前次妊娠期糖尿病临床特征对再次妊娠复发性糖尿病影响

目的:分析前次妊娠期糖尿病(GDM)的临床特征对再次妊娠糖尿病复发影响。方法:回顾性收集2017年1月-2019年10月本院产科常规产前检查且前次妊娠诊断为GDM的306例产妇临床资料,根据本次妊娠GDM诊断标准分为复发性GDM组与血糖正常组,再根据葡萄糖耐量试验(OGTT)各时间点血糖水平将复发性GDM组分为复发性GDM A组(单纯FPG异常)、复发性GDM B组(FPG正常但1hPG或/和2hPG异常)、复发性GDM C组(FPG异常,同时合并1hPG或/和2hPG异常)。比较各组前次妊娠临床特点与复发关系。结果:复发性GDM组与血糖正常组年龄、产次间隔≥5年比例、前次妊娠FPG、1hPG、2hPG值及OGTT异常类型比例、前次妊娠应用胰岛素比例均有差异(P<0.05),而前次妊娠前体质指数、妊娠期增重及早产发生情况无差异(P>0.05);年龄≥35岁、前次妊娠2hPG>9.10mmol/L、1hPG或(和)2hPG异常及FPG+1hPG或(和)2hPG异常是复发性GDM的危险因素(P<0.05),而产次间隔≥5年、前次妊娠OGTT FPG>5.35mmol/L、1hPG>10.59mmol/L、前次妊娠应用胰岛素与复发性GDM无相关性(P>0.05);复发性GDM C组与A组年龄、前次妊娠OGTT 1hPG、2hPG值有差异(P<0.05),而复发性GDM C组与B组、B组与A组比较无差异(P>0.05);复发性GDM A组、B组、C组前次妊娠OGTT异常类型构成比有差异(P<0.001),产次间隔时间≥5年、前次妊娠早产、应用胰岛素比例无差异(P>0.05);年龄≥35岁及前次妊娠FPG+1hPG或(和)2hPG异常是GDM复发时血糖异常类型高等级的危险因素(P<0.05),前次妊娠OGTT 1hPG>10.59mmol/L、2hPG>9.10mmol/L、前次妊娠1hPG或(和)2hPG异常与复发性GDM孕妇OGTT异常类型无相关性(P>0.05)。结论:孕妇年龄、前次妊娠OGTT 2hPG值及异常类型可能会影响再妊娠复发性GDM的发生率及严重程度。

Effect of clinical features of previous gestational diabetes mellitus of women and the influence on their recurrent of gestational diabetes mellitus

Objective:To analyze the clinical features of previous gestational diabetes mellitus(GDM)of women,and to study its influence on the recurrence of GDM.Methods:The clinical data of 306 pregnant women with previous GDM from January 2017 to October 2019 were collected retrospectively.According to the diagnostic criteria of GDM,these women were divided into group A(women with recurrent GDM)and group B(women without recurrent GDM).And according to the results of OGTT,the women in group A were further divided in Group A1(women with abnormal FPG),group A2(women with normal FPG and abnormal 1hPG and/or 2hPG)and group A3(women with abnormal FPG and 1hPG and/or 2hPG).The clinical features of previous GDM of the women were compared among these groups,and the relationship between previous GDM and the recurrence of GDM was analyzed.Results:There were significant different in age,the proportion of delivery interval≥5 years,the values of FPG,1hPG and 2hPG,and the proportions of OGTT abnormal types and insulin used during previous pregnancy of women between group A and group B(P<0.05),while there were no significant different in BMI,weight gain during pregnancy,and incidence of preterm birth of previous pregnancy of women between group A and group B(P>0.05).Age≥35 years old,and 2hPG>9.10mmol/L,the abnormal 1hPG and/or 2hPG,and abnormal FPG and 1hPG and/or 2hPG of previous pregnancy of women were the risk factors of their recurrence of GDM(P<0.05),while delivery interval≥5 years,and FPG>5.35mmol/L and 1hPG>10.59mmol/L,and the proportion of insulin used during previous pregnancy had no correlation with recurrence of GDM(P>0.05).There were significant different in age,and the values of 1hPG and 2hPG during previous pregnancy of women between group A3 and group A1(P<0.05),while those had no significant different between group A3 and group A2,and between group A1 and group A2(P>0.05).There were significant different in the proportions of OGTT abnormal types and insulin used during previous pregnancy of women among group A1,A2,and A3(P<0.001),while there were no significant different in the proportion of delivery interval≥5 years,the incidences of preterm birth and insulin used during previous pregnancy of women among group A1,A2,and A3(P>0.05).Age≥35 years old,and abnormal FPG and 1hPG and/or 2hPG values of previous pregnancy were the risk factors of the women with recurrence of GDM and glucose abnormality(P<0.05),while 1hPG>10.59mmol/L and 2hPG>9.10mmol/L,and the abnormal 1hPG and/or 2hPG values during previous pregnancy had no correlation with the recurrent GDM of women with OGTT abnormality(P>0.05).Conclusion:The age of pregnant women,the 2hPG value,and the abnormal OGTT type of women during previous pregnancy may affect the incidence and severity of the recurrent GDM.