2013-2017年北京市通州区34 637例孕妇妊娠期糖尿病流行情况及其影响因素研究

韩娜; 刘珏; 金楚瑶; 刘峥; 林力孜; 王海俊

doi:10.16462/j.cnki.zhjbkz.2019.02.007

2013-2017年北京市通州区34 637例孕妇妊娠期糖尿病流行情况及其影响因素研究

doi: 10.16462/j.cnki.zhjbkz.2019.02.007

韩娜¹,
刘珏²,
金楚瑶³,
刘峥³,
林力孜³,
王海俊^3, ,

1.
101100 北京市, 北京市通州区妇幼保健院
2.
100191 北京市, 北京大学公共卫生学院流行病与卫生统计学系
3.
100191 北京市, 北京大学公共卫生学院妇幼卫生学系

基金项目:

国家自然科学基金 81703240

北京大学优博人才培育项目 BMU20160568

详细信息

通讯作者:
王海俊, E-mail: whjun1@bjmu.edu.cn

中图分类号: R181
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出版历程
- 收稿日期: 2018-07-30
- 修回日期: 2018-09-28
- 刊出日期: 2019-02-10

Prevalence of gestational diabetes mellitus and its related risk factors among 34 637 pregnant women in Tongzhou district of Beijing from 2013 to 2017

1.
Tongzhou Maternal & Child Health Hospital of Beijing, Beijing 101100, China
2.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
3.
Department of Maternal and Child Health, School of Public Health, Peking University, Beijing 100191, China

Funds:

National Natural Science Foundation of China 81703240

the Talent Project of Peking University BMU20160568

More Information

Corresponding author: WANG Hai-jun, E-mail: whjun1@bjmu.edu.cn

摘要

摘要: 目的了解北京市通州区孕妇妊娠期糖尿病（gestational diabetes mellitus，GDM）的流行情况及其相关影响因素。方法收集2013年1月1日至2017年12月31日期间在北京市通州区妇幼保健院住院分娩的34 637例单胎孕妇的社会人口学特征、既往史、糖尿病家族史及本次妊娠情况等资料，分析孕妇GDM患病率，利用多因素Logistic回归分析GDM相关影响因素。结果 34 637例单胎孕妇的GDM患病率为23.19%（8 034/34 637）。多因素分析显示，高龄（aOR=1.87，95%CI：1.71~2.05）、高文化程度（aOR=1.19~1.23）、2016-2017年分娩（aOR=1.46，95%CI：1.38~1.55）、巨大儿分娩史（aOR=1.27，95%CI：1.02~1.59）、剖宫产史（aOR=1.18，95%CI：1.08~1.30）、自然流产史（aOR=1.23，95%CI：1.10~1.37）、药物及人工流产史（aOR=1.08，95%CI：1.01~1.14）、糖尿病家族史（aOR=1.51，95%CI：1.26~1.83）、经产妇（aOR=1.24，95%CI：1.15~1.34）、孕前超重（aOR=2.02，95%CI：1.89~2.15）、孕前肥胖（aOR=3.11，95%CI：2.81~3.43）、采用辅助生殖技术怀孕者（aOR=1.47，95%CI：1.03~2.10）是GDM的独立危险因素。结论北京市通州区住院分娩的孕妇中GDM处于较高的流行水平。应针对影响GDM发病的相关危险因素，开展孕前及孕期健康教育，及时监测及预防GDM的发生，以促进母婴健康。
- 妊娠期糖尿病 /
- 流行病学 /
- 影响因素
Abstract: Objective The study aims to investigate the prevalence of gestational diabetes mellitus (GDM) among pregnant women in Tongzhou district of Beijing and its related risk factors. Methods Information of 34 637 singleton pregnancies delivered in a maternal and child health care hospital in Tongzhou district of Beijing were collected from January 1, 2013 to December 31, 2017. GDM prevalence of pregnant women were calculated. Multivariable logistic regression analysis was used to analyze the association between GDM and its related factors. Results The prevalence of GDM in 34 637 singleton pregnant women in Tongzhou district of Beijing was 23.2% (8 034/34 637). Multivariate analysis showed that advanced maternal age(aOR=1.87, 95% CI: 1.71-2.05), high level of education(aOR=1.19-1.23), delivering during 2016-2017(aOR=1.46, 95% CI: 1.38-1.55), macrosomia(aOR=1.27, 95% CI: 1.02-1.59), history of cesarean section(aOR=1.18, 95% CI: 1.08-1.30), history of spontaneous abortion(aOR=1.23, 95% CI: 1.10-1.37), history of induced abortion(aOR=1.08, 95% CI: 1.01-1.14), family history of diabetes(aOR=1.51, 95% CI: 1.26-1.83), multipara(aOR=1.24, 95% CI: 1.15-1.34), pre-pregnancy overweight(aOR=2.02, 95% CI: 1.89-2.15), pre-pregnancy obesity(aOR=3.11, 95% CI: 2.81-3.43)and conceived by assisted reproductive technology(aOR=1.47, 95% CI: 1.03-2.10)were the independent risk factors for GDM. Conclusions Prevalence of GDM is high in pregnant women in Tongzhou district of Beijing. Health education before and during pregnancy should be carried out to monitor and prevent the occurrence of GDM in time to ensure maternal and child health.
- Gestational diabetes /
- Epidemiology /
- Infuential factors

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表 1 2013-2017年北京市通州区34 637例孕妇GDM流行趋势[n (%)]

Table 1. Trends of GDM prevalence in 34 637 pregnant women from 2013 to 2017 in Tongzhou, Beijing[n (%)]

年份	例数	GDM		χ²值	P值
年份	例数	人数	患病率(%)	χ²值	P值
2013	3 923 (11.32)	804	20.49	239.56	< 0.001
2014	7 979 (23.03)	1 597	20.01
2015	5 583 (16.11)	1 052	18.84
2016	8 797 (25.39)	2 346	26.67
2017	8 355 (24.12)	2 235	26.75
合计	34 637 (100.00)	8 034	23.19

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表 2 2013-2017年通州区不同特征孕妇的GDM患病率比较[n (%)]

Table 2. Comparison of GDM prevalence among pregnant women with different characteristics from 2013 to 2017 in Tongzhou, Beijing[n (%)]

分组	例数	GDM患病率	χ²值	P值
社会人口学特征
年龄(岁)			377.70	< 0.001^a
＜35	31 550(91.09)	6 883(21.82)
≥35	3 087(8.91)	1 151(37.29)
文化程度			11.78	0.008^a
初中及以下	4 047(12.39)	882(21.79)
高中及中专	6 927(21.20)	1 709(24.67)
大学及以上	21 693(66.41)	5 103(23.52)
民族			0.83	0.363
汉族	32 608(94.15)	7 581(23.25)
其他	2 025(5.85)	453(22.37)
现住地			18.04	< 0.001^a
北京	33 701(97.30)	7 871(23.36)
外地	936(2.70)	163(17.41)
分娩年			235.43	< 0.001^a
2013-2015	17 485(50.48)	3 453(19.75)
2016-2017	17 152(49.52)	4 581(26.71)
既往史及家族史
巨大儿分娩史			38.99	< 0.001^a
无	34 241(98.86)	7 890(23.04)
有	396(1.14)	144(36.36)
剖宫产史			127.40	< 0.001^a
无	30 048(86.75)	6 669(22.19)
有	4 589(13.25)	1 365(29.75)
自然流产史			38.57	< 0.001^a
无	32 676(94.35)	7 466(22.85)
有	1 955(5.65)	566(28.95)
药物及人工流产史			49.24	< 0.001^a
无	23 339(67.40)	5 155(22.09)
有	11 290(32.60)	2 877(25.48)
糖尿病家族史			38.41	< 0.001^a
无	34 064(98.35)	7 839(23.01)
有	573(1.65)	195(34.03)
本次妊娠情况
孕次			106.44	< 0.001^a
1次	16 969(49.03)	3 587(21.14)
2次	9 707(28.05)	2 295(23.64)
3次及以上	7 936(22.92)	2 144(27.02)
产次			63.80	< 0.001^a
初产	23 865(68.90)	5 245(21.98)
经产	10 772(31.10)	2 789(25.89)
孕前体质指数(kg/m²)			1 244.00	< 0.001^a
<18.5	3 316(11.07)	388(11.70)
18.5~	18 974(63.33)	3 879(20.44)
24~	5 744(19.17)	2 000(34.82)
≥28	1 925(6.43)	865(44.94)
多囊卵巢综合征			9.74	0.002^a
无	34 571(99.81)	8 008(23.16)
有	66(0.19)	26(39.39)
采用辅助生殖技术怀孕			20.12	< 0.001^a
无	34 490(99.58)	7 977(23.13)
有	147(0.42)	57(38.78)
合计	34 637 (100.00)	8 034 (23.19)
注：^aP<0.05。缺失数据：文化程度1 970例(5.69%)；民族4例(<0.01%)；孕次25例(<0.01%)；自然流产6例(<0.01%)；孕前体质指数4 678例(13.51%)。

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表 3 影响GDM发生的多因素Logistic回归分析

Table 3. Logistic regression analysis on the GDM related influential factors

因素	β	s_x	P值	aOR(95% CI) 值^a
年龄(岁)
＜35				1.00
≥35	0.626	0.047	< 0.001	1.87 (1.71~2.05)
文化程度
初中及以下				1.00
高中及中专	0.204	0.052	< 0.001	1.23 (1.11~1.36)
大学及以上	0.176	0.047	< 0.001	1.19 (1.09~1.31)
分娩年
2013-2015				1.00
2016-2017	0.379	0.030	< 0.001	1.46 (1.38~1.55)
巨大儿分娩史
无				1.00
有	0.238	0.114	0.036	1.27 (1.02~1.59)
剖宫产史
无				1.00
有	0.169	0.048	< 0.001	1.18 (1.08~1.30)
自然流产史
无				1.00
有	0.204	0.056	< 0.001	1.23 (1.10~1.37)
药物及人工流产史
无				1.00
有	0.073	0.031	0.017	1.08 (1.01~1.14)
糖尿病家族史
无				1.00
有	0.415	0.095	< 0.001	1.51 (1.26~1.83)
产次
初产				1.00
经产	0.215	0.039	0.000	1.24 (1.15~1.34)
孕前体质指数(kg/m²)
<18.5	-0.644	0.058	< 0.001	0.53 (0.47~0.59)
18.5~1.00
24~	0.701	0.034	< 0.001	2.02 (1.89~2.15)
≥28	1.134	0.051	< 0.001	3.11 (2.81~3.43)
采用辅助生殖技术怀孕
无				1.00
有	0.386	0.181	0.033	1.47 (1.03~2.10)
注：^aaOR：多因素Logistic回归模型调整其他因素的比值比；95% CI：95%置信区间。

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