高龄、肥胖、早孕期体重增长、一级亲属糖尿病家族史单因素以及复合因素对妊娠期糖尿病发病的影响

目的:研究高龄、孕前体质量指数(Pre-BMI)、孕期体重增长、一级亲属即父母患糖尿病单因素以及复合因素对妊娠期糖尿病(GDM)发病的影响,以达到控制某个可控因素来降低GDM发病风险。方法:对上海交通大学附属第一人民医院南院731例孕妇的年龄、孕前BMI、早孕期增重、糖尿病家族史进行logistic单因素回归分析并进行复合因素分析。结果:妊娠年龄(OR=1.071,95%CI=1.034~1.110,P=0.000),孕前BMI(OR=1.535,95%CI=1.087~2.170,P=0.015),早孕期体重增长(OR=1.132,95%CI=1.041~1.231,P=0.004),家族糖尿病史(OR=2.386,95%CI=1.393~4.086,P=0.002)。妊娠期合并1个高危因素孕妇患GDM的危险度是合并0个高危因素的1.966倍(95%CI=1.277~3.027,P=0.002),合并2个高危因素孕妇患GDM的危险度是合并0个高危因素的3.060倍(95%CI=1.912~4.898,P=0.000),合并≥3个高危因素孕妇患GDM的危险度是合并0个高危因素的8.444倍(95%CI=4.077~17.488,P=0.000)。结论:妊娠期间合并高危因素数越多,GDM发生危险度越高。对于合并高危因素的妇女,产科医师可在其备孕咨询时或初次产检时给予指导,降低可改变的1个或2个因素,达到很大程度降低GDM发病风险。

The effects of independent and combined factors of advanced age,pre-pregnancy BMI,weight gain during early pregnancy,first degree family history of diabetes on the incidence of gestational diabetes

Objective:To identify the effects of independent and combined factors of advanced age,pre-pregnancy BMI,weight gain during early pregnancy,first degree family history of diabetes on the incidence of gestational diabetes with a purpose of lowering the incidence of GDM by controlling some changeable factors.Methods:A retrospective cohort study of 731 pregnant women in Shanghai Jiaotong University Affiliated First People's Hospital was performed during which independent and combined factors of age,pre-pregnancy BMI,gestational weight gain(GWG)in first trimester,and family history of diabetes were analyzed through logistic regression analysis.Results:Maternal age(OR=1.071,95%CI=1.034~1.110,P=0.000),pre-pregnancy BMI(OR=1.535,95%CI=1.087~2.170,P=0.015),GWG in first trimester(OR=1.132,95%CI=1.041~1.231,P=0.004),and family history of diabetes(OR=2.386,95%CI=1.393~4.086,P=0.002)were confirmed again to be the independent risk factors for GDM.Compared with those without risk factors,women with one risk factor were 1.966 times(95%CI=1.277~3.027,P=0.002)to be diagnosed with GDM,at the same time,women with 2 risk factors were 3.06 times(95%CI=1.192~4.898,P=0.000)likely to develop GDM while the risk chance of women with 3 factors were 8.444 times(95%CI=4.077~17.488,P=0.000).Conclusion:The more risk factors of women complicated with,the chance of developing GDM is higher.For those with high risk factors,when asked for some advice about preparation for pregnancy or antenatal care,obstetricians can give them some guidance about how to reduce the risk of developing GDM by interfering one or two changeable risk factors.