高龄经产妇再次妊娠患妊娠期糖尿病的危险因素分析  

Analysis of risk factors for gestational diabetes mellitus in elderly multipara women in the next pregnancy

作　　者：王崇丹 马影 李术文 李迁逊 张丽 林玲玲 黄斌斌 姜云生[2] Wang Chongdan;Ma Ying;Li Shuwen;Li Qianxun;Zhang Li;Lin Lingling;Huang Binbin;Jiang Yunsheng(Department of Obstetrics and Gynecology,Tianjin Binhai New Area Tanggu Obstetrics and Gynecology Hospital,Tianjin 300450,China;Department of Endocrinology,Tianjin Fifth Central Hospital,Tianjin 300450,China)

机构地区：[1]天津市滨海新区塘沽妇产医院妇产科,天津300450 [2]天津市第五中心医院内分泌科,天津300450

出　　处：《中华医学杂志》2022年第6期418-422,共5页National Medical Journal of China

基　　金：天津市滨海新区社会发展领域科技项目(BHXQKJXM-SF-2018-12)。

摘　　要：目的探讨高龄经产妇再次妊娠患妊娠期糖尿病(GDM)的危险因素。方法以2018年1月至2019年5月在天津市滨海新区塘沽妇产医院分娩的高龄经产妇(即本次妊娠分娩时年龄≥35岁,且有连续2次分娩记录)为研究对象,共219例,其中正常糖耐量(NGT)组141例,GDM组78例。收集前次及本次妊娠临床资料,分析高龄经产妇GDM发病危险因素。结果219例高龄经产妇前次及本次妊娠年龄分别为(31.9±2.2)和(36.7±1.5)岁,GDM患病率35.62%(78例)。GDM组比NGT组前次及本次妊娠75 g口服葡萄糖耐量试验(OGTT)空腹血糖[前次(5.51±1.43)比(4.63±0.62)mmol/L];本次(5.26±0.63)比(4.59±0.30)mmol/L],服糖后1 h血糖[前次(11.74±2.36)比(9.50±1.82)mmol/L;本次(11.03±2.03)比(9.51±1.14)mmol/L]均更高,前次及本次妊娠期剖宫产率更高(前次34.6%比4.3%;本次52.6%比22.0%),差异均有统计学意义(均P<0.05)。多因素分析结果显示,前次妊娠剖宫产史[OR值(95%CI)为10.80(4.09~28.54)]和GDM史[OR值(95%CI)为10.64(4.02~28.20)]及75 g OGTT空腹血糖≥4.86 mmol/L[OR值(95%CI)为2.70(1.27~5.70)]和服糖后1 h血糖≥8.45 mmol/L[OR值(95%CI)为1.78(1.37~2.31)]是高龄经产妇本次妊娠患GDM的危险因素。结论前次妊娠剖宫产史和GDM史可增加本次妊娠GDM发病风险,前次妊娠OGTT血糖也有预测价值。Objective To investigate the risk factors for gestational diabetes mellitus(GDM)in elderly multipara women in the next pregnancy.Methods A total of 219 elderly multipara women with 2 consecutive delivery records in Tianjin Binhai New Area Tanggu Obstetrics and Gynecology Hospital from January 2018 to May 2019 were included.Among them,141 had normal glucose tolerance(NGT)and 78 of them had GDM.The clinical data of the previous and current pregnancy were collected to analyze the risk factors of GDM in elderly multipara women.Results The average ages of 219 elderly women in previous pregnancy and this pregnancy were(31.9±2.2)and(36.7±1.5)years old,and the prevalence of GDM was 35.62%(78 cases).Compared to NGT group,GDM patients had higher fasting blood glucose(previous(5.51±1.43)vs(4.63±0.62)mmol/L;current(5.26±0.63)vs(4.59±0.30)mmol/L,1 h blood glucose(previous(11.74±2.36)vs(9.50±1.82)mmol/L;current(11.03±2.03)vs(9.51±1.14)mmol/L)in 75 g oral glucose tolerance test(OGTT)in both previous and current pregnancy.The rates of cesarean section,in both previous and current pregnancy were higher in GDM group(previous 34.6%vs 4.3%;current 52.6%vs 22.0%).Furthermore,prenatal weight and body mass index(BMI)of the previous pregnancy,pre-pregnancy weight and BMI,and prenatal BMI of this pregnancy were also higher in GDM group,and the differences were all statistically significant(all P<0.05).Logistic multivariate regression analysis indicated cesarean section history(OR=10.80,95%CI:(4.09-28.54)),GDM history of previous pregnancy(OR=10.64,95%CI:(4.02-28.20)),75 g OGTT fasting blood glucose≥4.86 mmol/L(OR=2.70,95%CI:(1.27-5.70)),1 h blood glucose after glucose administration≥8.45 mmol/L(OR=1.78,95%CI:(1.37-2.31))were risk factors for GDM in elderly multipara women of this pregnancy.Conclusion The risk of GDM in elderly multipara women with a history of cesarean section and GDM increases significantly.Results of OGTT in previous pregnancy also has predictive value.

关 键 词：糖尿病 妊娠 高龄 经产妇 

分 类 号：R714.256[医药卫生—妇产科学]