妊娠期糖尿病与早产亚型之间的关联研究

Association between gestational diabetes mellitus and preterm birth subtypes

目的探讨妊娠期糖尿病(GDM)与早产亚型之间的关联。方法招募孕早、中期在安徽省安庆市立医院产前筛查的孕妇,进行基线调查和生物标本采集,随访孕妇至分娩或妊娠终止,通过医院电子病历系统、问卷调查等获取孕妇孕期情况、妊娠结局等信息,建设孕妇队列。采用log-binomial回归模型探讨GDM与早产[医源性早产和自发性早产(未足月胎膜早破和早产临产)]之间的关联;对于多个混杂因素,采用倾向性评分校正法构建模型计算调整后的关联。结果在2031例分娩单胎的孕妇中,GDM和早产的发生比例分别为10.0%(204例)和4.4%(90例);其中,GDM组(n=204)孕妇发生医源性早产和自发性早产的比例分别为1.5%和5.9%,非GDM组(n=1827)孕妇发生医源性早产、自发性早产的比例分别为0.9%和3.2%,两组自发性早产的比例差异有统计学意义(P=0.048)。进一步细化自发性早产亚型,结果显示GDM组发生未足月胎膜早破、早产临产的比例分别为4.9%和1.0%,非GDM组发生未足月胎膜早破、早产临产的比例分别为2.1%和1.1%。GDM孕妇发生未足月胎膜早破的风险是非GDM孕妇的2.34倍(aRR=2.34,95%CI:1.16~4.69)。结论GDM可能增加未足月胎膜早破的发生风险,未发现GDM孕妇早产临产发生比例显著增加。

Objective To investigate the association between gestational diabetes mellitus(GDM)and preterm birth subtypes.Methods Based on the cohort of pregnant women in Anqing Prefectural Hospital,the pregnant women who received prenatal screening in the first or second trimesters were recruited into baseline cohorts;and followed up for them was conducted until delivery,and the information about their pregnancy status and outcomes were obtained through electronic medical record system and questionnaire surveys.The log-binomial regression model was used to explore the association between GDM and preterm birth[iatrogenic preterm birth,spontaneous preterm birth(preterm premature rupture of membranes and preterm labor)].For multiple confounding factors,the propensity score correction model was used to compute the adjusted association.Results Among the 2031 pregnant women with a singleton delivery,the incidence of GDM and preterm birth were 10.0%(204 cases)and 4.4%(90 cases)respectively.The proportions of iatrogenic preterm birth and spontaneous preterm birth in the GDM group(n=204)were 1.5%and 5.9%respectively,while the proportions in non-GDM group(n=1827)were 0.9%and 3.2%respectively,and the difference in the proportion of spontaneous preterm birth between the two groups was significant(P=0.048).Subtypes of spontaneous preterm were further analyzed,and the results showed that the proportions of preterm premature rupture of membranes and preterm labor in the GDM group were 4.9%and 1.0%respectively,while the proportions in the non-GDM group were 2.1%and 1.1%respectively.It showed that the risk of preterm premature rupture of membranes in GDM pregnant women was 2.34 times(aRR=2.34,95%CI:1.16-4.69)higher than that in non-GDM pregnant women.Conclusions Our results showed that GDM might increase the risk of preterm premature rupture of membranes.No significant increase in the proportion of preterm labor in pregnant women with GDM was found.