2014—2018年郑州市某医院妊娠期糖尿病巨大儿发生影响因素和妊娠结局分析

陈玉荣; 段小凯; 刘春凡; 杨晓; 姜艳丽; 张振香; 杜少斐

doi:10.16766/j.cnki.issn.1674-4152.001960

2014—2018年郑州市某医院妊娠期糖尿病巨大儿发生影响因素和妊娠结局分析

doi: 10.16766/j.cnki.issn.1674-4152.001960

1.
郑州市第一人民医院航海东路社区卫生服务中心，河南郑州 450000
2.
郑州市第一人民医院全科医学科，河南郑州 450000
3.
郑州大学护理与健康学院，河南郑州 450000
4.
郑州市第一人民医院护理部，河南郑州 450000
5.
郑州市第一人民医院内分泌科，河南郑州 450000

基金项目:

河南省医学科技攻关项目 2018020734

河南省医学科技攻关项目 2018020730

河南省医学科技攻关项目 2018020733

河南省医学教育研究项目 Wjlx2017221

详细信息

通讯作者:
刘春凡, E-mail: LLL13014636706@126.com

中图分类号: R714.256 R715.3
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出版历程
- 收稿日期: 2020-09-30
- 网络出版日期: 2022-02-16

Analysis of influencing factors and pregnancy outcomes of macrosomia among pregnant women with diabetes in a hospital in Zhengzhou City from 2014 to 2018

1.
Hanghaidonglu Community Health Service Centre of Zhengzhou First People's Hospital, Zhengzhou, He'nan 450000, China

摘要

摘要: 目的对妊娠期糖尿病(gestational diabetes mellitus，GDM)巨大儿影响因素和妊娠结局进行分析，探讨降低GDM巨大儿的有效方法。方法将2014年1月—2018年12月郑州市某医院住院分娩的单胎GDM孕妇1 135例作为研究对象，分巨大儿组(体重≥4 000 g，175例)和非巨大儿组(体重 < 4 000 g，960例)，进行回顾性分析。结果本研究中发生GDM巨大儿发生率为15.42%，与孕妇糖尿病家族史、孕前BMI、增长体重、空腹血糖存在关联(均P < 0.05)。GDM巨大儿组并发孕妇妊娠高血压，出现手术产、早产、新生儿低血糖、胎儿窘迫以及产后出血不良妊娠结局显著高于非GDM巨大儿组(均P < 0.05)。研究发现，GDM巨大儿出现新生儿低血糖的危险系数是非巨大儿的1.599倍(95% CI：0.938~2.726)，发生妊娠高血压的危险系数是非巨大儿的1.756倍(95% CI：1.132~2.723)，出现产后大出血的危险系数是非巨大儿的2.489倍(95% CI：1.385~4.471)。结论 GDM巨大儿可增加手术产、早产、胎儿窘迫、妊娠高血压和产程中大出血等不良妊娠结局。因此对于有上述危险因素孕妇应尽早筛查口服葡萄糖耐量试验(oral glucose tolerance test, OGTT)，改变传统饮食结构及不良生活方式，科学控制孕期体重增长及血糖水平，做好GDM孕妇孕期、产时及产褥期的全程护理干预，从而有效降低本地区GDM巨大儿发生率，减少不良妊娠结局风险。
- 妊娠期糖尿病 /
- 巨大儿 /
- 影响因素 /
- 结局 /
- 护理干预
Abstract: Objective To analyse the influencing factors and pregnancy outcomes of fetal macrosomia in women with gestational diabetes mellitus (GDM) and discuss effective methods for reducing the incidence of this disease. Methods A total of 1 135 single pregnancy women with GDM who were admitted to Zhengzhou First People's Hospital from January 2014 to December 2018 were retrospectively analysed. They were divided into macrosomia group (175 cases with body weight of ≥4 000 g) and non-macrosomia group (960 cases with body weight of < 4 000 g). Results The incidence of GDM macrosomia was 15.42%, and this disease was found to be associated with family history of diabetes in pregnant women, pre-pregnancy BMI, gain too much pregnancy weight and high fasting blood glucose (all P < 0.05). The pregnant women in the macrosomia group were with a high incidence of gestational hypertension, surgical delivery and adverse pregnancy outcomes of premature delivery, neonatal hypoglycemia, fetal distress and postpartum haemorrhage, which were significantly higher than those in the non-GDM macrosomia group (all P < 0.05). The risk factors of neonatal hypoglycemia in the GDM macrosomia group was 1.599 times (95% CI: 0.938-2.726), 1.756 times (95% CI: 1.132-2.723) and 2.489 times (95% CI: 1.385-4.471) that in the non-macrosomia group. Conclusion GDM macrosomia can increase adverse pregnancy outcomes, such as surgery, preterm delivery, fetal distress, pregnancy hypertension and massive haemorrhage during labour. Pregnant women must be screened for oral glucose tolerance test (OGTT), their traditional diet and lifestyle must be changed, their weight gain and increase in blood sugar levels during pregnancy must be strictly limited and nursing intervention should be implemented during the entire process of intrapartum and puerperium to control the risk factors of GDM. These steps can effectively reduce the incidence of GDM macrosomia and reduce the risk of adverse pregnancy outcomes.
- Gestational diabetes mellitus /
- Macrosomia /
- Influencing factors /
- Outcome /
- Nursing intervention

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表 1 2组新生儿一般资料(x ±s)

组别	例数	出生体重(kg)	出生身长(cm)	出生1分钟评分(分)	性别(例)
组别	例数	出生体重(kg)	出生身长(cm)	出生1分钟评分(分)	男	女
巨大儿组	175	4.29±0.28	52.92±1.30	8.89±0.40	110	65
非巨大儿组	960	3.24±0.51	49.97±3.26	8.82±0.56	550	410
统计量		38.730^a	20.556^a	2.085^a	1.884^b
P值		< 0.001	< 0.001	0.038	0.170
注：^a为t值，^b为χ²值。

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表 2 2组孕妇基本情况(x ±s)

组别	例数	年龄(岁)	分娩孕周(周)	产前腹围(cm)	孕前体重(kg)	分娩前体重(kg)	FPG(mmol/L)
巨大儿组	175	30.91±4.78	38.88±1.16	110.72±8.25	66.36±11.45	82.43±11.50	5.81±1.35
非巨大儿组	960	31.33±5.04	38.00±2.15	104.74±7.58	61.11±10.44	75.28±10.94	5.35±0.99
t值		-1.025	7.941	9.457	6.025	7.892	4.302
P值		0.306	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

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表 3 GDM巨大儿发生的单因素分析(例)

项目	类别	活产儿	巨大儿	非巨大儿	统计量	P值
年龄(岁)	< 25	79	11	68	1.292^a	0.256
	25~35	730	120	610
	≥35	326	44	282
民族	汉族	1 116	173	943	0.349^a	0.555
	少数民族	19	2	17
文化程度	高中及以下	543	90	453	1.666^a	0.197
	大专或本科	311	48	263
	本科以上	281	37	244
职业	工人	6	1	5	0.936^a	0.333
	农民	7	1	6
	专业技术人员	88	17	71
	经商	31	6	25
	无业	1 003	150	853
孕前BMI	< 18.5	77	3	74	28.644^a	< 0.001
	18.5~24.0	568	68	500
	24.0~28.0	341	65	276
	≥28.0	149	39	110
增长体重(kg)	< 12.5	432	47	385	21.374^a	< 0.001
	12.5~18.0	429	65	364
	≥18.0	274	63	211
孕次	初次	303	43	260	3.918^a	0.789
	2次及以上	832	132	700
产次	初产	465	72	393	0.245^a	0.621
	经产	670	103	567
不良妊娠史	有	78	13	65	0.100^a	0.752
	无	1 057	162	895
糖尿病家族史	有	123	27	96	4.441^a	0.035
	无	1 012	148	864
干预治疗	饮食干预	1 104	169	935	0.373^a	0.541
	胰岛素治疗	31	6	25
FPG(x±s，mmol/L)		1 135	5.81±1.35	5.35±0.99	4.302^b	< 0.001
OGTT 1 h(x±s，mmol/L)		1 135	9.79±1.86	9.28±1.87	3.326^b	0.001
OGTT 2 h(x±s，mmol/L)		1 135	7.99±1.99	7.82±2.05	0.986^b	0.325
注：^a为χ²值，^b为t值。

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表 4 GDM巨大儿发生多因素logistic回归分析

变量	B	SE	Wald χ²	P值	OR值	95% CI
糖尿病家族史	0.497	0.254	1.634	0.049	1.354	1.009~2.672
孕前BMI	-0.728	0.185	15.244	< 0.001	2.071	1.483~2.893
增长体重	-0.095	0.017	26.305	< 0.001	1.302	1.652~2.939
FPG	-0.470	0.242	3.778	0.050	1.599	0.996~2.568
OGTT1 h	-0.086	0.049	3.035	0.081	0.918	0.833~1.011
注：变量赋值，是否有糖尿病家族史，否=0，是=1；孕前BMI， < 18.5=0，18.5~24.0=1，24.0~28.0=2，≥28.0=3；孕期增重， < 12.5 kg=0，12.5~18.0 kg=1，≥18.0 kg=2；FPG≥5.1 mmol/L，否=0，是=1；OGTT 1 h≥10.0 mmol/L，否=0，是=1。

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表 5 GDM妊娠结局的单因素分析(例)

变量		活产儿	巨大儿	非巨大儿	χ²值	P值
手术产	剖宫产	799	137	662	6.093	0.014
	顺产	336	38	298
妊娠高血压	是	170	35	135	4.051	0.044
	否	965	140	825
产后出血	是	65	19	46	9.540	0.002
	否	1 070	156	914
胎儿窘迫	是	175	11	164	12.068	0.001
	否	960	164	796
早产	是	145	3	142	15.198	< 0.001
	否	990	172	818
新生儿低血糖	是	107	24	83	4.429	0.035
	否	1 028	151	877
新生儿黄疸	是	657	102	555	3.944	0.047
	否	478	73	405

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表 6 GDM妊娠结局多因素logistic回归分析

变量	B	SE	Wald χ²	P值	OR值	95% CI
手术产	-0.445	0.202	4.842	0.028	0.641	0.431~0.953
妊娠高血压	0.563	0.224	6.322	0.012	1.756	1.132~2.723
产后出血	0.912	0.299	9.297	0.002	2.489	1.385~4.471
早产	-2.238	0.601	13.848	< 0.001	0.107	0.033~0.347
胎儿窘迫	-0.814	0.334	5.957	0.015	0.443	0.230~0.852
新生儿低血糖	0.470	0.272	2.978	0.084	1.599	0.938~2.726
注：变量赋值，是否有手术产，否=0，是=1；是否有妊娠高血压，否=0，是=1；是否有产后出血，否=0，是=1；是否有早产，否=0，是=1；是否有胎儿窘迫，否=0，是=1；是否有新生儿低血糖，否=0，是=1。

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