妊娠期糖尿病孕妇产后高血糖的危险因素分析

林苗; 周平

doi:10.16766/j.cnki.issn.1674-4152.002594

妊娠期糖尿病孕妇产后高血糖的危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002594

林苗^1, ,,
周平²

1.
文昌市人民医院华中科技大学同济文昌医院产科，海南文昌 571300
2.
儋州市第一人民医院妇产科，海南儋州 571700

基金项目:

海南省卫生计生行业科研项目 2018-179

详细信息

通讯作者:
林苗, E-mail: feitianzi@163.com

中图分类号: R587.1 R714.25
计量
- 文章访问数: 181
- HTML全文浏览量: 65
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-10

Risk factors of postpartum hyperglycaemia in pregnant women with gestational diabetes mellitus

LIN Miao^{1
, ,},
ZHOU Ping²

1.
Department of Obstetrics, Wenchang City People' s Hospital, Wenchang, Hainan 571300, China

摘要

摘要: 目的了解妊娠期糖尿病(GDM)孕妇产后高血糖情况，并分析GDM孕妇产后高血糖的影响因素。方法选取2017年5月—2020年2月在海南省文昌市人民医院门诊就诊的GDM孕妇206例，根据产后2个月的75 g口服葡萄糖耐量试验(OGTT)结果分为产后高血糖组(54例)和产后血糖正常组(152例)。收集2组孕妇的一般临床资料，对其产后高血糖发生的影响因素进行分析。结果 206例GDM孕妇产后发生高血糖共54例，产后高血糖发生率为26.21%。单因素分析结果显示，年龄、孕期BMI、巨大胎儿、糖尿病(DM)家族史、孕期OGTT异常项次、孕期使用胰岛素治疗、产后BMI、孕期空腹血糖水平、产后运动与GDM孕妇产后高血糖相关(均P < 0.05)；经logistic回归分析显示，年龄(OR=2.261, P=0.023)、DM家族史(OR=3.865, P=0.001)、产后BMI(OR=2.502, P=0.020)、孕期空腹血糖(OR=2.130, P=0.029)、孕期OGTT异常项次增多(OR=4.864, P < 0.001)、孕期使用胰岛素治疗(OR=3.251, P=0.001)是GDM孕妇产后高血糖的独立影响因素。结论年龄、DM家族史、产后BMI、孕期OGTT异常项次增多、孕期空腹血糖、孕期使用胰岛素治疗是GDM孕妇产后高血糖的独立影响因素，临床上应采取积极的干预措施，预防产后高血糖的发生。
- 妊娠期糖尿病 /
- 孕产妇 /
- 产后高血糖 /
- 危险因素
Abstract: Objective To investigate postpartum hyperglycaemia in pregnant women with gestational diabetes mellitus (GDM) and analyse the influencing factors of postpartum hyperglycaemia in pregnant women with GDM. Methods A total of 206 pregnant women with GDM who were admitted to the outpatient department of Wenchang City People ' s Hospital from May 2017 to February 2020 were selected. According to the results of 75 g oral glucose tolerance test (OGTT) at 2 months postpartum, the patients were divided into the postpartum hyperglycaemia group (54 cases) and postpartum normal blood glucose group (152 cases). The general clinical data of pregnant women in the two groups were collected, and the influencing factors of postpartum hyperglycaemia were analysed. Results Postpartum hyperglycaemia occurred in 54 of 206 pregnant women with GDM, and the incidence of postpartum hyperglycaemia was 26.21%. Univariate analysis showed that age, pregnancy body mass index, body mass index (BMI), macrosomia, diabetes (diabetes mellitus, DM) family history, pregnancy OGTT abnormality, using insulin therapy during pregnancy and postpartum BMI, fasting blood glucose level during pregnancy and postpartum movement were closely related to postpartum hyperglycaemia in GDM pregnant women (all P < 0.05). According to logistic regression analysis, Age (OR=2.261, P=0.023), family history of DM (OR=3.865, P=0.001), postpartum BMI (OR=2.502, P=0.020), fasting blood glucose during pregnancy (OR=2.130, P=0.029), increased number of abnormal OGTT during pregnancy (OR=4.864, P < 0.001) and insulin treatment during pregnancy (OR=3.251, P=0.001) were independent risk factors for postpartum hyperglycemia in GDM pregnant women. Conclusion Age, DM family history, postpartum BMI, increased OGTT abnormalities during pregnancy, fasting blood glucose during pregnancy and insulin treatment during pregnancy are independent risk factors for postpartum hyperglycaemia in GDM pregnant women. Therefore, active intervention measures should be taken clinically to prevent postpartum hyperglycaemia.
- Gestational diabetes mellitus /
- Maternal /
- Postpartum hyperglycaemia /
- Risk factors
利益冲突 无

HTML全文

表 1 GDM孕妇产后高血糖危险因素的单因素分析

Table 1. Univariate analysis of risk factors for postpartum hyperglycemia in women with GDM

组别	例数	年龄 (x±s, 岁)	孕期BMI (x±s)	产次[例(%)]			DM家族史[例(%)]		孕期OGTT异常项次(x±s, 次)
组别	例数	年龄 (x±s, 岁)	孕期BMI (x±s)	初产	经产		有	无	孕期OGTT异常项次(x±s, 次)
产后高血糖组	54	28.73±1.75	25.12±1.31	36(66.67)	18(33.33)		39(72.22)	15(27.78)	21.03±2.53
产后血糖正常组	152	27.79±1.85	24.43±1.78	95(62.50)	57(37.50)		58(38.16)	94(61.84)	12.85±2.87
统计量		3.252^a	3.008^a	0.299^b			18.557^b		18.536^a
P值		0.001	0.003	0.585			< 0.001		< 0.001

组别	例数	产后BMI (x±s)	孕期空腹血糖 (x±s, mmol/L)	孕期使用胰岛素治疗[例(%)]			分娩方式[例(%)]			吸烟史[例(%)]
组别	例数	产后BMI (x±s)	孕期空腹血糖 (x±s, mmol/L)	有	无		自然分娩	剖宫产		有	无
产后高血糖组	54	27.86±2.75	6.92±0.73	37(68.52)	17(31.48)		33(61.11)	21(38.89)		11(20.37)	43(79.63)
产后血糖正常组	152	22.82±2.91	5.97±0.31	56(36.84)	96(63.16)		100(65.79)	52(34.21)		26(17.11)	126(82.89)
统计量		11.088^a	9.271^a	16.144^b			0.381^b			0.288^b
P值		< 0.001	< 0.001	< 0.001			0.537			0.591

组别	例数	巨大胎儿[例(%)]			文化程度[例(%)]			产后运动[例(%)]
组别	例数	有	无		高中及以上	初中及以下		< 1 h/d	≥1 h/d
产后高血糖组	54	18(33.33)	36(66.67)		33(61.11)	21(38.89)		38(70.37)	16(29.63)
产后血糖正常组	152	28(18.42)	124(81.58)		91(59.87)	61(40.13)		79(51.97)	73(48.03)
统计量		5.109^b			0.026^b			5.496^b
P值		0.024			0.873			0.019
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 2 变量赋值情况

Table 2. Variable assignment

变量	赋值方法
年龄	连续型计量资料，以实际值赋值
孕期BMI	连续型计量资料
DM家族史	无=0；有=1
产后BMI	连续型计量资料，以实际值赋值
巨大胎儿	无=0；有=1
孕期空腹血糖	连续型计量资料，以实际值赋值
孕期OGTT异常项次	连续型计量资料，以实际值赋值
产后运动	无=0；有=1
孕期使用胰岛素	无=0；有=1
产后高血糖	无=0；有=1

下载: 导出CSV

表 3 影响GDM孕妇产后高血糖的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of postpartum hyperglycemia in pregnant women with GDM

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	0.816	0.359	5.172	0.023	2.261	1.119~4.570
孕期BMI	0.635	0.413	2.956	0.086	1.887	0.840~4.239
DM家族史	1.352	0.416	11.658	0.001	3.865	1.710~8.733
产后BMI	0.917	0.415	5.438	0.020	2.502	1.109~5.642
巨大胎儿	0.469	0.307	1.502	0.220	1.598	0.876~2.917
孕期空腹血糖	0.756	0.342	4.796	0.029	2.130	1.089~4.163
孕期OGTT异常项次增多	1.582	0.423	13.876	＜0.001	4.864	2.123~11.143
产后运动	0.438	0.317	1.475	0.225	1.550	0.833~2.884
孕期使用胰岛素	1.179	0.425	10.476	0.001	3.251	1.413~7.477

下载: 导出CSV

参考文献(17)

[1]	杨帆, 马晓娟. 妊娠期糖尿病影响因素分析及其对母婴结局影响[J]. 临床误诊误治, 2020, 33(11): 80-84. doi: 10.3969/j.issn.1002-3429.2020.11.016 YANG F, MA X J. Influencing factors of gestational diabetes mellitus and its influence on the outcome of mother and infant[J]. Clinical Misdiagnosis & Mistherapy, 2020, 33(11): 80-84. doi: 10.3969/j.issn.1002-3429.2020.11.016
[2]	COSSON E, CARBILLON L, VALENSI P. High fasting plasma glucose during early pregnancy: A review about early gestational diabetes mellitus[J]. J Diabetes Res, 2017, 2017: 8921712. DOI: 10.1155/2017/8921712.
[3]	朱洁, 高伟娜, 刘冲, 等. 妊娠期糖尿病孕妇产后糖代谢异常的危险因素和孕中期血清硒蛋白P的预测价值[J]. 郑州大学学报(医学版), 2019, 54(5): 750-753. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYK201905027.htm ZHU J, GAO W N, LIU C, et al. Influencing factors of abnormal postpartum glucose metabolism in pregnant women with gestational diabetes mellitus and the predictive value of serum selenium protein P in mid-pregnancy[J]. Journal of Zhengzhou University: Medical Sciences, 2019, 54(5): 750-753. https://www.cnki.com.cn/Article/CJFDTOTAL-HNYK201905027.htm
[4]	薛丽丽, 董金华. 妊娠期糖尿病RBP4水平与糖脂代谢指标及新生儿体重的相关性研究[J]. 中华全科医学, 2017, 15(8): 1371-1373. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.029 XUE L L, DONG J H. A correlation research of the relationship between serum retinol-binding protein 4 levels with Glucose and Lipid metabolism and body weight of the newborn in women with gestational diabetes mellitus[J]. Chinese Journal of General Practice, 2017, 15(8): 1371-1373. doi: 10.16766/j.cnki.issn.1674-4152.2017.08.029
[5]	IMMANUE J, SIMMONS D. Screening and treatment for early onset gestational diabetes mellitus: A systematic review and meta-analysis[J]. Curr Diab Rep, 2017, 17(11): 115. doi: 10.1007/s11892-017-0943-7
[6]	鲁慧, 张方琦. 降脂通心方结合阿托伐他汀对冠心病合并血脂代谢异常患者血管内皮功能和炎症因子的影响[J]. 四川中医, 2020, 38(9): 75-78. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY202009026.htm LU H, ZHANG F Q. Effect of Jiangzhi Tongxin decoction combined with atorvastatin on vascular endothelial function and inflammatory factors in patients with coronary heart disease complicated with dyslipidemia[J]. Journal of Sichuan of Traditional Chinese Medicine, 2020, 38(9): 75-78. https://www.cnki.com.cn/Article/CJFDTOTAL-SCZY202009026.htm
[7]	薛燕妮, 魏威. 高龄产妇妊娠期糖尿病发病情况及相关影响因素分析[J]. 中国妇幼保健, 2019, 34(1): 50-53. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201901017.htm XUE Y N, WEI W. Analysis of the incidence and related influencing factors of gestational diabetes mellitus in elderly women[J]. Maternal and Child Health Care of China, 2019, 34(1): 50-53. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201901017.htm
[8]	徐丹. 妊娠糖尿病患者产后血糖异常危险因素多元Logistic回归分析[J]. 湖北民族学院学报: 医学版, 2017, 34(1): 34-36. https://www.cnki.com.cn/Article/CJFDTOTAL-FBMZ201701012.htm XU D. Multivariate Logistic regression analysis on the risk factors of postpartum blood glucose in pregnant women with gestational diabetes mellitus[J]. Journal of Hubei University for Nationalities(Medical Edition), 2017, 34(1): 34-36. https://www.cnki.com.cn/Article/CJFDTOTAL-FBMZ201701012.htm
[9]	李敏怡. 妊娠期糖尿病孕妇产后血糖异常的影响因素分析[J]. 糖尿病新世界, 2018, 21(6): 40-41. https://www.cnki.com.cn/Article/CJFDTOTAL-TNBX201806021.htm LI M Y. Analysis of influencing factors of postpartum abnormal blood glucose in pregnant women with gestational diabetes mellitus[J]. Diabetes New World, 2018, 21(6): 40-41. https://www.cnki.com.cn/Article/CJFDTOTAL-TNBX201806021.htm
[10]	叶芬, 张慧莉. 影响妊娠期糖尿病孕妇产后糖代谢异常的多因素分析[J]. 湖北职业技术学院学报, 2018, 21(3): 110-112, 135. https://www.cnki.com.cn/Article/CJFDTOTAL-XGZJ201803025.htm YE F, ZHANG H L. The influencing factors of postpartum blood glucose abnormalities in pregnant women with gestational diabetes mellitus (GDM)[J]. Journal of Hubei Polytechnic Institute, 2018, 21(3): 110-112, 135. https://www.cnki.com.cn/Article/CJFDTOTAL-XGZJ201803025.htm
[11]	胡可军. 妊娠期糖尿病患者产后高血糖的危险因素研究[D]. 苏州: 苏州大学, 2018. HU K J. Risk factors of postpartum hyperglycemia in patients with gestational diabetes mellitus[D]. Suzhou: Soochow University, 2018.
[12]	董金华, 薛丽丽. 妊娠期糖尿病孕妇血清和脐血RBP4与胎儿体重的关系[J]. 中华全科医学, 2016, 14(10): 1786-1788. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.057 DONG J H, XUE L L. Relationship between serum and cord blood RBP4 and fetal weight in pregnant women with gestational diabetes mellitus[J]. Chinese Journal of General Practice, 2016, 14(10): 1786-1788. doi: 10.16766/j.cnki.issn.1674-4152.2016.10.057
[13]	汪艳丽. 空腹血糖、糖化血清蛋白和糖化血红蛋白在2型糖尿病治疗监测中的应用[J]. 国际检验医学杂志, 2017, 38(16): 2320-2322. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ201716058.htm WANG Y L. Application of fasting blood glucose, glycosylated serum protein and glycosylated hemoglobin in monitoring the treatment of type 2 diabetes mellitus[J]. International Journal of Laboratory Medicine, 2017, 38(16): 2320-2322. https://www.cnki.com.cn/Article/CJFDTOTAL-GWSQ201716058.htm
[14]	刘阳. 妊娠期糖尿病患者产后早期糖代谢转归的研究[D]. 泸州: 西南医科大学, 2020. LIU Y. Study on the outcome of early postpartum glucose metabolism in gestational diabetes mellitus[D]. Luzhou: Southwest Medical University, 2020.
[15]	李爱玲, 韩晓华, 杨艺君, 等. 妊娠期糖尿病孕妇产后糖代谢异常相关因素分析[J]. 中国妇幼保健, 2018, 33(21): 4860-4863. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201821019.htm LI A L, HAN X H, YANG Y J. Analysis of related factors of abnormal glucose metabolism in pregnant women with gestational diabetes mellitus[J]. Maternal and Child Health Care of China, 2018, 33(21): 4860-4863. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201821019.htm
[16]	文立莲. 妊娠期糖尿病孕妇产后血糖异常危险因素分析[J]. 医学理论与实践, 2020, 33(2): 275-276. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202002053.htm WEN L L. Risk factors of postpartum abnormal blood glucose in pregnant women with gestational diabetes mellitus[J]. The Journal of Medical Theory and Practice, 2020, 33(2): 275-276. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLL202002053.htm
[17]	王玲. 妊娠期糖尿病孕妇产后血糖异常相关危险因素Logistic回归分析[J]. 中国处方药, 2019, 17(9): 4-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCF201909006.htm WANG L. Logistic investigate the relevant risk factors for postpartum blood glucose abnormal in pregnant women[J]. Journal of China Prescription Drug, 2019, 17(9): 4-5. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCF201909006.htm