初产妇妊娠期糖尿病的风险因素分析及二甲双胍治疗的价值研究

Risk Factors Analysis of Primipara Gestational Diabetes Mellitus and the Value of Metformin Therapy

目的:探讨初产妇妊娠期糖尿病的风险因素及二甲双胍治疗的价值。方法:选取信丰县人民医院2021年9月—2023年8月收治的78例GDM孕妇作为GDM组,选取同期78例非GDM孕妇作为非GDM组。收集两组孕妇临床资料,包括孕妇年龄、家庭月收入、妊娠前体质指数、学历、是否为独生子女、糖尿病家族史、本次妊娠受孕方式、吸烟史、多囊卵巢综合征史、孕前3个月阴道流血情况等,采用单因素和多因素Logistic回归分析其危险因素。根据治疗方法不同将GDM孕妇分为观察组(n=39例,采用二甲双胍治疗)和对照组(n=39例,采用临床常规治疗),比较两组糖脂代谢指标水平、妊娠结局及治疗满意度。结果:经单因素分析结果显示,两组孕妇年龄、妊娠前BMI、有糖尿病家族史、初潮年龄比较,差异具有统计学意义(P<0.05);多因素Logistic回归分析显示:年龄>35岁(OR=4.697,95%CI:2.855~7.728)、妊娠前BMI≥24kg/m^(2)(OR=2.965,95%CI:2.055~4.278)、有糖尿病家族史(OR=2.396,95%CI:2.093~2.774)均为初产妇GDM发生的高危因素;治疗后两组糖脂代谢指标水平均降低,且观察组低于对照组(P<0.05);观察组不良妊娠结局总发生率为15.38%,低于对照组的38.46%;观察组治疗总满意度为94.87%,高于对照组的79.49%,差异具有统计学意义(P<0.05)。结论:年龄、妊娠前BMI、有糖尿病家族史是初产妇GDM发生的独立危险因素,并且给予二甲双胍方案治疗,能有效改善糖脂代谢,降低不良妊娠结局发生率,提高治疗满意度。

Objective:To investigate the risk factors of Gestational Diabetes Mellitus(GDM)in primipara and the value of metformin therapy.Methods:78 pregnant women with GDM treated in our hospital from September 2021 to August 2023 were selected as the GDM group,and 78 pregnant women without GDM were selected as the non-GDM group during the same period.Clinical data of the two groups of pregnant women were collected,including age of pregnant women,monthly family income,Body Mass Index(BMI)before pregnancy,educational background,whether they were the only child,family history of diabetes,method of conception of this pregnancy,smoking history,history of polycystic ovary syndrome,and vaginal bleeding 3 months before pregnancy,etc.The risk factors were analyzed by univariate and multivariate Logistic regression.According to different treatment methods,pregnant women with GDM were divided into observation group(n=39 cases,treated with metformin)and control group(n=39 cases,treated with conventional clinical treatment).The levels of glucose and lipid metabolism indexes,pregnancy outcomes and treatment satisfaction of the two groups were compared.Results:Univariate analysis showed that there were significant differences in age,BMI before pregnancy,family history of diabetes and age of menarche between the two groups(P<0.05).Multivariate Logistic regression analysis showed that:age>35 years old(OR=4.697,95%CI:2.855~7.728),pre-pregnancy BMI≥24kg/m^(2)(OR=2.965,95%CI:2.055~4.278),family history of diabetes(OR=2.396,95%CI:2.093~2.774)were high risk factors for GDM in primipara.After treatment,the levels of glucose and lipid metabolism indexes in both groups were decreased,and the observation group was lower than the control group(P<0.05).The total incidence of adverse pregnancy outcomes in the observation group was 15.38%,which was lower than that in the control group 38.46%.The total satisfaction of the observation group was 94.87%,higher than that of the control group 79.49%,and the difference was statistically significant(P<0.05).Conclusion:Age,pre-pregnancy BMI and family history of diabetes are independent risk factors for GDM in primipara.Treatment with metformin regimen can effectively improve glucose and lipid metabolism,reduce the incidence of adverse pregnancy outcomes and improve treatment satisfaction.