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目的探讨再生育孕妇妊娠期糖尿病(gestational diabetes mellitus,GDM)发病的相关危险因素。方法于2015—2016年在厦门市妇幼保健院围产营养门诊,按照孕期保健手册的建卡编号随机选择393例GDM患者,并以年龄段为匹配因素进行1∶1配对,以393例糖耐量试验正常的孕妇作为对照组。收集妊娠前体质指数、文化程度、流产次数、产检时的孕周及体重、父母亲患糖尿病史、上一胎胎儿出生体重、有无妊娠期糖尿病史等资料,两组人群均为再生育孕妇。结果 (1)单因素分析显示:GDM组孕妇孕24周前体重增长高于对照组[(9.11±3.09)kg vs(7.54±2.95)kg,t=2.121,P=0.004],母亲患糖尿病的比例高于对照组(64/393 vs 38/393,χ~2=7.616,P=0.006),而对照组文化程度总体水平高于GDM组(Z=-4.060,P=0.001)。配对卡方分析显示,巨大儿分娩史(χ~2=14.297,P=0.001)、妊娠期糖尿病史(χ~2=12.938,P=0.001)及流产次数≥2次(χ~2=7.078,P=0.010)均是再生育孕妇发生GDM的危险因素。随着上一胎胎儿出生体重的增长,下一孕期GDM发病的风险也逐渐增加。当出生体重达到3.8 kg时,OR=3.467,该风险值达到强相关程度。(2)多因素Logistic回归分析显示:单因素分析中,差异有统计学意义的危险因子均是GDM发病的高危因素,其中孕24周前体重增长超过10 kg的影响最大(OR=1.875,P=0.001)。结论妊娠期糖尿病史、巨大儿分娩史、流产次数≥2次、妊娠24周前体重总增长超过10 kg、文化程度水平相对低、孕妇母亲患糖尿病史均是GDM发病的危险因素;对于上一胎胎儿出生体重达到3.8 kg以上的再生育孕妇,应被纳入GDM发病的高危人群。
Objective To explore the risk factors associated with the development of gestational diabetes mellitus (GDM) in pregnant women. Methods A total of 393 cases of GDM patients were selected according to the card number of health care manual during pregnancy from 2015 to 2016 at the MCH clinic in Xiamen City. The patients were matched with 1: 1 age-matched factors and 393 cases of glucose tolerance The normal pregnant women as a control group. Pre-pregnancy body mass index, educational level, the number of abortions, gestational age and weight at birth, parents with diabetes history, the previous birth weight of the fetus, with or without gestational diabetes mellitus and other data, the two groups of pregnant women are pregnant women . Results (1) Univariate analysis showed that the weight gain of pregnant women in GDM group was significantly higher than that of control group before pregnancy ([9.11 ± 3.09] kg vs (7.54 ± 2.95) kg, t = 2.121, P = 0.004] (64/393 vs 38/393, χ ~ 2 = 7.616, P = 0.006), while the overall educational level of the control group was higher than that of the GDM group (Z = -4.060, P = 0.001). Paired chi-square analysis showed that the history of giant childbirth (χ ~ 2 = 14.297, P = 0.001), gestational diabetes mellitus (χ ~ 2 = 12.938, P = 0.001) and miscarriage ≥ 2 (χ ~ 2 = 7.078, P = 0.010) are risk factors for GDM in fertile pregnant women. As the birth weight of a fetus increases, the risk of developing GDM in the next trimester increases. When birth weight reached 3.8 kg, OR = 3.467, the risk reached a strong correlation. (2) Multivariate Logistic regression analysis showed that in the univariate analysis, the statistically significant risk factors were the risk factors of GDM. The weight gain of more than 10 kg before 24 weeks’ gestation was the most significant (OR = 1.875, P = 0.001). Conclusion The history of gestational diabetes mellitus, the history of giant childbirth, the number of miscarriage ≥ 2 times, the total weight gain over 10 kg before pregnancy 24 weeks, the relatively low level of education, the history of pregnant women with mothers with diabetes are the risk factors for the development of GDM; Reproductive pregnant women with fetal birth weight above 3.8 kg should be included in high-risk groups with GDM.