妊娠糖尿病的影响因素及围产期结局

孟耀涵; 曲翌敏; 湛永乐; 陈云利; 石英杰; 景傲; 马良坤; 江宇

doi:10.16462/j.cnki.zhjbkz.2022.09.005

妊娠糖尿病的影响因素及围产期结局

doi: 10.16462/j.cnki.zhjbkz.2022.09.005

1.
100730 北京，中国医学科学院北京协和医学院群医学及公共卫生学院流行病与生物统计学系
2.
999077 香港，香港大学李嘉诚医学院公共卫生学院
3.
100020 北京，中国医学科学院北京协和医学院医学信息研究所
4.
100021 北京，中国医学科学院北京协和医学院医学实验动物研究所
5.
100005 北京，中国医学科学院北京协和医学院北京协和医院妇产科

基金项目:

中国医学科学院医学与健康科技创新工程 2019-I2M-2-007

详细信息

通讯作者:
江宇，E-mail: jiangyu@pumc.edu.cn

中图分类号: R715.3
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- PDF下载量: 75
- 被引次数: 0
出版历程
- 收稿日期: 2022-02-24
- 修回日期: 2022-05-24
- 网络出版日期: 2022-09-17
- 刊出日期: 2022-09-10

The influencing factors and perinatal outcomes of gestational diabetes

1.
Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
2.
School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong 999077, China
3.
Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100020, China
4.
Institute of Laboratory Animals Science, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
5.
Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China

Funds:

CAMS Innovation Fund of Medical Sciences (CIFMS) 2019-I2M-2-007

More Information

Corresponding author: JIANG Yu, E-mail: jiangyu@pumc.edu.cn

摘要

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。
- 妊娠糖尿病 /
- 围产结局 /
- 影响因素
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.
- 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)

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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

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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

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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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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)

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妊娠糖尿病的影响因素及围产期结局

doi: 10.16462/j.cnki.zhjbkz.2022.09.005

通讯作者:
江宇，E-mail: jiangyu@pumc.edu.cn

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The influencing factors and perinatal outcomes of gestational diabetes

Corresponding author: JIANG Yu, E-mail: jiangyu@pumc.edu.cn

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目录

留言板

妊娠糖尿病的影响因素及围产期结局

doi: 10.16462/j.cnki.zhjbkz.2022.09.005

通讯作者: 江宇，E-mail: jiangyu@pumc.edu.cn

计量

出版历程

The influencing factors and perinatal outcomes of gestational diabetes

Corresponding author: JIANG Yu, E-mail: jiangyu@pumc.edu.cn

计量

出版历程

目录

通讯作者:
江宇，E-mail: jiangyu@pumc.edu.cn