妊娠糖尿病筛查与筛查阳性的危险因素分析

Screening for gestational diabetes mellitus and risk factors for positive screening

目的 在天津市区开展系统的妊娠糖尿病筛查、诊断和治疗 ,调查筛查阳性率和危险因素。方法 于 1999年在天津市内六区进行了妊娠糖尿病筛查。筛查孕周为 2 6～ 30周 ,使用 1小时 5 0g葡萄糖筛查试验 (GCT) ,血糖值≥7 8mmol/L的孕妇再进一步做口服葡萄糖耐量试验 (OGTT)。结果 筛查 94 71名孕妇 ,其中 9 38%的孕妇筛查阳性。 70 1名接受OGTT ,174名诊断为妊娠糖尿病。筛查阳性的危险因素有 :年龄 (OR :1 0 5 2 ,95 %CI:1 0 30～ 1 0 73) ,孕前体重 (OR :1 0 37,95 %CI:1 0 2 7～ 1 0 4 6 ) ,孕期增重 (OR :1 0 2 6 ,95 %CI:1 0 0 9～ 1 0 4 4 ) ,身高 (OR :0 94 3,95 %CI:0 92 7～ 0 95 9) ,糖尿病家族史 ,吸烟 (OR :3 2 84 ,95 %CI:1 0 5 2～ 10 2 5 3) ,妊高征 (OR :1 5 90 ,95 %CI:1 2 2 7～ 2 0 6 0 )。结论 天津市区妊娠糖尿病的筛选阳性率为 9 38%。高龄 ,身材矮 ,孕前体重高 ,孕期过多增重 ,糖尿病家族史 。

Objective To introduce systematic screening for diagnosis and management of gestational diabetes mellitus (GDM),to analyse risk factors of positive glucose challenge test and investigate the baseline incidence.Methods From December 1998 to December 1999,a screening for GDM was conducted within six urban districts of Tianjin at 26～30 gestational weeks by using a 1-h 50-g oral glucose challenge test (GCT).The cutoff point was set at ≥7.8mmol/L.Women with a positive screening result were given a 75-g 2-h glucose tolerance test (OGTT).Results A total of 9471 women were screened.About 9.4% (888/9471)of them were positive in the GCT.Of them,701 women had a subsequent OGTT.174 women were diagnosed as GDM.The predictors for a positive GCT were: age (OR:1.052,95%CI:1.030-1.073),pregravid body weight (OR:1.037,95%CI:1.027-1.046),pregnancy weight gain at GCT (OR:1.026,95%CI:1.009-1.044),stature (OR:0.943,95%CI:0.927-0.959),family history of diabetes,habitual cigarette smoking (OR:3.284,95%CI:1.052-10.253),Pregnancy-induced hypertension (OR:1.590,95%CI:1.227-2.060).Conclusion The incidence of positive GCT in urban Tianjin was 9.38%.Older age,short stature,high pregravid body weight,undue pregnancy weight gain,family history of diabetes,smoking,and pregnancy-induced hypertension were predictive of a positive GCT.