妊娠期糖尿病新生儿低血糖影响因素分析

目的探讨影响妊娠期糖尿病(GDM)新生儿低血糖的相关因素,为管理新生儿低血糖提供理论依据。方法本研究选取本院2014年12月至2015年12月分娩的212例GDM新生儿为研究对象,其中发生新生儿低血糖48例为病例组,其余164例对照组,同时分析孕周、分娩方式、羊水性状、出生体重等对GDM新生儿血糖的影响。结果 212例GDM新生儿中,出现低血糖的新生儿共有48例,新生儿低血糖发生率为22.6%。对于48例GDM新生儿危险因素分析表明孕周小于37周、巨大儿、羊水混浊、母亲孕期合并妊娠高血压容易发生新生儿低血糖。结论 GDM新生儿低血糖的影响因素很多,应该及时对症处理,降低新生儿低血糖发生率及可能造成的损伤。     

妊娠期糖尿病病人自我管理现状及相关影响因素调查分析

目的:探讨妊娠期糖尿病(GDM)病人自我管理现状及相关影响因素。方法:选取2016年6月—2019年6月于医院建档产检的GDM病人398例作为研究对象。通过问卷调查法收集病人一般资料、临床资料及自我管理现状情况进行回顾性分析,采用单因素分析法分析其自我管理的相关影响因素、多元线性回归分析法分析其独立影响因素。结果:GMD病人自我管理总分为(58.94±3.76)分。单因素分析显示,孕周、居住地、文化程度、家庭收入、付费方式、分娩次数、焦虑程度、自我效能及社会支持为GDM病人自我管理的相关影响因素(P<0.05);多元线性回归分析显示,居住地、付费方式、分娩次数、自我效能及社会支持为GDM病人自我管理的独立影响因素。结论:GDM病人自我管理水平处于一般水平,居住地、付费方式、分娩次数、自我效能及社会支持为GDM病人自我管理的独立影响因素,帮助病人提高其自我效能感是提高其自我管理水平的有效方式。     

浙江省舟山市40 819名孕妇妊娠期血压变化趋势及影响因素研究

目的 描述浙江省舟山市40 819名孕妇妊娠期血压的变化趋势,并分析其影响因素。 方法 采用回顾性分析,对2001年1月至2016年12月期间在浙江省舟山市妇幼保健院进行围产保健并住院分娩的40 819名孕妇的血压变化趋势进行描述,并采用多因素广义估计方程分析其影响因素。 结果 随着孕周增加,孕妇的平均收缩压（SBP）和平均舒张压（DBP）均呈上升趋势;孕妇的年龄越大,孕前体质量指数（BMI）越大,孕期血压水平越高。 此外,孕妇文化程度越高,孕期DBP也会越高,但对SBP的影响不显著。孕妇分娩史和胎儿性别对血压无显著性影响。 多因素广义估计方程分析结果显示,孕前BMI、孕妇年龄、孕龄、文化程度与孕期SBP、DBP有关,而孕妇产次、胎儿性别等与孕期SBP、DBP关系不明显。 结论 孕妇年龄、孕前BMI、孕龄、文化程度是影响孕期血压升高的主要因素。 孕期血压的监测管理应贯穿整个孕期,在体重管理过程中应特别关注孕前超重或肥胖以及高龄孕妇的血压管理工作。      

妊娠期糖尿病妇女膳食状况与巨大儿的相关影响因素研究

目的探讨妊娠期糖尿病妇女膳食状况与发生巨大儿的相关影响因素。方法选取2012年1月至2015年6月在该院产前门诊接受治疗的妊娠期糖尿病妇女60例作为研究对象,根据分娩的新生儿体质量分为巨大儿组和正常体质量儿组,统计分析一般资料和膳食状况,探讨膳食状况中影响妊娠期糖尿病妇女发生巨大儿的相关影响因素。结果本研究纳入的60例妊娠期糖尿病妇女中共发生8例巨大儿,单因素分析结果显示,影响妊娠期糖尿病妇女发生巨大儿的因素包括身高、孕前体质量、孕前体质量指数(BMI)值、分娩前体质量、孕期增重、水果、蔬菜、油类;多因素Logistic回归分析结果显示,孕前体质量、孕期增重过多、油类的摄入量过多均为妊娠期糖尿病妇女发生巨大儿的危险因素。结论对妊娠期糖尿病妇女合理膳食干预和增加运动量可减少巨大儿的发生。     

妊娠期糖尿病孕妇血糖管理决策行为及影响因素的研究

目的了解妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇血糖管理决策行为现况并探讨其影响因素。方法采用便利抽样法,于2019年9月—2020年7月采用一般资料调查表、GDM血糖管理保护动机问卷、GDM血糖管理知识问卷和GDM血糖管理决策行为问卷对上海市和江苏省6所医院的1 127例GDM孕妇进行调查。结果 GDM孕妇的血糖管理决策行为问卷得分为(69.30±6.85)分,处于高水平。多元线性回归分析结果表明,孕周、严重性、易感性、反应效能、自我效能、反应代价是GDM孕妇血糖管理决策行为的影响因素(P<0.05)。结论临床护理人员应增强GDM孕妇血糖管理的保护动机,尤其是处于孕晚期的孕妇,通过提高GDM孕妇对疾病严重性及血糖管理不良行为易感性的认知,并激励孕妇在血糖管理过程中的反应效能和自我效能,减少血糖管理中可能的障碍因素,以改善孕妇血糖管理决策行为。     

妊娠期糖尿病对母儿的影响及治疗

糖尿病（DM）在妊娠期分为两种情况，一种是妊娠前已有糖尿病，为糖尿病合并妊娠。另一种是在妊娠期发生或首次发现的糖耐量异常，为妊娠期糖尿病（GDM）。糖尿病本身又分为两型即Ⅰ型糖尿病和Ⅱ型糖尿病。病理生理均由于胰岛素绝对或相对不足而引起的糖代谢紊乱的症候群，但在临床表现、处理、母婴合并症及预后等方面都存在明显的差异。正确识别和恰当处理不同类型的糖尿病直接关系到母婴结局。     

妊娠期糖尿病孕妇睡眠质量现状及其影响因素

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇的睡眠质量,分析其影响因素。方法便利抽样法选取2013年1月至2014年12月在连云港市第一人民医院GDM专病门诊诊治的100例GDM孕妇及产科门诊血糖水平正常的100例孕妇为研究对象,采集一般人口学特征,并采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)量表评定其睡眠情况。结果 GDM孕妇的PSQI总分为(7.52±1.97)分,高于正常孕妇的(5.56±1.78)分,差异有统计学意义(P0.05)。PSQI量表中,GDM孕妇在睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、日间功能障碍等项目上的评分分别为(1.34±0.50)、(1.18±0.63)、(1.00±0.59)、(0.69±0.81)、(1.85±0.88)、(1.03±0.71)分,均高于正常孕妇的评分,差异均有统计学意义(均P0.05)。不同年龄、学历、工作情况、孕前体质量指数(body mass index,BMI)的GDM孕妇的睡眠质量差异均有统计学意义(均P0.05)。二分类Logistic回归分析筛选出学历、孕前BMI是GDM孕妇睡眠障碍的影响因素。结论GDM孕妇的睡眠质量明显较正常孕妇差,睡眠障碍的发生受孕妇学历和孕前BMI的影响。     

妊娠期糖尿病产妇母乳喂养自我效能现状及其影响因素

目的 调查妊娠期糖尿病（GDM）产妇母乳喂养自我效能现状,分析其影响因素,以便于有针对性的对GDM产妇进行母乳喂养健康宣教。方法 选取甘肃省人民医院2021年12月—2022年12月分娩的164例妊娠期糖尿病产妇为调查对象。发放问卷164份,回收有效问卷160份,问卷有效回收率97.56%。调查产妇母乳喂养自我效能现状,并通过单因素分析及多元线性回归分析探讨其影响因素。结果 产妇母乳喂养自我效能得分为102.09±12.18分。单因素分析结果显示,文化程度、收入、孕期增重、分娩方式、产次、产前是否手挤奶、是否参加孕妈妈培训是影响产妇的母乳喂养自我效能得分的因素（P<0.05）。多因素分析结果显示,文化程度、收入、产次、产前是否手挤奶、是否参加孕妈妈培训是母乳喂养自我效能的影响因素（P<0.05）,其中文化程度高、收入高、经产妇、产前手挤奶、参加孕妈妈培训的产妇母乳喂养自我效能感更强。结论 妊娠期糖尿病产妇母乳喂养自我效能得分处于中等水平,文化程度、收入、产次、产前手挤奶、是否参加孕妈妈培训是妊娠期糖尿病产妇母乳喂养自我效能的影响因素。     

北京市大兴区居民糖尿病患病率及其影响因素分析

目的了解北京市大兴区社区居民糖尿病患病情况及其影响因素。方法对2017年北京市大兴区基于PPS配额抽样的常住居民7019人进行糖尿病诊断性测量、健康指标测量以及相关因素问卷调查,获得有效样本6348份。采用χ²检验分析不同特征人群间糖尿病患病率差异、非条件logistic回归分析人群糖尿病患病相关因素。结果糖尿病患病率8.61%,男性高于女性。糖尿病患病率在不同年龄组、不同文化程度、不同婚姻状况和不同家庭平均收入间的差异有显著性(χ²_年龄=559.48,χ²_文化=135.67,χ²_婚姻=116.97,χ²_家庭收入=21.81,P<0.05)。行为习惯如定期监测血糖、吸烟、饮食口味、低脂饮食和控制饮食等不同时,糖尿病患病率不同(χ²_血糖检测=529.84,χ²_吸烟=12.25,χ²_口味=20.25,χ²_低脂饮食=38.66,χ²_控制饮食=213.87,P<0.05)。回归分析结果显示,年龄、肥胖、吸烟、高血压是危险因素,了解糖尿病治疗控制措施、控制血糖、血糖监测、血糖随访、运动是保护性因素(OR>1)。结论除了个人基本情况对糖尿病的患病率有不同程度的影响外,行为习惯不同时,糖尿病的患病率也不相同。应针对不同人群采取有针对性的干预措施,对糖尿病患者进行相关教育,促进生活方式改变,减少糖尿病危害。     

Incidence, prevalence and risk factors for non-insulin-dependent diabetes mellitus

Non-insulin-dependent diabetes is a worldwide disease. In the United States nearly 10 million persons are affected and the prevalence is increasing. Considerable advances in the understanding of the pathogenesis and determinants of non-insulin-dependent diabetes have occurred in recent years. Genetic and environmental determinants are associated with the development of diabetes, but the mode of inheritance of the genetic determinants is unknown. Obesity, particularly if it is centrally distributed and of long duration, is the most prominent environmental risk factor for non-insulin-dependent diabetes. Although it has long been suspected as an etiological factor, evidence that physical activity is a predictor of the disease is now emerging. The adoption of a western lifestyle and improvements in socioeconomic conditions are at least partially responsible for the very high rates of diabetes among several ethnic and racial groups, although the specific components of these changes that contribute to development of non-insulin-dependent diabetes are still uncertain. Other factors that worsen insulin resistance are likewise predictive of the development of disease. An understanding of the risk factors for non-insulin-dependent diabetes may lead to more specific intervention, and possibly to prevention of this disease.     

Subsequent pregnancy after gestational diabetes mellitus: frequency and risk factors for recurrence in Korean women

OBJECTIVE—The purpose of this study was to determine the frequency of recurrent gestational diabetes mellitus (GDM) and to find risk factors that can predict the recurrence of GDM in Korean women with previous GDM.RESEARCH DESIGN AND METHODS—We evaluated women who had GDM in an index pregnancy (1993–2001) and a subsequent pregnancy by 2003. An oral glucose tolerance test (OGTT) was performed during the index pregnancy and 2 months postpartum. The recurrence rate of GDM was assessed among 111 women who had a subsequent pregnancy. Multivariate logistic regression analysis was used to identify independent predictors of recurrent GDM.RESULTS—The frequency of recurrent GDM in subsequent pregnancies was 45.0% (95% CI 35.6–54.4%). Women with impaired fasting glucose and/or impaired glucose tolerance 2 months postpartum were at increased risk for recurrent GDM (relative risk 2.31, 95% CI 1.24–4.30). Higher BMI before the subsequent pregnancy (P = 0.024), higher fasting glucose concentration (P = 0.007) 2 months postpartum, and lower 1-h insulin concentration (P = 0.004) of the diagnostic OGTT in the index pregnancy were independent risk factors for recurrence of GDM in subsequent pregnancies.CONCLUSIONS—GDM recurred in nearly half of subsequent pregnancies in Korean women. Fasting glucose 2 months postpartum might be a clinically valuable predictor of recurrent GDM risk.Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy (1). GDM is associated with adverse outcomes of pregnancy such as preeclampsia, cesarean delivery, macrosomia, and birth trauma (1,2). Furthermore, women with GDM and their offspring are at increased risk for the development of diabetes later in life (3–5). Recently, a randomized clinical trial demonstrated that treatment of maternal hyperglycemia significantly reduced perinatal morbidity in GDM (6). If we could identify risk factors for recurrent GDM, we might possibly prevent its recurrence. It may also be possible to reduce perinatal morbidity by early diagnosis and optimal treatment of recurrent GDM during the subsequent pregnancy.The reported frequency of recurrent GDM varies widely, from 30 to 84%, depending on the ethnicity of the subjects and the diagnostic criteria used (7). Although one study reported the recurrence rate of GDM in Asian women (8), the sample size was small and widely used diagnostic criteria for GDM were not applied.Risk factors associated with recurrence of GDM have also varied among reported studies (7,9). In general, greater maternal age, obesity, degree of hyperglycemia in the index pregnancy, increased weight gain, and short interval between pregnancies were suggested to be associated with recurrent GDM (7–11). However, biochemical parameters, such as glucose and insulin levels during pregnancy and/or early postpartum, have not often been evaluated as risk factors for recurrence of GDM. It is recommended that women with GDM have a glucose tolerance test to reevaluate glycemic status at the first postpartum visit (12). We hypothesized that the early postpartum glucose concentration might provide important information for predicting risk of recurrence of GDM. In this study we evaluated the recurrence rate of GDM in Korean women and risk factors for its recurrence, including a postpartum oral glucose tolerance test (OGTT).     

探讨应用血管回声跟踪技术评价妊娠期糖尿病患者血管内皮功能及危险因素

目的 应用血管回声跟踪(ET)技术评价妊娠期糖尿病(GDM)患者出现血管并发症之前有无血管内皮功能损害,并分析影响血管内皮功能的相关危险因素。方法 收集GDM患者50例(GDM组)和正常孕妇50名(对照组),应用ET技术检测肱动脉,获得血管内皮功能参数,比较两组血管内皮功能参数和妊娠前体质量指数(BMI)、空腹血糖(FBG)、餐后1 h血糖(P1hPG)、餐后2 h血糖(P2hPG)、总胆固醇(TC)、甘油三酯(TG)及胰岛素抵抗指数(IR)的差异;以BMI、FBG、P1hPG、P2hPG、TC、TG、IR为自变量,以血管硬化度(β)、脉搏波传导速度(PWVβ)、弹性系数(Eρ)和顺应性(AC)为因变量,行多因素多元逐步线性回归分析,分析影响血管内皮功能的相关危险因素。结果 GDM组β、PWVβ、Eρ、 BMI、FBG、P1hPG、P2hPG、TC、TG、IR均较对照组增高,AC较对照组减低(P均<0.05);IR、FBG对β,IR对PWVβ,TG对Eρ,BMI对AC有显著危险性(P均<0.05)。结论 GDM患者在出现血管并发症之前即有发生血管内皮功能损害的可能;产前有效调整及控制孕妇体质量、FBG、TG及胰岛素水平对防治GDM患者血管内皮功能损害有重要意义。     

Rates and risk factors for recurrence of gestational diabetes

OBJECTIVE: To determine the recurrence rate of gestational diabetes (GDM) during a subsequent pregnancy among women who had GDM during an index pregnancy and to identify factors associated with the probability of recurrence RESEARCH DESIGN AND METHODS: A retrospective longitudinal study was performed in Nova Scotia, Canada, of women who were diagnosed as having GDM during a pregnancy between the years of 1980 and 1996 and who had at least one subsequent pregnancy during this time period. When only the index and first subsequent pregnancy were analyzed, the cohort included 651 women. The recurrence rate of GDM in the pregnancy after the pregnancy with the initial diagnosis of GDM was determined. Multivariate regression models were constructed to model the recurrence of GDM in a subsequent pregnancy as functions of potential predictors to estimate RRs and CIs. RESULTS: The rate of recurrence of GDM in the pregnancy subsequent to the index pregnancy was found to the 35.6% (95% CI = 31.9-39.3%). Multivariate regression models showed that infant birth weight in the index pregnancy and maternal prepregnancy weight before the subsequent pregnancy were predictive of recurrent GDM. CONCLUSIONS: In this large cohort of women, slightly more than one-third of the subjects had diabetes in a subsequent pregnancy, which is consistent with recurrence rates in other predominately white populations. Strategies to reduce the occurrence of neonatal macrosomia and maternal prepregnancy obesity may help lower the rate of recurrence of GDM.     

Lifestyle intervention to prevent gestational diabetes mellitus and adverse maternal outcomes among pregnant women at high risk for gestational diabetes mellitus

ObjectiveWe assessed the effects of a lifestyle intervention on gestational diabetes mellitus (GDM) incidence and risk of adverse maternal outcomes among pregnant women at high risk for GDM.MethodsFrom July to December 2018, we enrolled 1822 eligible pregnant women; of these, 304 had at least one risk factor for GDM. Participants were randomly allocated to the intervention or control group. Usual prenatal care was offered to both groups; the intervention group also received individually modified education on diet, physical activity, and weight control. The GDM diagnosis was based on an oral glucose tolerance test at 24–28 gestational weeks. Multivariate logistic regression was used to evaluate the effects of the lifestyle intervention on risk of GDM and adverse maternal outcomes.ResultsA total of 281 women (139 in the intervention group and 142 controls) were included. Incidences of GDM and adverse maternal outcomes were all significantly lower in the intervention than in the control group. Multivariate logistic regression indicated that women in the intervention group had a lower risk of GDM and adverse maternal outcomes, after adjusting potential confounding factors.ConclusionThe present lifestyle intervention was associated with lower risks of GDM and adverse maternal outcomes.     

Occurrence of diabetes mellitus after gestational diabetes mellitus in Trinidad

We undertook this study to determine the incidence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) after gestational diabetes mellitus (GDM). It is a follow-up study of a consecutive sample of women with GDM in a tertiary care center in Trinidad, West Indies. The cohort was a consecutive sample of 157 women with GDM who delivered in the hospital between June 1981 and December 1984. Of these, a volunteer sample of 60 women (38%) consented to participate 3.5-6.5 yr later. The two groups were remarkably similar in ethnic composition, mean age at index delivery, marital status, and family history of DM. Interviews revealed that 26 women (43%) had already developed DM for which they were receiving treatment. The remaining 34 women (57%) were given a 2-h 75-g oral glucose tolerance test, and fasting and half-hourly venous blood samples were obtained and analyzed for plasma glucose. Based on accepted diagnostic criteria, 11 (32%) of 34 had DM, 10 (29%) had IGT, and 13 (38%) had normal glucose tolerance. A total of 37 (62%) of 60 women had developed DM, and another 10 (17%) had IGT in the intervening 3.5-6.5 yr. The results support findings that GDM is associated with an increased risk of mothers developing DM in later life.     

南充地区妊娠期糖尿病危险因素及妊娠结局分析

目的 探讨南充地区妊娠期糖尿病(gestational diabetes mellitus,GDM)的危险因素及妊娠结局,为南充地区育龄妇女GDM防治提供参考依据.方法 选取2018年7月1日至2019年9月30日在川北医学院附属医院产检并住院分娩的孕产妇1800例,其中确诊GDM 537例(GDM组),血糖正常126...     

妊娠期糖尿病产妇分娩新生儿低血糖的危险因素分析

目的探讨妊娠期糖尿病（GDM）产妇分娩新生儿发生低血糖的危险因素。 方法将229例GDM产妇分娩的新生儿根据产后24 h内血糖是否<2.2 mmol/L分为低血糖组（63例）及对照组（166例）。比较两组GDM产妇的年龄、分娩方式（平产、急诊剖宫产、择期剖宫产）及羊水清洁度,新生儿的体质量、喂养方式（母乳喂养及混合喂养）。采用Logistic回归模型分析影响GDM产妇分娩的新生儿低血糖发生的相关危险因素。 结果两组新生儿体质量及产妇分娩方式间的比较,差异均有统计学意义（t = 2.821,P = 0.006;χ² = 32.616,P = 0.001）,而GDM产妇年龄及羊水清洁度,新生儿喂养方式间的比较,差异均无统计学意义（t = 0.864,P = 0.389;χ² = 14.822,P = 0.641;χ² = 4.775,P = 0.092）。通过多因素Logistic回归模型发现,体质量[比值比（OR）= 3.025,95%置信区间（CI）（1.263,7.244）,P = 0.013]、急诊剖宫产[OR = 5.227,95%CI（2.049,13.330）,P = 0.001]、择期剖宫产[OR = 8.237,95%CI（2.967,22.869）,P<0.001]均是影响GDM产妇分娩新生儿发生低血糖的危险因素。 结论体质量、急诊剖宫产、择期剖宫产均是影响GDM产妇分娩新生儿发生低血糖的危险因素。