早孕期空腹血糖及高危因素对单双胎妊娠期糖尿病及其他不良围产结局的影响  

Impact of fasting blood glucose in early pregnancy and high-risk factors on gestational diabetes mellitus and other adverse perinatal outcomes in singleton and twin pregnancies

作　　者：李想 盛晴[1] 吴天晨 宫晓丽 王颖[1] 陈练[1] 原鹏波[1] 赵扬玉[1] 魏瑗[1] LI Xiang;SHENG Qing;WU Tian-chen;GONG Xiao-li;WANG Ying;CHEN Lian;YUAN Peng-bo;ZHAO Yang-yu;WEI Yuan(Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院妇产科,北京100191

出　　处：《中国实用妇科与产科杂志》2025年第2期228-233,共6页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家重点研发计划(2023YFC2705904)。

摘　　要：目的 探讨早孕期空腹血糖(FPG)及妊娠期糖尿病(GDM)高危因素在单胎妊娠和双胎妊娠人群中对GDM及其他不良围产结局的影响。方法 回顾性分析2011年12月1日至2021年1月31日于北京大学第三医院建档产检并分娩的17 070例单胎及1027例双胎妊娠孕妇的一般资料、早孕期FPG结果及妊娠结局等。将入组孕妇按照年龄、孕前体重指数(BMI)、GDM病史、巨大儿分娩史、多囊卵巢综合征、慢性高血压合并妊娠及糖尿病家族史分为GDM高危组和非GDM高危组。采用独立样本t检验、χ^(2)检验、二元logistic回归分析对数据进行统计学分析。结果(1)在单胎妊娠中,早孕期FPG、是否高危与GDM相关,高危因素年龄、孕前BMI、GDM病史、巨大儿分娩史、多囊卵巢综合征、慢性高血压合并妊娠及糖尿病家族史均与GDM关联(P<0.05)。在双胎妊娠中,早孕期FPG、是否高危与GDM相关,其中年龄、孕前BMI为主要关联高危因素(P<0.05)。与双胎妊娠相比,孕前BMI(P=0.023)、糖尿病家族史(P=0.048)在单胎妊娠中与GDM关联性更强。(2)在单胎妊娠中,随着早孕期FPG升高,妊娠期高血压疾病(HDP)、巨大儿、大于孕龄儿(LGA)风险增高、小于孕龄儿(SGA)风险降低(P<0.05)。在双胎妊娠中,早孕期FPG升高与双胎之一LGA风险增高及剖宫产、双胎之一低出生体重儿风险降低相关(P<0.05)。与双胎妊娠相比,早孕期FPG在单胎妊娠中与HDP关联性更强(P=0.036),与剖宫产关联性更弱(P=0.013)。(3)在单胎妊娠中,是否高危与剖宫产、早产、胎膜早破、巨大儿、低出生体重儿、LGA、SGA均相关(P<0.05)。在双胎妊娠中,是否高危仅与双胎之一LGA相关(P=0.040)。与双胎妊娠相比,是否高危在单胎妊娠中与剖宫产、胎膜早破、LGA关联性更强(P<0.05)。结论 在单双胎妊娠中,早孕期FPG及GDM高危因素与GDM发病率密切相关,早孕期FPG也与其他不良围产结局相关。在单胎妊娠中,GDM危�Objective To explore the impact of fasting blood glucose(FPG)in early pregnancy and high-risk factors of gestational diabetes mellitus on development of gestational diabetes mellitus(GDM)and other adverse perinatal outcomes in singleton and twin pregnancies.Methods Retrospective analysis was performed on 17070 singleton and 1027 twin pregnancies who had regular prenatal examinations and delivered in Peking University Third Hospital from December 1,2011 to January 31,2021,concerning the general data,FPG results in early pregnancy and pregnancy outcomes of the pregnant women.Based on age,pre-pregnancy body mass index(BMI),GDM history,macrosomia delivery history,polycystic ovary syndrome,chronic hypertension and family history of diabetes,participants were grouped into GDM high-risk group and non-GDM high-risk group.T-test,χ~2 test and binary logistic regression analysis were used for statistical analysis of the data.Results(1)In singleton pregnancy,early pregnancy FPG and GDM highrisk factors were related to GDM,and high-risk factors such as age,pre-pregnancy BMI,GDM history,macrosomia delivery historypolycystic ovary syndromechronic delivery history,polycystic ovary syndrome,chronic hypertension and family history of diabetes were all associated with GDM(P<0.05).In twin pregnancies,early pregnancy FPG and GDM high-risk factors were associated with GDM,and age and pre-pregnancy BMI were the main high-risk factors(P<0.05).Compared with twin pregnancies,pre-pregnancy BMI(P=0.023)and family history of diabetes(P=0.048)had a stronger association with GDM in singleton pregnancy.(2)In singleton pregnancy,with the increase of early pregnancy FPG,the risk of hypertensive disorders of pregnancy(HDP),macrosomia,and large for gestational age(LGA)increased,and the risk of small for gestational age(SGA)decreased(P<0.05).In twin pregnancies,increased early pregnancy FPG was associated with an increased risk of one of the twin LGA and a decreased risk of cesarean section and one of the twin lowbirth-weight infant(P<0.05).Compare

关 键 词：双胎妊娠 妊娠期糖尿病 早孕期空腹血糖 高危因素 

分 类 号：R714.23[医药卫生—妇产科学]