高龄妊娠糖尿病危险因素及其母婴结局分析

龚莉; 赵晶; 陈曙新; 崔焕焕; 刘靖

doi:10.16766/j.cnki.issn.1674-4152.002771

高龄妊娠糖尿病危险因素及其母婴结局分析

doi: 10.16766/j.cnki.issn.1674-4152.002771

无锡市惠山区人民医院内分泌科, 江苏无锡 214100

基金项目:

国家重点研发计划重大慢性非传染性疾病防控研究项目 2017YFC1309800

详细信息

通讯作者:
龚莉, E-mail: 18168895012@163.com

中图分类号: R714.256
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- 被引次数: 0
出版历程
- 收稿日期: 2021-12-01
- 网络出版日期: 2023-02-07

Risk factors of gestational diabetes mellitus in advanced age and analysis of maternal and infant outcomes

Department of Endocrinology, Huishan District People' s Hospital, Wuxi City, Wuxi, Jiangsu 214100, China

摘要

摘要: 目的探究本地区高龄妊娠糖尿病(GDM)发生的相关危险因素及母婴结局。方法本研究共收集2017年9月—2020年12月在无锡市惠山区人民医院就诊的938例孕妇资料，依据口服葡萄糖耐量试验结果分为4组, A组: 高龄(≥35岁)GDM组64例；B组: 非高龄GDM组188例；C组: 高龄非GDM组112例；D组: 非高龄非GDM组574例。比较4组孕妇的基线资料；以是否发生GDM为因变量，进一步行logistic回归分析研究高龄妊娠糖尿病的独立危险因素并进行对比分析；采用χ²检验比较4组间母婴结局的差异。结果 GDM中高龄占比25.40%(64/252)。高龄GDM组的BMI(27.89±8.74)、1胎次以上妊娠比例(87.50%)、巨大儿分娩史比例(25.00%)、有DM家族史的比例(12.50%)分别显著高于高龄非GDM组(25.59±2.56、53.57%、8.93%、3.57%)。高龄GDM组的25(OH)D₃[17.76(14.71，20.00)ng/mL]显著低于高龄非GDM组[21.34(15.10, 30.13)ng/mL]，多因素分析结果显示，血清25(OH)D₃水平(OR=0.901, 95% CI: 0.815~0.996)和1胎次以上妊娠(OR=6.412, 95% CI: 1.559~26.380)是高龄产妇人群发生GDM的独立影响因素，其中低25(OH)D₃为危险因素。高龄GDM组的剖宫产率(15.63%)、羊水过多率(12.50%)、巨大儿分娩率(9.38%)分别显著高于高龄非GDM组的3.57%、3.57%、1.79%。结论孕晚期低25(OH)D₃和1胎次以上妊娠是高龄孕妇人群发生GDM的独立危险因素，高龄孕妇患GDM有较高的母婴不良妊娠结局风险，临床应多关注。
- 高龄 /
- 妊娠糖尿病 /
- 危险因素 /
- 母婴结局
Abstract: Objective To explore the risk factors and maternal and infant outcomes of gestational diabetes mellitus (GDM) in this area. Methods Data of 938 pregnant women who were treated in Huishan District People' s Hospital of Wuxi City from September 2017 to December 2020 were collected in this study. Based on the oral glucose tolerance fest results, they were divided into four groups: group A [advanced age (≥ 35 years) GDM group, 64 cases], group B (non-advanced age GDM group, 188 cases), group C (advanced age non-GDM group, 112 cases), and group D (non- advanced age non-GDM group, 574 cases). The baseline data of four groups of pregnant women were compared. Taking the occurrence of GDM as the dependent variable, the independent risk factors of advanced age GDM were further analysed by logistic factors and a comparative analysis was carried out. The chi-square test was used to compare the differences in maternal and infant outcomes among the four groups. Results The elderly accounted for 25.40% (64/252) of all GDMs. The BMI (27.89±8.74), the proportion of pregnancies with more than one parity (87.5%), the proportion of macrosomia (25.00%) and the proportion of family history of DM (12.50%) in the elderly GDM group were significantly higher than those in the elderly non-GDM group (25.59±2.56, 53.57%, 8.93% and 3.57%). 25(OH)D₃ in the elderly GDM group [17.76 (14.71, 20.00) ng/mL] was significantly lower than that in the elderly non GDM group [21.34 (15.10, 30.13) ng/mL]. Multivariate analysis showed that serum 25(OH)D₃ level (OR=0.901, 95% CI: 0.815-0.996) and pregnancy of more than one parity (OR=6.412, 95% CI: 1.559-26.380) were independent influencing factors for the occurrence of GDM in the elderly parturient population, of which 25(OH)D₃ was negatively related. The caesarean section rate (15.63%), polyhydramnios rate (12.50%) and macrosomia delivery rate (9.38%) of the elderly GDM group were significantly higher than those in the of the elderly non-GDM group (3.57%, 3.57% and 1.79%). Conclusion The detection rate of gestational diabetes in elderly pregnant women is high. The 25(OH)D₃ in the third trimester and pregnancies over one parity are independent influencing factors for the occurrence of GDM in the population of elderly pregnant women. Hence, the higher maternal and infant pregnancy outcomes of elderly pregnant women with GDM deserve more clinical attention.
- Advanced age /
- Gestational diabetes mellitus /
- Risk factors /
- Maternal and infant outcomes

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表 1 4组孕妇基线资料比较

Table 1. Comparison of baseline data of 4 groups of pregnant women

组别	例数	年龄 (x±s，岁)	BMI (x±s)	FPG (x±s，mmol/L)	1hPG (x±s，mmol/L)	2hPG (x±s，mmol/L)	HbA1C (x±s，%)	HOMA-IR [M(P₂₅, P₇₅)]
A组	64	37.44±2.69	27.89±8.74	5.01±0.50	9.79±1.67	8.80±1.48	5.02±0.34	1.51(1.16, 1.74)
B组	188	27.94±3.71^a	26.32±3.94	5.22±0.89^a	9.21±2.00	8.74±3.17	5.10±0.49	2.28(1.36, 3.14)^a
C组	112	37.36±1.80^b	25.59±2.56^a	4.75±0.23^ab	8.04±1.42^ab	7.12±1.29^ab	4.90±0.33	1.48(1.21, 1.93)^b
D组	574	27.92±3.89^ac	24.36±3.56^abc	4.59±0.27^abc	7.20±1.34^abc	6.67±1.08^ab	5.12±3.64	1.36(1.01, 1.91)^b
统计量		330.609 ^d	22.157^d	88.853^d	119.349^d	82.985^d	0.197^d	83.549^f
P值		< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	0.898	< 0.001

组别	例数	25(OH)D₃ [M(P₂₅, P₇₅)，mmol/L]	孕期体重增长 [M(P₂₅, P₇₅)，kg]		DM家族史 [例(%)]	1胎次以上妊娠 [例(%)]	中专及以上学历 [例(%)]	巨大儿分娩史 [例(%)]
A组	64	17.76(14.71，20.00)	7.50(5.23, 10.00)		8(12.50)	56(87.50)	8(12.50)	16(25.00)
B组	188	18.65(15.60, 24.70)	6.00(4.50, 10.00)		20(10.64)	100(53.19)^a	16(8.51)	12(6.38)^a
C组	112	21.34(15.10, 30.13)^ab	7.5(5.00, 10.00)		4(3.57)^ab	60(53.57)^a	16(14.29)	10(8.93)^a
D组	574	21.30(15.50, 28.20)^ab	7.00(5.00, 9.00)		24(4.18)^ab	238(41.46)^ab	54(9.41)	22(3.83)^a
统计量		18.187^f	4.679^f		16.579^e	53.164^e	3.410^e	44.494^e
P值		0.142	0.156		< 0.001	< 0.001	0.333	< 0.001
注：与A组比较，^aP < 0.05；与B组比较，^bP < 0.05；与C组比较，^cP < 0.05。^d为F值，^e为χ²值，^f为H值。

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表 2 高龄孕妇发生GDM的logistic多因素分析

Table 2. Logistic multivariate analysis of GDM in elderly pregnant women

变量	B	SE	Wald χ²	P值	OR值	95% CI
25(OH)D₃	-0.105	0.051	4.161	0.041	0.901	0.815~0.996
1胎次以上妊娠	1.858	0.722	6.631	0.010	6.412	1.559~26.380

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表 3 4组间母婴结局比较[例(%)]

Table 3. Comparison of maternal and infant outcomes among the 4 groups [cases (%)]

组别	例数	早产	剖宫产	羊水过多	新生儿窒息	巨大儿分娩
A组	64	2(3.13)	10(15.63)	8(12.50)	2(3.13)	6(9.38)
B组	188	6(3.19)	16(8.51)	20(10.64)	6(3.19)	14(7.45)
C组	112	2(1.79)	4(3.57)^a	4(3.57)^ab	2(1.79)	2(1.79)^ab
D组	574	3(0.52)^ab	22(3.83)^ab	6(1.05)^abc	3(0.52)^ab	6(1.05)^ab
χ²值		9.162	19.623	46.148	9.162	29.961
P值		0.027	0.001	< 0.001	0.027	< 0.001
注：与A组比较，^aP < 0.05;与B组比较，^bP < 0.05，与C组比较，^cP < 0.05。

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