南方医科大学学报

南方医科大学学报 ›› 2019, Vol. 39 ›› Issue (05): 572-.doi: 10.12122/j.issn.1673-4254.2019.05.12

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基于IADPSG标准分析妊娠期糖尿病的危险因素

王燕，罗碧如   

  • 出版日期:2019-05-20 发布日期:2019-05-20

Risk factors analysis of gestational diabetes mellitus based on International Association of Diabetes Pregnancy Study Groups criteria

  • Online:2019-05-20 Published:2019-05-20

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摘要： 目的探讨妊娠期糖尿病（GDM）的危险因素。方法采用回顾性病例对照研究。选取2016年3月~2018年5月在四川大 学华西第二医院产科门诊建卡的孕妇为研究对象。根据国际糖尿病妊娠研究组协会（IADPSG）标准诊断GDM，将研究对象分 为病例组（GDM）和对照组（Non-GDM），收集孕妇的年龄、文化程度、民族等社会人口学资料以及孕周、产次、多囊卵巢综合征 病史、家族糖尿病史、脂肪质量、人体水分、矿物质等临床特征。对以上因素进行二分类单变量Logistic回归筛选，将其中有统计 学差异、具有临床意义的变量纳入多因素Logistic回归分析，研究GDM的危险因素。结果共有3608名孕妇纳入研究。单因素 Logistic回归分析结果显示，年龄，GDM病史，细胞内外水分，脂肪质量，臂围，骨骼肌质量等变量均为妊娠期糖尿病的危险因 素。多因素Logistic回归分析结果显示，控制孕前体质量指数后，年龄，GDM病史，家族糖尿病史，臂围过大是妊娠期糖尿病的 独立危险因素；（30~35）岁、≥36岁孕妇发生GDM的风险分别是（20~29）岁孕妇的1.883（P<0.001）、2.883（P<0.001）倍；有GDM 病史孕妇发生GDM的风险是无该病史者的6.604（P<0.001）倍；与无家族糖尿病史者相比，有家族糖尿病史者发生GDM的风险 是2.518（P<0.001）倍；与臂围≤25.5 cm相比，臂围≥28.5 cm的孕妇发生GDM的风险增加为2.815（P<0.001）倍。去脂体质量是 妊娠期糖尿病的保护因素，与去脂体重≤35.1 kg相比，去脂体重≥40.1 kg者GDM发病风险下降为0.515（P<0.001）倍。结论妊 娠期糖尿病发病受多因素影响，其中年龄，GDM病史，家族糖尿病史，臂围过大是其独立危险因素，为降低其发病，应针对相关 影响因素采取预防措施。

Abstract: Objective To study the risk factors for gestational diabetes mellitus (GDM). Methods This retrospective case-control study was conducted among women registered at the Department of Obstetrics of West China Second University Hospital between March, 2016 and May, 2018. The women were divided into case group (GDM) and control group (Non- GDM) according to the diagnosis of GDM based on the International Association of Diabetes Pregnancy Study Groups (IADPSG) criteria. The data including age, education level, ethnicity and other socio-demographic data, as well as the gestational week, parity, polycystic ovary syndrome, family history of diabetes, fat mass, total body water, minerals and other clinical characteristics were collected. Univariate Logistic regression analysis was performed and the variables with statistical difference and clinical significance were included in multivariate Logistic regression analysis to identify the risk factors of GDM. Results A total of 3608 pregnant women were included in the study. Univariate logistic analysis revealed that age, previous GDM, intracellular/extracellular water, fat mass, arm circumference, skeletal muscle mass were risk factors for GDM. Multivariate logistic analysis showed that age, previous GDM, family history of DM, and an arm circumference ≥28.5 cm were independent risk factors for GDM after controlling pre-pregnancy BMI. The risk of GDM in pregnant women aged 30-35 years and 36 years or older was 1.883 (P<0.001) and 2.883 (P<0.001) times of that in women aged 20-29 years, respectively. Women with a history of GDM had a 6.604 (P<0.001) greater risk of developing GDM than women without a history of GDM. Compared with those without a family history of diabetes, those with a family history of diabetes were 2.518 times more likely to develop GDM (P<0.001). Compared with those with an arm circumference no greater than 25.5 cm, pregnant women with an arm circumference over 28.5 cm had an increased risk of GDM by 2.815 times (P<0.001). High fat free mass was a protective factor for GDM, and compared with a fat free mass below 35.1 kg, a fat free mass over 40.1 kg was associated with a lowered risk of GDM by 0.515 times (P<0.001). Conclusion The onset of GDM was affected by multiple factors. Age, history of GDM, family history of diabetes, and a large arm circumference are all independent risk factors of GDM and should be controlled to reduce the incidence of GDM.