昆明地区妊娠期糖尿病发生的母亲人口统计学和社会危险因素

目的:调查中国昆明地区妊娠期糖尿病(GDM)孕妇的人口统计学和社会危险因素。方法:对2004年1月至2009年12月期间在昆明一所三甲教学医院和两家民营医院接受75g口服葡萄糖耐量试验(OGTT)的8538例单胎孕妇进行前瞻性研究。结果:研究期间该地区GDM的总体发生率为12.5%(IGT 11.7%,GDM 0.8%);孕妇受教育程度最高组(硕士及以上)GDM的发生率最高(16.4%),显著高于大学大专组(16.4%vs12.8%,P=0.036)、高中中专组(16.4%vs 12.4%,P=0.028)和初中及以下组(16.4%vs 10.9%,P=0.002)。多元Logistic回归显示孕妇年龄(OR=1.61,95%CI 1.42～1.83,P=0.000),OGTT时体重指数(OR=1.15,95%CI 1.11～1.20,P=0.000),一级亲属糖尿病(DM)家族史(OR=1.96,95%CI 1.45～2.64,P=0.000),受教育程度(OR=1.16,95%CI 1.02～1.35,P=0.047)是发生GDM的独立危险因素。结论:昆明地区研究期间妊娠期糖代谢异常的发生率和高危因素与国外和香港的报道相似,受教育程度作为独立的危险因素在一定程度上反映了中国社会经济方面的变化。     

820例妊娠期糖尿病孕妇的高危因素分析

目的探讨妊娠期糖尿病发病的高危因素。方法 2013年9月17日至2014年3月3日在北京友谊医院行产前保健、完成75 g口服葡萄糖耐量试验,并顺利完成分娩的孕妇共820例,其中诊断为妊娠期糖尿病167例(GDM组),同期正常孕妇653例(非GDM组)。收集两组孕妇的临床资料进行单因素和多因素Logistic回归分析。结果 1对GDM发病有统计学意义的危险因素有孕妇年龄(OR=1.308,95CI%:1.001~1.710),早孕期空腹血糖水平(OR=4.165,95CI%:2.515~6.895),孕早期体质量指数(OR=2.259,95CI%:1.559~3.273),中孕期体质指数增长(OR=1.370,95CI%:1.050~1.788);2校正其他高危因素的混杂作用,早孕期空腹血糖4.4 mmol/L、4.4~5.1 mmol/L、5.1 mmol/L发生GDM的概率分别为11.1%、24.9%、42.9%。早孕期体质量指数23.5组和≥23.5组发生GDM的概率分别为15.2%,31.5%,将孕妇年龄分组(29岁、29~34岁,≥35岁)后发生GDM的概率为16.0%,22.0%,31.0%。结论孕妇年龄、早孕期空腹血糖、孕早期体质量指数、中孕期体质量指数增长≥2.2 kg/m2为GDM发病的独立危险因素。     

妊娠糖尿病危险性因素分析及预防对策

目的探讨妊娠期糖尿病(Gestational diabetes mellitus,GDM)发病危险因素及预防措施。方法收集2016年1月至2016年12月在上海市第十人民医院分娩的2729例孕妇资料进行分析;选取同期诊断为糖尿病的足月妊娠妇女148例,年龄20~40岁,平均(32.7±3.8)岁;排除糖尿病合并妊娠及其他系统性并发症孕妇26例;同时,随机选取同期入院的足月正常妊娠妇女122例作为对照,对妊娠年龄、孕前人体质量指数(BMI)、孕期增重、身高、孕次、适龄妇女经期及家庭经济月收入等因素进行Logistic或t检验等统计学分析。结果通过对比122例GDM孕妇和122例足月正常妊娠妇女,发现GDM和妊娠年龄、孕前BMI及孕期增重均为孕妇罹患糖尿病的危险因素(P0.05);并且,通过对2 729例孕妇进行分析发现,随着高危因素数目的增加,GDM发病率也呈现逐渐增加趋势;无高危因素孕妇GDM发病率为2.5%(23/920),当危险因素累计3项时,孕妇GDM发病率达到9.4%,是无高危因素的3.84倍。结论适龄期受孕,控制体重及降低孕前BMI指数能够降低GDM发病率;并且,对高危孕妇进行早期糖耐量筛查能够为临床预防GDM提供指导。     

妊娠期糖尿病危险因素的分析

目的:系统评价妊娠期糖尿病(GDM)的危险因素。方法:通过检索中国知网、万方、维普、中国生物医学文献、pubmed等数据库,纳入有关GDM危险因素的文献。对纳入文献采用RevMan 5.2统计软件进行Meta分析。结果:共纳入文献30篇,共126374例。乙肝表面抗原(HbsAg)阳性(合并OR为2.11,95%CI为1.52~2.93)、多囊卵巢综合征(PCOS)(合并OR为7.48,95%CI为2.80~19.96)、不良孕产史(合并OR为2.25,95%CI为1.86~2.72)、年龄(合并OR为2.36,95%CI为1.67~3.34)、孕前超重或肥胖(孕前BMI24kg/m2)(合并OR为4.86,95%CI为3.04~7.79)、糖尿病家族史(合并OR为5.34,95%CI为3.77~7.57)均为GDM的可能危险因素;文化程度合并结果无统计学意义(P0.05)。结论:HbsAg阳性、PCOS、不良孕产史、年龄(≥25岁)、超重或肥胖、糖尿病家族史均为GDM危险因素。     

上海地区妊娠期糖尿病孕妇孕前体重指数及孕期体重增加现状分析

目的:分析上海地区妊娠期糖尿病(GDM)孕妇孕前体重指数(BMI)和孕期增重(GWG)特点。方法:选取2017年7月至2018年7月在上海十家医院规律产检并住院分娩的单胎孕妇共3961例,其中610例GDM孕妇和3351例非GDM孕妇。分析GDM的发病高危因素,比较GDM孕妇和非GDM孕妇孕前BMI、GWG、早中晚孕期增重、妊娠合并症等差异,并将两组GWG与美国科学研究院医学协会(IOM)推荐增重标准进行比较。结果:孕前BMI和年龄是GDM发生的独立高危因素(OR=1.18,95%CI为1.05～1.34;OR=1.09,95%CI为1.06～1.11)。GDM组的孕前BMI值为(22.3±3.4)kg/m~2,高于NGDM组[(21.1±2.7)kg/m~2],两者差异有统计学意义(P0.05)。GDM组的GWG为(11.9±4.8)kg,明显低于NGDM组[(13.3±4.3)kg]。两组早孕期增重无统计学差异。GDM组的中、晚孕期增重[(5.5±2.4)kg、(4.1±2.4)kg]少于NGDM组孕妇[(6.5±2.7)kg、(4.8±2.5)kg],差异均有统计学意义(P均0.001)。与IOM推荐孕期增重标准比较,孕前BMI适中、超重的GDM组孕妇中增重偏少者占比均较NGDM组高;NGDM组增重偏多者占比均较GDM组高。结论:孕前超重或肥胖及高龄可导致GDM发生率增加,应对该群体进行孕前指导,合理控制BMI后再备孕。孕中晚期良好的医疗管理可有效控制GDM孕妇的孕期增重,进而减少不良妊娠结局。     

早孕期母体血清中PAPP-A水平与妊娠期糖尿病的相关性及预测价值研究

目的:分析早孕期母体外周血中妊娠相关血浆蛋白A(PAPP-A)水平与妊娠期糖尿病(GDM)的关系,探究PAPP-A对GDM的预测价值。方法:对完成产前检查并分娩的599例GDM孕妇(GDM组)和986例正常孕妇(对照组)的临床资料进行回顾性分析,比较两组孕妇早孕期血清中PAPP-A水平的差异,采用二分类Logistic回归分析GDM的相关影响因素,采用受试者工作特征(ROC)曲线分析PAPP-A对GDM的预测价值。结果:(1)GDM组年龄、孕前BMI、糖尿病家族史、经产妇、辅助生殖技术的比例、剖宫产的比例高于对照组,差异有统计学意义(P0.01);GDM组分娩孕周早于对照组,差异有统计学意义(P0.01)。(2)GDM组PAPP-A Mo M值为0.88(0.601.28),低于对照组的0.97(0.671.37),差异有统计学意义(P0.01)。(3)Logistic回归分析:PAPP-A与GDM的发生呈负相关,比值比(OR)值为0.794(95%CI 0.6410.983)。(4)临床资料预测GDM的ROC曲线下面积(ROC-AUC)为0.680(95%CI 0.6530.707),临床资料联合PAPP-A Mo M预测ROC-AUC为0.682(95%CI 0.6550.709),两者差异无统计学意义(P=0.429)。结论:尽管早孕期孕妇外周血中PAPP-A水平是GDM发生的独立影响因素,但其对GDM的预测价值有限。     

早孕期母体血清中Omentin-1、Betatrophin水平与妊娠期糖尿病的相关性及预测价值研究

目的探讨早孕期母体Omentin-1、Betatrophin水平与妊娠期糖尿病(GDM)的相关性及预测价值。方法回顾性选择2016年5月至2017年5月西安医学院附属西安市北方医院妇产科接诊的53例GDM患者(GDM组),同期50例糖耐量正常孕妇(NGT组)和50例健康未孕妇女(对照组)为研究对象。酶联免疫吸附试验检测各组血清Omentin-1、Betatrophin的水平和糖脂代谢指标的差异,分析Omentin-1、Betatrophin与糖代谢指标的关系。结果血清Omentin-1、HDL-C组间对比:GDM组相似文献   

妊娠期糖尿病75g OGTT不同时点血糖异常孕妇的临床特点与妊娠结局分析

目的:分析妊娠期糖尿病(GDM)75g葡萄糖耐量试验(75g OGTT)不同时点血糖异常孕妇的临床特点与妊娠结局。方法:选取2013年1月至2015年3月在华北理工大学附属医院行产前检查并住院分娩的妊娠期糖尿病孕妇150例,孕24~28周均直接行75g OGTT,检测结果中仅其中1项时点血糖异常为GDMⅠ组、2项时点血糖异常为GDMⅡ组、3项时点血糖均异常为GDMⅢ组。结果:(1)GDMⅢ组的孕前体重指数(BMI)高于GDMⅡ组和GDMⅠ组,两两比较差异均有统计学意义(P0.05);(2)GDMⅢ组的胰岛素使用率高于GDMⅡ组和GDMⅠ组(P0.05),GDMⅡ组与GDMⅠ组比较,差异无统计学意义(P0.05)。GDMⅢ组使用胰岛素的风险是GDMⅠ组的23.05倍(OR=23.05,95%CI 2.61~203.18);(3)GDMⅢ组的OGTT结果 3项时点血糖水平、FINS和胰岛素抵抗指数均高于GDMⅡ组和GDMⅠ组,两两比较差异均有统计学意义(P0.05);(4)GDMⅢ组的巨大儿发生率高于GDMⅡ组和GDMⅠ组(P0.05),GDMⅡ组与GDMⅠ组比较,差异无统计学意义(P0.05)。GDMⅢ组发生巨大儿的风险是GDMⅠ组的5.029倍(OR=5.029,95%CI 1.789~14.132)。结论:OGTT结果 3项时点均异常的GDM孕妇的孕前体重指数、胰岛素使用率、胰岛素抵抗水平均明显升高,也是发生巨大儿的高危人群。此类高危GDM孕妇临床应高度重视并积极干预。     

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

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。     

妊娠期糖尿病相关因素的Meta分析

目的:探讨妊娠期糖尿病(GDM)与部分相关因素的关系。方法:通过中国期刊全文数据库、中国生物医学文献数据库、HighWire Press、Medline等数据库收集1995年至2011年国内外公开发表的关于GDM相关因素的文献,采用Meta分析综合定量分析最终纳入的文献。结果:糖尿病家族史(合并OR为2.84,95%CI为1.95～4.15),超重或肥胖(合并OR为2.23,95%CI为1.90～2.61),年龄(合并OR为2.97,95%CI为2.28～3.89),肿瘤坏死因子α基因启动子308位点(TNF-α-308)G/A基因多态性(GA+AA基因型合并OR为3.69,95%CI为2.52～5.36;携带A等位基因合并OR为3.40,95%CI为2.56～4.53),糖化血红蛋白(HbA1c)含量(合并OR为84.43,95%CI为17.01～418.96),不良孕产史(合并OR为1.90,95%CI为1.55～2.34),吸烟(合并OR为2.23,95%CI为1.16～4.28),体育锻炼(合并OR为0.69,95%CI为0.49～0.96),种族差异(白色人种合并OR为0.62,95%CI为0.53～0.74,黄色人种合并OR为2.58,95%CI为1.90～3.50),上述因素均为GDM相关因素。文化程度和非洲裔美国人的合并结果无统计学差异(P>0.05)。结论:糖尿病家族史、超重或肥胖、年龄(≥25岁)、TNF-α-308携带A等位基因、不良孕产史和吸烟均为GDM危险因素,体育锻炼为其保护因素;种族差异可能是造成对GDM敏感性不同的影响因素之一;作为判定血糖长期控制情况的良好指标,糖化血红蛋白为妊娠期糖尿病的筛查和诊断提供了新途径和新方法。     

孕妇体质量及其他因素与分娩巨大儿的相关性研究

目的:探讨孕妇孕前和孕期体质量及有关因素与分娩巨大儿的相关性,为其预防提供指导。方法:选择2013年1月1日至2014年12月31日在四川大学华西第二医院住院分娩符合纳入标准的孕产妇10044例,其中分娩巨大儿466例,非巨大儿9578例。采用Logistics回归分析孕妇体质量及其他因素(妊娠期糖尿病、分娩巨大儿史、多胎妊娠等)与分娩巨大儿的相关性及不同BMI分类与分娩巨大儿的相关性。结果:(1)孕前BMI、孕期总体质量增长、妊娠期糖尿病及既往分娩过巨大儿是分娩巨大儿的独立危险因素(P0.05);多胎妊娠是分娩巨大儿的保护因素(P0.05)。(2)通过BMI分层后,对于孕前BMI正常者,孕期体质量增长过少和多胎妊娠是分娩巨大儿的保护因素(P0.05);孕期总体质量增长、孕期体质量增长过多、有巨大儿分娩史是分娩巨大儿的独立危险因素(P0.05)。对于孕前体质量过轻者,孕期总体质量增长和孕期体质量增长过多是分娩巨大儿独立危险因素(P0.05)。对于孕前超重的孕妇,孕期总体质量增长和妊娠期糖尿病是分娩巨大儿独立危险因素(P0.05)。结论:孕前BMI过高、孕期体质量增长过多、发生妊娠期糖尿病及既往分娩巨大儿史均可使再次妊娠发生巨大儿的风险明显增高;孕前不同BMI孕妇其分娩巨大儿的危险因素有不同,孕期体质量增长过多可能增加孕前偏瘦和体质量正常孕妇巨大儿的发生风险。     

Maternal obesity and familial history of diabetes have opposing effects on infant birth weight in women with mild glucose intolerance in pregnancy.

OBJECTIVE: Pregnant women with an abnormal screening glucose challenge test (GCT) but without gestational diabetes mellitus (GDM) on subsequent oral glucose tolerance test (OGTT) are at increased risk of delivering macrosomic and large for gestational age (LGA) neonates. We thus sought to evaluate the maternal constitutional and biochemical factors that determine infant birth weight in this patient population. METHODS: Women with an abnormal GCT were evaluated at the time of their OGTT in late pregnancy. This analysis was restricted to Caucasian women without GDM (N = 86). Maternal demographic and biochemical factors were evaluated in relation to infant birth weight and LGA. RESULTS: After adjustment for length of gestation, birth weight was positively associated with pre-pregnancy body mass index (BMI) (r = 0.31, p = 0.0063) and negatively correlated with maternal serum levels of the insulin-sensitizing protein adiponectin (r = -0.30, p = 0.0084). On multiple linear regression analysis, pre-pregnancy BMI and weight gain in pregnancy were positive independent determinants of infant birth weight, while family history of diabetes emerged as a negative independent correlate. Logistic regression analysis confirmed that pre-pregnancy BMI was a positive predictor of LGA (odds ratio (OR) = 1.25, 95% confidence interval (CI) 1.05-1.49), whereas family history of diabetes was again identified as a negative determinant (OR = 0.10, 95% CI 0.02-0.59). In contrast, neither measures of glycemia nor insulin resistance/sensitivity were independently associated with birth weight or LGA. CONCLUSION: In pregnant women with an abnormal GCT but without GDM, pre-gravid maternal obesity predicts increased infant birth weight, whereas family history of diabetes is independently associated with decreased infant size.     

Excessive gestational weight gain predicts large for gestational age neonates independent of maternal body mass index

Objective: To determine the effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on large-for-gestational-age (LGA) birth weight (≥90th % ile). Methods: We examined 4321 mother-infant pairs from the Ottawa and Kingston (OaK) birth cohort. Multivariate logistic regression (controlling for gestational and maternal age, pre-pregnancy weight, parity, smoking) were performed and odds ratios (ORs) calculated. Results: Prior to pregnancy, a total of 23.7% of women were overweight and 16.2% obese. Only 29.3% of women met GWG targets recommended by the Institute of Medicine (IOM), whereas 57.7% exceeded the guidelines. Adjusting for smoking, parity, age, maternal height, and achieving the IOM’s recommended GWG, overweight (OR 1.99; 95%CI 1.17–3.37) or obese (OR 2.64; 95% CI 1.59–4.39) pre-pregnancy was associated with a higher rate of LGA compared to women with normal BMI. In the same model, exceeding GWG guidelines was associated with higher rates of LGA (OR 2.86; 95% CI 2.09–3.92), as was parity (OR 1.49; 95% CI 1.22–1.82). Smoking (OR 0.53; 95%CI 0.35–0.79) was associated with decreased rates of LGA. The adjusted association with LGA was also estimated for women who exceeded the GWG guidelines and were overweight (OR 3.59; 95% CI 2.60–4.95) or obese (OR 6.71; 95% CI 4.83–9.31). Conclusion: Pregravid overweight or obesity and gaining in excess of the IOM 2009 GWG guidelines strongly increase a woman’s chance of having a larger baby. Lifestyle interventions that aim to optimize GWG by incorporating healthy eating and exercise strategies during pregnancy should be investigated to determine their effects on LGA neonates and down-stream child obesity.     

Acknowledgement of Reviewers

Objective. Pregnant women with an abnormal screening glucose challenge test (GCT) but without gestational diabetes mellitus (GDM) on subsequent oral glucose tolerance test (OGTT) are at increased risk of delivering macrosomic and large for gestational age (LGA) neonates. We thus sought to evaluate the maternal constitutional and biochemical factors that determine infant birth weight in this patient population.

Methods. Women with an abnormal GCT were evaluated at the time of their OGTT in late pregnancy. This analysis was restricted to Caucasian women without GDM (N = 86). Maternal demographic and biochemical factors were evaluated in relation to infant birth weight and LGA.

Results. After adjustment for length of gestation, birth weight was positively associated with pre-pregnancy body mass index (BMI) (r = 0.31, p = 0.0063) and negatively correlated with maternal serum levels of the insulin-sensitizing protein adiponectin (r = ?0.30, p = 0.0084). On multiple linear regression analysis, pre-pregnancy BMI and weight gain in pregnancy were positive independent determinants of infant birth weight, while family history of diabetes emerged as a negative independent correlate. Logistic regression analysis confirmed that pre-pregnancy BMI was a positive predictor of LGA (odds ratio (OR) = 1.25, 95% confidence interval (CI) 1.05–1.49), whereas family history of diabetes was again identified as a negative determinant (OR = 0.10, 95% CI 0.02–0.59). In contrast, neither measures of glycemia nor insulin resistance/sensitivity were independently associated with birth weight or LGA.

Conclusion. In pregnant women with an abnormal GCT but without GDM, pre-gravid maternal obesity predicts increased infant birth weight, whereas family history of diabetes is independently associated with decreased infant size.     

Analysis of risk factors related to gestational diabetes mellitus

ObjectiveWith the rapid rising prevalence, gestational diabetes mellitus (GDM) has become one of the leading causes of maternal and child mortality and morbidity worldwide. The present study aimed to analyze GDM-related risk factors for early intervention.Materials and methodsFrom January to June 2018, a total of 250 pregnant women from Chengdu Second People's Hospital were enrolled in the study. According to the diagnostic criteria for GDM, they were assigned into GDM group (n = 48) and non-GDM group (n = 202). The clinical data and biochemical indicators were compared between GDM group and non-GDM group, and Logistic regression analysis was performed to analyze the risk factors of GDM.ResultsGDM group was significantly higher than non-GDM group in the age, pregnancy times, pre-pregnancy body mass index (BMI), low-density lipoprotein cholesterol (LDL-C) level, history of diabetes mellitus in first-degree relatives, incidence of subclinical hypothyroidism (SCH) and the positive rate of thyroid peroxidase antibody (TPOAb) (P < 0.05), whereas was conspicuously lower than non-GDM group in the education level above junior college (P < 0.05). The results of Logistic regression analysis revealed that the age [odds ratios (OR) = 1.125, 95% confidential interval (CI) = 1.019–1.241, P = 0.020], pre-pregnancy BMI (OR = 1.280, 95%CI = 1.118–1.466, P < 0.001), history of diabetes mellitus in first-degree relatives (OR = 4.938, 95%CI = 1.418–17.196, P = 0.012) and TPOAb (+) (OR = 4.849, 95%CI = 1.742–13.501, P = 0.003) were the risk factors of GDM.ConclusionsAdvanced age, pre-pregnancy BMI overweight, history of diabetes mellitus in first-degree relatives and TPOAb (+) are associated with an increased risk of GDM.     

妊娠间隔对经产妇妊娠结局的影响多中心回顾性研究

目的探讨不同妊娠间隔(IPI)对经产妇妊娠结局的影响。方法基于全国14个省区市共21家医院开展多中心回顾性研究,通过查阅病历收集2011—2018年间两次妊娠均在同一家医院分娩的经产妇的年龄、身高、孕前体重、IPI、既往史、妊娠合并症和并发症、分娩孕周、分娩方式、妊娠结局等资料。根据不同IPI分为4组:<18个月组、18~23个月组、24~59个月组和≥60个月组,分析其临床特征和妊娠结局。根据WHO的推荐,以24~59个月组作为参照,比较各组经产妇的妊娠结局。进一步根据年龄、妊娠期糖尿病(GDM)史、巨大儿分娩史和早产史进行分层分析,探讨不同特征经产妇中IPI对其妊娠结局的影响。结果本研究共纳入经产妇8026例,其中<18个月组、18~23个月组、24~59个月组和≥60个月组分别为423、623、5512和1468例。(1)<18个月组、18~23个月组、24~59个月组和≥60个月组的妊娠年龄、本次妊娠前体质指数(BMI)、剖宫产史比例、GDM发生率、妊娠期高血压发生率以及剖宫产术分娩比例均逐渐增加,分别比较,差异均有统计学意义(P均<0.05)。(2)校正混杂因素后,与24~59个月组经产妇相比,≥60个月组经产妇的早产、胎膜早破和羊水过少的发生风险分别增加42%(OR=1.42,95%CI为1.07~1.88,P=0.015)、46%(OR=1.46,95%CI为1.13~1.88,P=0.004)和64%(OR=1.64,95%CI为1.13~2.38,P=0.009),其他组均未见不良妊娠结局的发生风险增加(P均>0.05)。(3)根据妊娠年龄分层,校正混杂因素后,与24~59个月组比较,高龄经产妇≥60个月组羊水过少的发生风险明显增加(OR=2.87,95%CI为1.41~5.83,P=0.004);非高龄经产妇<18个月组胎膜早破的发生风险明显增加(OR=1.59,95%CI为1.04~2.43,P=0.032),≥60个月组胎膜早破(OR=1.58,95%CI为1.18~2.13,P=0.002)和早产(OR=1.52,95%CI为1.07~2.17,P=0.020)的发生风险均显著增加。根据有无GDM史分层,校正混杂因素后,与24~59个月组比较,≥60个月组有GDM史经产妇产后出血的风险显著增加(OR=5.34,95%CI为1.45~19.70,P=0.012),无GDM史经产妇胎膜早破的发生风险显著增加(OR=1.44,95%CI为1.10~1.90,P=0.009)。根据有无巨大儿分娩史分层,校正混杂因素后,与24~59个月组比较,≥60个月组有巨大儿分娩史经产妇剖宫产术分娩的比例显著增加(OR=4.11,95%CI为1.18~14.27,P=0.026),无巨大儿分娩史经产妇胎膜早破的发生风险显著增加(OR=1.46,95%CI为1.12~1.89,P=0.005)。根据有无早产史分层,校正混杂因素后,与24~59个月组比较,≥60个月组无早产史经产妇胎膜早破的发生风险显著增加(OR=1.47,95%CI为1.13~1.92,P=0.004)。结论IPI≥60个月或<18个月均会造成经产妇不良妊娠结局的发生风险增加,应通过对育龄期妇女孕前咨询和产后保健的健康教育,指导育龄期妇女再次妊娠时保持适宜的IPI,以降低不良妊娠结局的发生风险。