妊娠期糖尿病危险因素及妊娠期高血糖对不良妊娠结局影响的研究  

Study of the risk factors for gestational diabetes mellitus and the effect of gestational hyperglycemia on adverse pregnancy outcomes

作　　者：陈岚[1] 张玉 孙聪 陆慧萍[1] 蔡任之 崔欣 虞慧婷 Chen Lan;Zhang Yu;Sun Cong;Lu Huiping;Cai Renzhi;Cui Xin;Yu Huiting(Songjiang District Center for Disease Control and Prevention,Shanghai 201620,China;Shanghai Municipal Center for Disease Control and Prevention,Shanghai 200051,China;Shanghai Health Statistics Center,Shanghai 200040,China)

机构地区：[1]上海市松江区疾病预防控制中心,上海201620 [2]上海市卫生健康统计中心,上海200040 [3]上海市疾病预防控制中心,上海200051

出　　处：《中华糖尿病杂志》2023年第10期933-940,共8页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学青年科学基金项目(82003486);上海市“科技创新行动计划”技术标准项目(22DZ2206000)。

摘　　要：目的探讨妊娠期糖尿病(GDM)的危险因素并分析妊娠期高血糖包括孕前糖尿病合并妊娠(PGDM)和GDM与不良妊娠结局的关系。方法为历史性队列研究。纳入有2013—2020年上海市松江区出生登记数据与2011—2020年医疗机构临床疾病诊断数据的单胎妊娠产妇和新生儿。收集产妇的户籍、年龄、学历、产次、流产次数、孕周、分娩方式,以及妊娠高血压、多囊卵巢综合征(PCOS)、PGDM和GDM的患病情况。同时收集新生儿的出生体重和出生缺陷的发生情况。依据PGDM和GDM的诊断标准,将产妇分为PGDM组、GDM组和糖代谢水平正常组(对照组)。3组之间的比较采用χ2检验和方差分析。采用多因素logistic回归模型分析产妇生育特征对GDM发病的影响。并采用多水平logistic回归模型分析PGDM和GDM对不良妊娠结局的影响。结果共纳入116 041名产妇,对照组104 379名,妊娠期高血糖患者共11 662例(10.05%),其中PGDM产妇1 055例(0.91%),GDM产妇10 607例(9.14%)。多因素logistic回归分析显示,沪籍(OR=1.39,95%CI 1.32~1.46)、有既往流产史(OR1次=1.11,95%CI 1.06~1.17;OR≥3次=1.17,95%CI 1.07~1.27)、患有PCOS(OR=2.24,95%CI 1.92~2.60)与较高的GDM风险有关,经产妇发生GDM的风险低于初产妇(OR=0.84,95%CI 0.80~0.88)。在调整母亲户籍、年龄、学历、胎数、产次、既往流产史、妊娠高血压和PCOS等因素后,与血糖水平正常产妇相比,GDM产妇发生剖宫产(OR=1.08,95%CI 1.03~1.13)、巨大儿(OR=1.35,95%CI 1.24~1.47)和出生缺陷(OR=2.20,95%CI 1.97~2.45)的风险显著增高。而PGDM产妇发生剖宫产(OR=1.36,95%CI 1.18~1.56)、早产(OR=1.76,95%CI 1.43~2.15)、巨大儿(OR=2.33,95%CI 1.90~2.85)和出生缺陷(OR=2.44,95%CI 1.82~3.26)的风险进一步增高,且强度大于GDM。结论上海市孕产妇中,妊娠期高血糖总的患病率为10.05%。沪籍、流产史、PCOS是GDM的危险因素,PGDM和GDM患者发生不良妊娠结局的风险均增高。Objective To investigate the risk factors for gestational diabetes mellitus(GDM),and to analyze the relationship between gestational hyperglycemia,including pregestational diabetes mellitus(PGDM)and GDM,and adverse pregnancy outcomes.Methods A retrospective historical cohort study was used.Birth registration data from Songjiang District,Shanghai between 2013 and 2020 and the clinical disease diagnosis data from medical institutions between 2011 and 2020 were collected.Household registration,maternal age,educational level,parity,abortion times,gestational age,delivery mode,gestational hypertension,polycystic ovary syndrome(PCOS),PGDM and GDM were collected.Birth weight and birth defects were also collected.According to the diagnostic criteria of PGDM and GDM,parturients were divided into PGDM group,GDM group and normal glucose metabolism population(control group).Chi-square test and analysis of variance were used to compare the statistical difference among the three groups.Multivariate logistic regression model was used to analyze the association between maternal fertility characteristics and GDM,and multi-level logistic model analysis was used to analyze the association between PGDM,GDM and adverse pregnancy outcomes.Results A total of 116041 parturients were included,and 104379 were in the control group.There were 11662(10.05%)with gestational hyperglycemia,including 1055(0.91%)of PGDM and 10607(9.14%)with GDM.Multivariate logistic regression analysis showed that Shanghai residents(OR=1.39,95%CI 1.32-1.46),abortion history(OR1 time=1.11,95%CI 1.06-1.17;OR≥3 times=1.17,95%CI 1.07-1.27),and PCOS(OR=2.24,95%CI 1.92-2.60)were associated with a higher risk of GDM,but the risk of GDM was lower in multipara than in primipara(OR=0.84,95%CI 0.80-0.88).After adjusting for maternal household registration,age,educational level,parity,abortion times,previous abortion history,gestational hypertension and PCOS,the risk of cesarean section(OR=1.08,95%CI 1.03-1.13),macrosomia(OR=1.35,95%CI 1.24-1.47),and birth defects(OR=2.20,

关 键 词：糖尿病 妊娠 糖尿病患者妊娠 不良妊娠结局 巨大儿 出生缺陷 

分 类 号：R714.256[医药卫生—妇产科学]