初产妇妊娠期糖尿病产后血糖转归相关因素的前瞻性队列研究

A prospective cohort study on related factors of postpartum blood glucose outcome in gestational diabetes of primipara

目的跟踪评估初产妇妊娠期糖尿病(GDM)患者产后1年糖代谢转归情况并对转归失败因素进行探讨分析。方法选取2019年1月—2020年8月在丽水市人民医院定期产前检测的GDM患者266例建立前瞻性队列,收集孕期、产后基本情况信息,在产后6~12周和1年随访行75 g口服葡萄糖耐量试验(OGTT)检测,根据患者糖代谢水平分为正常组和异常组,分析影响血糖转归的相关因素。结果对861例GDM女性进行筛选,共纳入266例(30.89%)符合标准的GDM患者,其中252例(94.74%)完成产后6周随访,231例(86.84%)完成产后1年随访。252例中糖代谢异常98例,占比38.89%(98/252);随访至产后1年时,糖代谢异常90例,占比38.96%(90/231)。1年随访期间,2型糖尿病(T2DM)累积发病率为11.51%(29/252)。单因素分析结果显示,两组GDM患者孕期体质指数(BMI)、合并脂肪肝、诊断孕周、餐后1 h血糖(1h PG)、餐后2 h血糖(2h PG)、胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β)、胰岛素敏感性指数(matsuda指数)、血清总胆固醇(TC)及三酰甘油(TG)等因素比较,差异均有统计学意义(均P<0.05)。将单因素分析中差异有统计学意义的因素纳入多因素logistic逐步回归分析模型,结果显示,孕期BMI(≥28 kg/m^(2))、诊断孕周、孕期1h PG、孕期HOMA-IR为GDM患者产后1年糖代谢转归失败的独立危险因素(均P<0.05)。结论对于孕期BMI较大、诊断孕周越早、1h PG水平越高及HOMA-IR指数越大的GDM孕妇,其在产后1年内发生糖代谢异常的风险越高。

Objective To follow up and evaluate the outcome of glucose metabolism in primiparous women with gestational diabetes mellitus(GDM)1 year after delivery,and to explore and analyze the failure factors of the outcome.Methods Enrolled GDM patients who were regularly prenatally tested in Lishui People’s Hospital from January 2019 to August 2020.A prospective cohort was established to collect basic information during pregnancy,and re-examine 75g oral glucose tolerance at 6-12 weeks and 1 year after delivery.The patients were divided into normal group and abnormal group according to the glucose metabolism level,and the relevant factors affecting the outcome of blood sugar were analyzed.Results 861 cases of GDM women were screened.A total of 266 cases(30.89%)of GDM women meeting the criteria were recruited.Among them,252 cases(94.74%)completed the 6-week postpartum follow-up,and 231 cases(86.84%)completed the 1-year postpartum follow-up.Among the 252 cases,98 cases were in the abnormal glucose metabolism group,accounting for 38.89%(98/252);after follow-up to 1 year postpartum,90 cases were abnormal in glucose metabolism,accounting for 38.96%(90/231).During the 1-year follow-up,the cumulative incidence of T2DM was 11.51%(29/252).Univariate analysis found that there were significant differences in BMI during pregnancy,combined fatty liver,diagnosis week,1h PG,2h PG,HOMA-IR,HOMA-β,matsuda index,TC and TG factors(P<0.05).The factors with differences in univariate analysis were included in the logistic multivariate stepwise regression analysis model.The results showed that BMI during pregnancy(≥28 kg/m^(2)),the number of weeks of pregnancy diagnosed,1h PG during pregnancy,and HOMA-IR during pregnancy are independent risk factors for failure of glucose metabolism outcome within 1 year of GDM patients.(P<0.05).Conclusion For pregnant women with gestational diabetes who have a larger BMI during pregnancy,the earlier the diagnosis week,the higher the 1h PG level and the larger the HOMA-IR index,the higher the risk of abnormal glucose metabolism within 1 year after delivery.