南充地区妊娠期糖尿病危险因素及妊娠结局分析

doi:10.3969/j.issn.1004-583X.2021.09.006

摘要/Abstract

摘要：

目的探讨南充地区妊娠期糖尿病(gestational diabetes mellitus,GDM)的危险因素及妊娠结局,为南充地区育龄妇女GDM防治提供参考依据。方法选取2018年7月1日至2019年9月30日在川北医学院附属医院产检并住院分娩的孕产妇1 800例,其中确诊GDM 537例(GDM组),血糖正常1 263例(NGT组),分析GDM的发病率、危险因素及妊娠结局。结果南充地区GDM发病率为29.83%。年龄、居住地、产前体重指数(body mass index,BMI)、多囊卵巢综合征(PCOS)、乙型病毒性肝炎表面抗原(HBsAg)、妊娠期高血压疾病(HDP)、妊娠期甲状腺功能、瘢痕子宫、体外受精(IVF)、流产史及分娩史与GDM发病相关;GDM与剖宫产、HDP、妊娠期肝内胆汁淤积症(ICP)、产后出血、早产、巨大儿发病相关(均P<0.05)。年龄、居住地、产前BMI、PCOS、HBsAg、HDP、妊娠期甲状腺功能、IVF及流产史是GDM发病的危险因素;GDM是剖宫产、HDP、ICP、产后出血及巨大儿发病的危险因素(均P<0.05)。结论南充地区GDM发病率可能与年龄、居住地、产前BMI、PCOS、HBsAg、HDP、妊娠期甲状腺功能、IVF及流产史有密切联系;GDM孕产妇剖宫产、HDP、ICP、产后出血及分娩巨大儿的风险较高。

关键词: 糖尿病, 妊娠, 发病率, 危险因素, 妊娠结局

Abstract:

Objective To discuss the risk factors and pregnancy outcomes of gestational diabetes mellitus(GDM) for GDM prevention and treatment in Nanchong area. Methods This study enrolled 1,800 pregnant women who performed prenatal check-up and delivery in Affiliated Hospital of North Sichuan Medical College from July 1, 2018 to September 30, 2019. Among the subjects, 537 cases were diagnosed GDM (GDM group), 1,263 cases with normal blood glucose (NGT group).The key observation involved the incidence, risk factors and pregnancy outcomes of GDM. Results In Nanchong area, the incidence of GDM was 29.83%. Age, residence, prenatal body mass index(BMI), polycystic ovary syndrome(PCOS), hepatitis B surface antigen(HBsAg), hypertensive disorder of pregnancy(HDP), thyroid function during pregnancy, scar uterus, in vitro fertilization(IVF), abortion history and delivery history were related to the onset of GDM. GDM was related to cesarean section, HDP, intrahepatic cholestasis of pregnancy(ICP), postpartum hemorrhage, preterm delivery, and macrosomia(all P<0.05). The risk factors of GDM were age, residence, prenatal BMI, PCOS, HBsAg, HDP, thyroid function during pregnancy, IVF and abortion history. GDM was a risk factor for cesarean section, HDP, ICP, postpartum hemorrhage and macrosomia (all P<0.05). Conclusion In Nanchong area, the incidence of GDM may be closely related to age, residence site, prenatal BMI, PCOS, HBsAg, HDP, thyroid function during pregnancy, IVF and abortion history. The risks of cesarean section, HDP, ICP, postpartum hemorrhage and macrosomia were higher in pregnant women with GDM.

Key words: diabetes, gestational, incidence, risk factors, pregnancy outcome

中图分类号:

R714.256

石瑶, 王虎, 陈敏, 李玉玲. 南充地区妊娠期糖尿病危险因素及妊娠结局分析[J]. 临床荟萃, 2021, 36(9): 795-798.

Shi Yao, Wang Hu, Chen Min, Li Yuling. Risk factors and pregnancy outcomes of gestational diabetes mellitus in Nanchong area[J]. Clinical Focus, 2021, 36(9): 795-798.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.09.006

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I9/795

图/表 4

参考文献 19

[1]	中华医学会糖尿医学分会. 中国2型糖尿病防治指南(2017年版)[J]. 中华糖尿病杂志, 2018, 10(1):4-67.
[2]	Carracher AM, Marathe PH, Close KL. International diabetes federation 2017[J]. J Diabetes, 2018, 10(5):353-356. doi: 10.1111/1753-0407.12644 pmid: 29345068
[3]	陈莎丽, 张京燕, 张开红, 等. 长治地区1038例孕妇糖耐量曲线特点调查分析[J]. 中国妇幼保健, 2020, 35(5):918-920.
[4]	Ding TT, Xiang J, Luo BR, et al. Relationship between the IADPSG-criteria-defined abnormal glucose values and adverse pregnancy outcomes among women having gestational diabetes mellitus: A retrospective cohort study[J]. Medicine (Baltimore), 2018, 97(43):e12920. doi: 10.1097/MD.0000000000012920 URL
[5]	Wahlberg J, Ekman B, Arnqvist HJ. Most women with previous gestational diabetes mellitus have impaired glucose metabolism after a decade[J]. Int J Mol Sci, 2018, 19(12):3724. doi: 10.3390/ijms19123724 URL
[6]	Ma RC, Tutino GE, Lillycrop KA, et al. Maternal diabetes, gestational diabetes and the role of epigenetics in their long term effects on offspring[J]. Prog Biophys Mol Biol, 2015, 118(1-2):55-68. doi: 10.1016/j.pbiomolbio.2015.02.010 URL
[7]	Metzger BE, Gabbe SG, Persson B, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J]. Diabetes Care, 2010, 33(3):676-682. doi: 10.2337/dc09-1848 pmid: 20190296
[8]	杨慧霞. 我国妊娠期糖尿病诊治现状和应对措施[J]. 中国实用妇科与产科杂志, 2013, 29(4):241-243.
[9]	Xu M, Liu B, Wu MF, et al. Relationships among acylation-stimulating protein, insulin resistance, lipometabolism, and fetal growth in gestational diabetes mellitus women[J]. J Obstet Gynaecol, 2015, 35(4):341-345. doi: 10.3109/01443615.2014.960376 pmid: 26018222
[10]	Frasca D, Blomberg BB, Paganelli R. Aging, obesity, and inflammatory age-related diseases[J]. Front Immunol, 2017, 8:1745. doi: 10.3389/fimmu.2017.01745 URL
[11]	Choe SA, Eliot MN, Savitz DA, et al. Ambient air pollution during pregnancy and risk of gestational diabetes in New York city[J]. Environ Res, 2019, 175:414-420. doi: 10.1016/j.envres.2019.04.030
[12]	Friedman JE, Kirwan JP, Jing M, et al. Increased skeletal muscle tumor necrosis factor-alpha and impaired insulin signaling persist in obese women with gestational diabetes mellitus 1 year postpartum[J]. Diabetes, 2008, 57(3):606-613. pmid: 18083784
[13]	华沛旻, 顾颖. 甲状腺功能异常与妊娠期糖尿病的相关性及其对妊娠结局的影响[J]. 中国妇幼保健, 2018, 33(22):5062-5065.
[14]	Evrenos AN, Cakir Gungor AN, Gulerman C, et al. Obstetric outcomes of patients with abortus imminens in the first trimester[J]. Arch Gynecol Obstet, 2014, 289(3):499-504. doi: 10.1007/s00404-013-2979-5 pmid: 23912531
[15]	赵丽娟, 秦家碧, 王婷婷, 等. 基于前瞻性队列研究先天畸形的危险因素及其对其他不良妊娠结局的影响[J]. 中华疾病控制杂志, 2019, 23(4):376-381+396.
[16]	Hosseini E, Janghorbani M, Shahshahan Z. Comparison of risk factors and pregnancy outcomes of gestational diabetes mellitus diagnosed during early and late pregnancy[J]. Midwifery, 2018, 66:64-69. doi: S0266-6138(18)30230-4 pmid: 30130677
[17]	梁艳, 徐先明. 妊娠期糖尿病与妊娠期高血压疾病相关性的研究进展[J]. 现代妇产科进展, 2007(12):939-941.
[18]	Yang Y, Wang Z, Mo M, et al. The association of gestational diabetes mellitus with fetal birth weight[J]. J Diabetes Complications, 2018, 32(7):635-642. doi: 10.1016/j.jdiacomp.2018.04.008 URL
[19]	Greenberg AS, McDaniel ML. Identifying the links between obesity, insulin resistance and beta-cell function: Potential role of adipocyte-derived cytokines in the pathogenesis of type 2 diabetes[J]. Eur J Clin Invest, 2002, 32(Suppl 3):24-34.

危险因素	GDM组 (n=537)	NGT组 (n=1 263)	χ²/ Z值	P值
年龄[例(%)]
≥35岁 <35岁	140(26.07) 397(73.93)	158(12.51) 1 105(87.49)	50.158	0.000
初潮年龄(岁)	13(12, 14)	3(12, 13)	-0.338	0.735
居住[例(%)]
城市农村	317(59.03) 220(40.97)	533(42.20) 730(57.80)	42.826	0.000
文化程度[例(%)]
小学及以下	16(2.98)	40(3.17)
初中	114(21.23)	261(20.67)	1.123	0.772
高中	94(17.50)	247(19.56)
大专及以上	313(58.29)	715(56.61)
身高(cm)	158(155, 162)	159(156, 162)	-1.363	0.173
产前BMI[例(%)]
≥28 kg/m² <28 kg/m²	252(46.93) 285(53.07)	457(36.18) 806(63.82)	18.217	0.000
PCOS[例(%)]
有无	23(4.28) 514(95.72)	19(1.50) 1 244(98.50)	12.766	0.000
HBsAg[例(%)]
HBsAg(+) HBsAg(-)	57(10.61) 480(89.39)	86(6.81) 1 177(93.19)	7.461	0.006
HDP[例(%)]
有无	41(7.64) 496(92.36)	51(4.04) 1 212(95.96)	10.052	0.002
妊娠期甲状腺功能[例(%)]
异常正常	181(33.71) 356(66.29)	324(25.65) 939(74.35)	11.834	0.001
瘢痕子宫[例(%)]
有无	179(33.33) 358(66.67)	355(28.11) 908(71.89)	4.931	0.026
IVF[例(%)]
IVF 自然受孕	54(10.06) 483(89.94)	69(5.46) 1 194(94.54)	12.484	0.000
流产史[例(%)]
有无	337(62.76) 200(37.24)	654(51.78) 609(48.22)	18.340	0.000
分娩史[例(%)]
有无	292(54.38) 245(45.62)	578(45.76) 685(54.24)	11.191	0.001
妊娠[例(%)]
单胎双胎	476(88.64) 61(11.36)	1 144(90.58) 119(9.42)	1.571	0.210

危险因素	GDM组 (n=537)	NGT组 (n=1 263)	χ²/ Z值	P值
年龄[例(%)]
≥35岁 <35岁	140(26.07) 397(73.93)	158(12.51) 1 105(87.49)	50.158	0.000
初潮年龄(岁)	13(12, 14)	3(12, 13)	-0.338	0.735
居住[例(%)]
城市农村	317(59.03) 220(40.97)	533(42.20) 730(57.80)	42.826	0.000
文化程度[例(%)]
小学及以下	16(2.98)	40(3.17)
初中	114(21.23)	261(20.67)	1.123	0.772
高中	94(17.50)	247(19.56)
大专及以上	313(58.29)	715(56.61)
身高(cm)	158(155, 162)	159(156, 162)	-1.363	0.173
产前BMI[例(%)]
≥28 kg/m² <28 kg/m²	252(46.93) 285(53.07)	457(36.18) 806(63.82)	18.217	0.000
PCOS[例(%)]
有无	23(4.28) 514(95.72)	19(1.50) 1 244(98.50)	12.766	0.000
HBsAg[例(%)]
HBsAg(+) HBsAg(-)	57(10.61) 480(89.39)	86(6.81) 1 177(93.19)	7.461	0.006
HDP[例(%)]
有无	41(7.64) 496(92.36)	51(4.04) 1 212(95.96)	10.052	0.002
妊娠期甲状腺功能[例(%)]
异常正常	181(33.71) 356(66.29)	324(25.65) 939(74.35)	11.834	0.001
瘢痕子宫[例(%)]
有无	179(33.33) 358(66.67)	355(28.11) 908(71.89)	4.931	0.026
IVF[例(%)]
IVF 自然受孕	54(10.06) 483(89.94)	69(5.46) 1 194(94.54)	12.484	0.000
流产史[例(%)]
有无	337(62.76) 200(37.24)	654(51.78) 609(48.22)	18.340	0.000
分娩史[例(%)]
有无	292(54.38) 245(45.62)	578(45.76) 685(54.24)	11.191	0.001
妊娠[例(%)]
单胎双胎	476(88.64) 61(11.36)	1 144(90.58) 119(9.42)	1.571	0.210

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.540	0.148	13.362	0.000	1.717	1.285	2.294
居住地	0.586	0.110	28.433	0.000	1.797	1.449	2.229
产前BMI≥28 kg/m²	0.303	0.111	7.478	0.006	1.353	1.090	1.681
PCOS	0.985	0.334	8.711	0.003	2.679	1.392	5.153
HBsAg(+)	0.411	0.187	4.805	0.028	1.508	1.044	2.177
HDP	0.527	0.229	5.322	0.021	1.695	1.083	2.653
妊娠期甲状腺功能异常	0.340	0.117	8.519	0.004	1.405	1.118	1.766
IVF	0.602	0.208	8.376	0.004	1.826	1.214	2.744
流产史	0.246	0.119	4.237	0.039	1.279	1.013	1.616

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.540	0.148	13.362	0.000	1.717	1.285	2.294
居住地	0.586	0.110	28.433	0.000	1.797	1.449	2.229
产前BMI≥28 kg/m²	0.303	0.111	7.478	0.006	1.353	1.090	1.681
PCOS	0.985	0.334	8.711	0.003	2.679	1.392	5.153
HBsAg(+)	0.411	0.187	4.805	0.028	1.508	1.044	2.177
HDP	0.527	0.229	5.322	0.021	1.695	1.083	2.653
妊娠期甲状腺功能异常	0.340	0.117	8.519	0.004	1.405	1.118	1.766
IVF	0.602	0.208	8.376	0.004	1.826	1.214	2.744
流产史	0.246	0.119	4.237	0.039	1.279	1.013	1.616

结局	GDM组 (n=537)	NGT组 (n=1 263)	χ²值	P值
剖宫产	445(82.87)	908(71.89)	24.316	0.000
HDP	41(7.64)	51(4.04)	10.052	0.002
ICP	119(22.16)	150(11.88)	31.349	0.000
产后出血	36(6.70)	46(3.64)	8.124	0.004
胎膜早破	86(16.01)	212(16.79)	0.162	0.687
泌尿生殖道感染	43(8.01)	97(7.68)	0.056	0.812
早产	154(28.68)	283(22.41)	8.060	0.005
巨大儿	31(5.78)	29(2.30)	14.135	0.000
足月低体重儿	18(3.35)	53(4.20)	0.709	0.400
胎儿窘迫	21(3.91)	21(3.91)	3.637	0.057
新生儿窒息	19(3.54)	31(2.45)	1.639	0.201