孕期体质量增长及血脂水平对妊娠期糖尿病发病的影响研究  

The Effect of the Body Weight Gain and the Level of the Blood Lipid that on the Occurrence of the Gestational Diabetes Mellitus

作　　者：范岩峰 谢婧娴 蔡李倩 郭奇伟 许榕仙[2] FAN Yanfeng;XIE Jingxian;CAI Liqian(The Maternal and Child Health Hospital, Xiamen Fujian 361003, China)

机构地区：[1]厦门市妇幼保健院,福建厦门361000 [2]福建医科大学公共卫生学院,福建福州350004

出　　处：《实用妇产科杂志》2018年第9期706-711,共6页Journal of Practical Obstetrics and Gynecology

基　　金：厦门市科技计划局资助项目(编号:3502Z20164030);厦门市卫生和计划生育委员会资助课题(编号:2014-2-76);福建省医药卫生科技创新项目(编号:2014-CXB-46)

摘　　要：目的:探讨孕期体质量增长及血脂各项指标的变化对妊娠期糖尿病(GDM)发病的影响。方法:以273例GDM患者为病例组,并以年龄段为匹配因素进行1∶1的频数配对,以273例糖耐量试验正常的孕妇作为对照组。收集两组孕妇年龄、孕前体质量、身高、每次产检的孕周及体质量,检测孕早期(孕13周前)空腹血糖、糖耐量结果及孕早期(孕13周前)、孕中期(孕19~20周)、孕晚期(孕36~37周)的血脂水平等资料,分析GDM的影响因素。结果:多因素Logistic回归分析显示,孕前BMI≥24.0 kg/m2(OR=2.015,P=0.040)、孕早期空腹血糖≥5.10 mmol/L(OR=2.183,P=0.014)、孕中期低密度脂蛋白≥2.80 mmol/L(OR=3.484,P=0.001)及平均每周体质量增长≥0.80 kg(OR=2.789,P=0.004)均是GDM发病的独立危险因素,而孕中期高密度脂蛋白≥1.90 mmol/L(OR=2.015,P=0.04)则是GDM发病的保护因素。结论:临床上,产科医生应及早关注孕前BMI≥24.0 kg/m2、孕早期空腹血糖≥5.10 mmol/L、孕中期平均每周体质量增长≥0.80 kg及低密度脂蛋白≥2.80 mmol/L的孕妇。以上指标作为GDM独立危险因素的评估,可能对GDM的发生风险能进行更好的预测。Objective： To discuss the effect of the body weight gain during the pregnancy and the level of the blood lipid that the occurrence of the gestational diabetes mellitus（ GDM）.Methods： We collected 273 pregnant women as the GDM group.Meanwhile,we chose 273 pregnant women whose levels of the glucose were normal as the control group through pairing the age with the case group.We collected the pregnant women＇s information,including the age,the bodyweight before pregnancy,the height,the growth of bodyweight and the level of the blood fat in the different periods of the pregnancy,the level of the fasting plasma glucose before 13 th week,the results of the oral glucose tolerance test and other basic data.Through analyzing their basic data,we wanted to explore the risk factors of the GDM.Results： Multivariate Logistic regression analysis showed that pre-pregnancy BMI was ≥24. 0 kg/m2（ OR= 2. 015,P = 0. 040）,fasting blood glucose during pregnancy was ≥5. 10 mmol/L（ OR = 2. 183,P =0. 014）,and mid-pregnancy low-density lipoprotein≥2. 80 mmol/L（ OR = 3. 484,P = 0. 001） and average weekly weight gain ≥0. 80 kg（ OR = 2. 789,P = 0. 004） were both independent risk factors for the onset of GDM,and high-density lipoprotein≥1. 90 mmol/L during the second trimester（ OR = 2. 015,P = 0. 040） was the protective factor of GDM.Conclusions： In clinical practice,the obstetricians should pay more attention to the pregnant women whose pre-pregnancy BMI over 24. 0 kg/m2,the fasting plasma glucose before 13 th week over 5. 1 mmol/L,the low density lipoprotein from 19 th to 20 th week over 2. 80 mmol/L and the body weight gain form the 13 th to the28 th week over 0. 80 kg/w.If we using the above indicators as independent risk factors to predict the occurrence of the GDM,maybe we can obtain a satisfactory result.

关 键 词：体质量增长 血脂水平 妊娠期糖尿病 

分 类 号：R714.256[医药卫生—妇产科学]