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摘要:
目的 分析妊娠糖尿病(gestational diabetes mellitus, GDM)的相关危险因素,并探讨GDM的围产期结局。 方法 本研究数据来源于中国孕产妇队列研究协和项目,共纳入孕妇3 874例,根据75 g口服葡萄糖耐量试验结果,分为GDM组(494例)和正常组(3 380例)。收集各组母婴的临床资料、围产结局和新生儿结局,并采用χ2检验、秩和检验、Fisher确切概率法、单因素logistic回归分析模型和多因素logistic回归分析模型分析GDM发病的相关危险因素。 结果 GDM组早产、胎膜早破及大于胎龄儿的发生率大于正常组,差异均有统计学意义(均有P<0.05)。logistic回归分析模型分析结果显示:随着年龄的增加,发生GDM的风险也逐渐增加;南方地区(OR=1.719, 95% CI: 1.401~2.109, P < 0.001)、孕期增重不足(OR=1.485, 95% CI: 1.164~1.893, P=0.001)及孕前超重(OR=1.634, 95% CI: 1.241~2.151, P < 0.001)也是GDM发病的独立危险因素。 结论 高龄、南方地区、孕前超重及孕期增重不足是GDM的影响因素,应尽早识别相关危险因素并积极干预,从而降低不良妊娠结局的发生,改善母婴健康状况。 Abstract:Objective To analyze the risk factors of gestational diabetes mellitus (GDM) and to explore the perinatal outcomes of GDM. Methods Data were derived from the Chinese Pregnant Women Cohort Study, and 3 874 pregnant women were included. According to the results of 75 g oral glucose tolerance test, 494 cases were in the GDM group, and 3 380 cases were in the non-GDM group. The clinical characteristics, perinatal outcomes and neonatal outcomes of mothers and infants in each group were recorded, and the data were compared by χ2 test, Wilcoxon rank sum test, Fisher exact probability method and univariate logistic regression analysis. Results The incidence of premature delivery and premature rupture of membranes of GDM were higher than those in the normal group, with statistically significant differences (all P < 0.05). The multivariate logistic regression showed that the risk of developing GDM increased with age. In addition, the southern region (OR=1.719, 95% CI: 1.401-2.109, P < 0.001), insufficient weight gain during pregnancy (OR=1.485, 95% CI: 1.164-1.893, P=0.001) and preconception overweight (OR=1.634, 95% CI: 1.241-2.151, P < 0.001) were independent risk factors of GDM. Conclusion Advanced age, southern region, overweight before pregnancy and insufficient weight gain during pregnancy are influencing factors of GDM. The related risk factors should be identified as soon as possible and actively intervened, in order to reduce the occurrence of adverse pregnancy outcomes and improve health status of mothers and infants. -
Key words:
- Gestational diabetes mellitus /
- Perinatal outcomes /
- Influencing factors
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表 1 研究对象的一般特征[n(%)]
Table 1. Demographic characteristics of participants [n(%)]
变量 合计(N=3 874) GDM组(n=494) 非GDM组(n=3 380) χ2/Z值 P值 年龄(岁) 10.373 < 0.001 < 25 571(14.7) 26(5.3) 545(16.1) 25~<30 1 911(49.3) 201(40.7) 1 710(50.6) 30~<35 975(25.2) 162(32.8) 813(24.1) ≥35 417(10.8) 105(21.2) 312(9.2) 地域 32.488 < 0.001 南方 1 975(51.0) 311(63.0) 1 664(49.2) 北方 1 899(49.0) 183(37.0) 1 716(50.8) 民族 3.189 0.074 汉族 3 672(94.8) 460(93.1) 3 212(95.0) 少数民族 202(5.2) 34(6.9) 168(5.0) 户口类型 26.740 < 0.001 城镇 1 784(46.1) 281(56.9) 1 503(44.5) 农村 2 090(53.9) 213(43.1) 1 877(55.5) 文化程度 1.646 0.100 初中及以下 544(14.0) 64(13.0) 480(14.2) 高中 779(20.1) 90(18.2) 689(20.4) 本科 2 285(59.0) 300(60.7) 1 985(58.7) 硕士及以上 266(6.9) 40(8.1) 226(6.7) 职业 5.078 0.024 无业 1 115(28.8) 121(24.5) 994(29.4) 有业 2 759(71.2) 373(75.7) 2 386(70.6) 家庭年收入(万元) 3.807 < 0.001 < 6 698(18.0) 69(14.0) 629(18.6) 6~<10 609(15.7) 63(12.8) 546(16.2) 10~<20 1 487(38.4) 197(39.9) 1 290(38.2) ≥20 1 080(27.9) 165(33.4) 915(27.1) 孕期增重 -4.383 < 0.001 不足 839(21.7) 145(29.4) 694(20.5) 适宜 1 513(39.1) 188(38.1) 1 325(39.2) 过多 1 522(39.3) 161(32.6) 1 361(40.3) 孕前BMI(kg/m2) 3.803 < 0.001 消瘦 544(14.0) 49(9.9) 495(14.6) 正常 2 767(71.4) 351(71.1) 2 416(71.5) 超重 503(13.0) 86(17.4) 417(12.3) 肥胖 60(1.5) 8(1.6) 52(1.5) 孕产史 4.926 0.026 初产妇 2 179(56.2) 255(51.6) 1 924(56.9) 经产妇 1 695(43.8) 239(48.4) 1 456(43.1) 糖尿病家族史 0.108 0.742 无 3 682(95.0) 471(95.3) 3 211(95.0) 有 192(5.0) 23(4.7) 169(5.0) 表 2 GDM影响因素的logistic回归分析模型分析结果
Table 2. Logistic regression model analysis results of GDM influencing factors
变量 β值 Wald值 OR(95% CI)值 P值 年龄组(岁) < 25 1.000 25~<30 0.829 14.511 2.290(1.495~3.507) < 0.001 30~<35 1.346 34.866 3.840(2.457~6.002) < 0.001 ≥35 1.861 55.874 6.432(3.948~10.479) < 0.001 地域 北方 1.000 南方 0.542 26.954 1.719(1.401~2.109) < 0.001 户口 城镇 1.000 农村 -0.142 1.711 0.868(0.702~1.073) 0.191 职业 无业 1.000 有业 -0.006 0.002 0.994(0.782~1.263) 0.960 家庭年收入(万元) < 6 1.000 6~<10 -0.066 0.119 0.936(0.645~1.360) 0.730 10~<20 0.135 0.730 1.145(0.839~1.563) 0.393 ≥20 0.213 1.592 1.238(0.889~1.724) 0.207 孕期增重 适宜 1.000 不足 0.395 10.159 1.485(1.164~1.893) 0.001 过多 -0.187 2.479 0.829(0.657~1.047) 0.115 孕前BMI(kg/m2) 正常 1.000 消瘦 -0.272 2.706 0.762(0.552~1.053) 0.100 超重 0.491 12.241 1.634(1.241~2.151) < 0.001 肥胖 0.327 0.666 1.387(0.632~3.044) 0.414 孕产史 初产妇 1.000 经产妇 -0.190 2.914 0.827(0.665~1.029) 0.088 表 3 两组孕妇围产结局的分布情况[n(%)]
Table 3. Distribution of perinatal outcomes in two groups [n(%)]
变量 GDM组 非GDM组 OR(95% CI)值 P值 早产 是 40(8.1) 147(4.3) 1.510(1.028~2.220) 0.036 否 454(91.9) 3 233(95.7) 1.000 分娩方式 剖宫产 256(51.8) 1 514(44.8) 1.093(0.893~1.337) 0.389 自然分娩 238(48.2) 1 866(55.2) 1.000 胎盘早剥 是 1(0.2) 23(0.7) 0.265(0.035~2.019) 0.200 否 493(99.8) 3 357(99.3) 1.000 胎膜早破 是 94(19.0) 449(13.3) 1.409(1.091~1.821) 0.009 否 400(81.0) 2 931(86.7) 1.000 产后出血 是 10(2.0) 48(1.4) 1.182(0.577~2.420) 0.648 否 484(98.0) 3 332(98.6) 1.000 表 4 两组新生儿围产结局的分布情况[n(%)]
Table 4. Distribution of perinatal outcomes between the two groups [n(%)]
变量 GDM组 非GDM组 OR(95% CI)值 P值 SGA 是 26(5.3) 226(6.7) 0.737(0.479~1.135) 0.166 否 468(94.7) 3 154(93.3) 1.000 LGA 是 102(20.6) 542(16.0) 1.343(1.048~1.720) 0.020 否 392(79.4) 2 838(84.0) 1.000 新生儿并发症 是 8(1.6) 37(1.1) 1.446(0.649~3.219) 0.366 否 486(98.4) 3 343(98.9) 1.000 是否转入NICU 是 20(4.0) 110(3.3) 1.419(0.851~2.365) 0.180 否 474(96.0) 3 270(96.7) 1.000 -
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