中国妊娠期糖尿病孕妇不良妊娠结局危险因素的Meta分析

Risk factors of adverse pregnancy outcomes in pregnant women with gestational diabetes mellitus in China:a Meta-analysis

目的系统评价妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇发生不良妊娠结局(adverse pregnancy outcomes,APO)的危险因素。方法计算机检索中国知网、万方、维普、中国生物医学文献数据库(CBM)、PubMed、Web of Science、Embase、the Cochrane library数据库中从建库至2024年3月22日发表的有关GDM孕妇发生APO危险因素的文献,采用RevMan 5.4和Stata 16.0软件进行Meta分析。结果最终纳入20篇文献,整合14项危险因素。Meta分析结果显示,年龄≥35岁[OR=3.02,95%CI(2.02~4.52),P<0.001]、孕前体重指数(body mass index,BMI)≥24.0 kg·m^(-2)[OR=2.31,95%CI(1.51~3.54),P<0.001]、孕期体重增加≥16 kg[OR=4.50,95%CI(2.24~9.06),P<0.001]、不良孕产史[OR=2.05,95%CI(1.76~2.38),P<0.001]、糖尿病家族史[OR=1.97,95%CI(1.68~2.30),P<0.001]、空腹血糖[OR=1.45,95%CI(1.17~1.81),P<0.001]、糖化血红蛋白[OR=1.22,95%CI(1.08~1.37),P=0.001]、口服葡萄糖耐量测试(oral glucose tolerance test,OGTT)血糖指标3项异常[OR=2.60,95%CI(1.72~3.93),P<0.001]、妊娠期血糖控制不佳[OR=3.23,95%CI(1.85~5.64),P<0.001]、血清胰高血糖素样肽-1(glucagon-likepeptide-1,GLP-1)水平低[OR=2.30,95%CI(1.62~3.27),P<0.001]、合并妊娠期高血压[OR=1.77,95%CI(1.03~3.05),P=0.040]、总胆固醇[OR=1.26,95%CI(1.15~1.38),P<0.001]均为导致GDM孕妇发生APO的危险因素。结论年龄≥35岁、孕前BMI≥24.0 kg·m^(-2)、孕期体重增加≥16 kg、不良孕产史、糖尿病家族史、空腹血糖、糖化血红蛋白、OGTT血糖指标3项异常、妊娠期血糖控制不佳、血清GLP-1水平低、合并妊娠期高血压和总胆固醇是GDM孕妇发生APO的危险因素,为该类人群APO的预防、诊治及护理提供了理论依据。

Objective To systematically evaluate the risk factors for adverse pregnancy outcomes(APO)in pregnant women with gestational diabetes mellitus(GDM).Methods CNKI,WanFang Data,VIP,CBM,PubMed,Web of Science,Embase,and The Cochrane library were searched for literature on risk factors for APO in pregnant women with GDM from the establishment of the databases to March 22,2024.Meta-analysis was performed using the RevMan 5.4 and Stata 16.0 softwares.Results 20 articles were included and 14 risk factors were integrated.The results of Meta-analysis showed that age≥35 years[OR=3.02,95%CI(2.02-4.52),P<0.001],pre-pregnancy body mass index(BMI)≥24.0 kg·m^(-2)[OR=2.31,95%CI(1.51-3.54),P<0.001],and weight gain≥16 kg during pregnancy[OR=4.50,95%CI(2.24-9.06),P<0.001],adverse maternal history[OR=2.05,95%CI(1.76-2.38),P<0.001],family history of diabetes mellitus[OR=1.97,95%CI(1.68-2.30),P<0.001],fasting blood glucose[OR=1.45,95%CI(1.17-1.81),P<0.001],glycosylated hemoglobin[OR=1.22,95%CI(1.08-1.37),P=0.001],3 abnormal blood glucose indexes in oral glucose tolerance test(OGTT)[OR=2.60,95%CI(1.72-3.93),P<0.001],poor glycemic control during pregnancy[OR=3.23,95%CI(1.85-5.64),P<0.001],low serum glucagonlike peptide-1(GLP-1)level[OR=2.30,95%CI(1.62-3.27),P<0.001],comorbid gestational hypertension[OR=1.77,95%CI(1.03-3.05),P=0.040],and total cholesterol[OR=1.26,95%CI(1.15-1.38),P<0.001]were risk factors for APO in pregnant women with GDM.Conclusion Age≥35 years,pre-pregnancy BMI≥24.0 kg·m^(-2),weight gain during pregnancy≥16 kg,adverse maternal history,family history of diabetes,fasting glucose,glycated hemoglobin,3 abnormal blood glucose indexes in OGTT,poor glycemic control during pregnancy,low serum GLP-1 level,combined gestational hypertension,and total cholesterol were the risk factors for APO in pregnant women with GDM,which provided a theoretical basis for the prevention,diagnosis and treatment,and care of APO in this population.