diabetes mellitus at re-pregnancy in women with gestational diabetes mellitus(OR=2.184,12.147,7.767,7.448,P<0.05 to P<0.01).Conclusions:The incidence of gestational diabetes mellitus is higher in women with gestational diabetes mellitus who become pregnant again.Excess body mass before pregnancy,high body mass index,insulin resistance,and use of insulin therapy in the first pregnancy are risk factors for the development of gestational diabetes mellitus during re-pregnancy.