妊娠期糖尿病孕妇产后糖代谢异常的危险因素分析

Analysis of the Risk Factors Related to Abnormal Postpartum Glucose Metablism in Patients with Gestational Diabetes Mellitus

目的:探讨妊娠期糖尿病(GDM)孕妇产后糖代谢异常的发病率及危险因素。方法:选取2020年7月~2021年12月在本院分娩且产后6~12周复查75 g葡萄糖耐量试验(OGTT)的153例妊娠期糖尿病孕妇,根据产后OGTT结果分为产后糖代谢正常组和产后糖代谢异常组,对两组的临床资料进行单因素和多因素Logistic回归分析,以明确GDM孕妇产后发生糖代谢异常的危险因素。结果:① 产后6~12周糖代谢异常64例(41.8%, 64/153),其中2型糖尿病(T2DM) 13例(8.5%)、葡萄糖耐量受损(IGT) 47例(30.8%)、空腹血糖受损(IFG) 4例(2.6%)。② 单因素分析显示:两组间年龄、孕前体质量指数(BMI)、既往GDM病史、孕早期空腹血糖(FPG)、甘油三酯(TG)、血白细胞(WBC)、谷丙转氨酶(ALT)及孕中期OGTT血糖水平具有统计学差异(P < 0.05)。③ 多因素Logistic回归分析显示:年龄 ≥ 35岁、孕前BMI ≥ 24 kg/m2、既往有GDM病史、孕中期OGTT ≥ 2个时点血糖异常是GDM孕妇产后发生糖代谢异常的独立危险因素(P < 0.05)。结论:GDM孕妇产后糖代谢异常发病率高,年龄 ≥ 35岁、孕前BMI ≥ 24 kg/m2、既往有GDM病史、孕期OGTT ≥ 2个时点血糖异常是GDM孕妇产后发生糖代谢异常的独立高危因素,临床应重视这类孕妇的产后糖代谢随访及干预。

Objective: To explore the incidence and risk factors of abnormal postpartum glucose metabolism in patients with gestational diabetes mellitus (GDM). Methods: A total of 153 patients with GDM who were delivered to our hospital from July 2020 to December 2021 and evaluated with 75 g glucose tolerance test (OGTT) at 6 to 12 weeks follow-up at postpartum. The patients were allocated into normal glucose metabolism group and abnormal glucose metabolism group depending on the result of 75 g OGTT. Univariate analysis and multivariate Logistic regression were operated to analyze the risk factors of abnormal postpartum glucose metablism in GDM patients. Results: ① There were 64 abnormal glucose metabolism (41.8%, 64/153) with abnormal glucose metabolism from 6 to 12 weeks postpartum, including 13 (8.5%) with type 2 diabetes (T2DM), 47 (30.8%) with impaired glucose tolerance (IGT), and 4 (2.6%) with impaired fasting glucose (IFG). ② Univariate analysis showed that age, pre-pregnancy BMI, previous GDM history, fasting blood glucose, triglycerides, white blood cell, alanine transaminase in the early stages of pregnancy, and OGTT blood glucose levels during pregnancy were significantly different between the two groups (P < 0.05). ③ Multivariate Logistic regression analysis showed that age ≥ 35, pre-pregnancy BMI ≥ 24 kg/m2, previous history of GDM, and more than 2 abnormal blood glucose items in OGTT were independent risk factors for abnormal postpartum glucose metabolism in GDM (P < 0.05). Conclusion: GDM patients have a high incidence of abnormal postpartum glucose metabolism. Age ≥ 35, pre-pregnancy BMI ≥ 24 kg/m2, previous history of GDM, and more than 2 abnormal blood glucose items in OGTT were independent risk factors, and more clinical attention should be paid to the follow-up and intervention of postpartum glucose metabolism in such patients.