6230例GDM临床危险因素分析及妊娠和分娩结局观察
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摘要
目的了解广东佛山地区2013年1月至2017年12月妊娠期糖尿病(GDM)患病率变化趋势,分析GDM患病的相关因素,探讨GDM与妊娠结局和出生结局及相关并发症的关系。方法采用回顾性研究设计,统计2013至2017年在佛山市妇幼保健院住院分娩的GDM人数,以及每年住院分娩的孕产妇总人数,计算GDM患病率,并分析其患病趋势。同时收集孕妇妊娠前及本次妊娠的相关信息,包括基本信息、妊娠前疾病、妊娠结局及相关并发症、后代出生结局及相关并发症,采用二元Logistics回归分析GDM患病的相关因素,以及GDM与妊娠结局和出生结局的关系。结果①2013年1月至2017年12月5年期间共50 895名产妇分娩,其中6 230例GDM患者,每年GDM患病率分别为8.5%、8.9%、13.3%、12.4%、15.6%,整体呈现上升趋势,差异有统计学意义(χ~2=248.47,P<0.001)。②GDM发生相关危险因素中,经过二元Logistics多因素回归分析,有6项进入回归模型:妊娠前患高血压(OR=2.454),婴儿数(B>1)(OR=1.494)、流产史(OR=1.148)、死胎史(OR=1.682)、高龄(OR=1.135)、试管婴儿妊娠(OR=1.402)。单因素分析中,年龄>35岁孕妇患GDM的风险是年龄≤35岁的3.219倍(95%CI:3.012～3.441)。孕妇患GDM风险随着胎次、产次的增加而升高(χ~2/F值分别157.634、180.456,均P<0.01)。③GDM对母婴结局的影响中,经过二元Logistics多因素回归分析,GDM患者与非GDM患者相比,GDM孕妇发生剖宫产和妊娠期高血压、子痫前期、羊水过多、早产、产后出血、产后转重症监护的风险分别是非GDM孕妇的1.909、1.851、1.523、2.115、1.777、1.248、2.291倍(均P<0.05)。GDM孕妇后代发生不良出生结局的危险性均高于非GDM孕妇,包括小于胎龄儿、低出生体重儿、巨大儿、新生儿气促、新生儿低血糖(OR值分别为1.163、1.563、1.374、1.435、4.859,均P<0.05),其中GDM孕妇新生儿低血糖的患病风险最高,是非GDM孕妇的4.859倍,远高于其他不良结局。结论①2013至2017年佛山地区GDM患病率呈上升趋势;②高龄、婴儿数>1、试管婴儿妊娠、妊娠前患高血压、不良妊娠史(流产史、死胎史)等是GDM患病的危险因素;③GDM与妊娠期高血压、妊娠期肝内胆汁淤积、子痫前期、羊水过多有相关性,GDM是早产、剖宫产、产后出血、产后转重症监护、平均住院天数、死产、低出生体重儿、巨大儿、新生儿低血糖、新生儿出生体重的影响因素。
Objective To explore the variation trend of incidence of gestational diabetes mellitus(GDM) and its related factors during January 2013 to December 2017 in Foshan district, and to explore the impact of GDM on pregnancy outcomes, childbirth outcomes and relevant complications. Methods Using retrospective study method, number of GDM patients hospitalized in Foshan Maternal and Child Health Care Hospital from 2013 to 2017 and total number of hospitalized pregnant women in each year were counted. Incidence of GDM was calculated and its prevalence trend was analyzed. Relevant pre-pregnancy and pregnancy information of pregnant women including basic information, pre-pregnancy diseases, pregnancy outcomes and relevant complications, birth outcomes and relevant complications of child were collected. Relative factors of GDM and relationship between GDM and pregnancy outcomes and birth outcomes were analyzed by binary Logistic regression. Results From January 2013 to December 2017, a total of 50 895 maternity women underwent childbirth. There were 6 230 cases of GDM among them. Annual incidence of GDM in five years was 8.5%, 8.9%, 13.3%, 12.4%, 15.6%, respectively, showing an uprising trend, and differences had statistic significance(χ~2=248.47, P<0.001). Among risk factors of GDM, through binary Logistic multivariate regression analysis, there were six items entering regression model, which were pre-pregnancy hypertension(OR=2.454), number of infants(B>1)(OR=1.494), abortion history(OR=1.148), history of stillbirth(OR=1.682), senior age(OR=1.135), and IVF pregnancy(OR=1.402). Single factor analysis showed that risk of GDM of women>35 years was 3.219 times that of women aged ≤ 35 years(95% CI:3.012-3.441) and risk of GDM in pregnant women increased with increase in number of pregnancy and childbirth(χ~2/F value was 157.634 and 180.456, respectively, both P<0.01). According to the effects of GDM on maternal and fetal outcomes analyzed with binary Logistic multivariate regression,the risk of incidence of cesarean section, pregnancy-induced hypertension, preeclampsia, hydramnion, premature delivery, postpartum hemorrhage, postpartum transfer to intensive care unit of pregnant women with GDM was 1.909, 1.851, 1.523, 2.115, 1.777, 1.248 and 2.291 times that of normal pregnant women(all P<0.05). Risks of adverse outcomes including small for gestational age infant, low birth weight infant, macrosomia, neonatal dyspnea and neonatal hypoglycemia of offspring of GDM pregnant women were higher than those of normal pregnant women(OR value was 1.163, 1.563, 1.374, 1.435 and 4.859, respectively, all P<0.05). Risk of neonatal hypoglycemia of GDM pregnant women was highest, which was 4.859 times that of normal pregnant women and higher than other risks. Conclusion From 2013 to 2017, GDM incidence has shown a rising trend in Foshan. Advanced age, infant number>1, IVF pregnancy, pre-pregnancy hypertension, history of adverse pregnancy(abortion, stillbirth) are risk factors of GDM. GDM might be related with gestational hypertension, intrahepatic cholestasis during pregnancy, preeclampsia, hydramnios, and it is influencing factor of premature birth, cesarean section, postpartum hemorrhage, postpartum transfer to intensive care unit, average length of stay in hospital, stillbirth, low birth weight infants, macrosomia, neonatal hypoglycemia, and neonatal birth weight.
Objective To explore the variation trend of incidence of gestational diabetes mellitus(GDM) and its related factors during January 2013 to December 2017 in Foshan district, and to explore the impact of GDM on pregnancy outcomes, childbirth outcomes and relevant complications. Methods Using retrospective study method, number of GDM patients hospitalized in Foshan Maternal and Child Health Care Hospital from 2013 to 2017 and total number of hospitalized pregnant women in each year were counted. Incidence of GDM was calculated and its prevalence trend was analyzed. Relevant pre-pregnancy and pregnancy information of pregnant women including basic information, pre-pregnancy diseases, pregnancy outcomes and relevant complications, birth outcomes and relevant complications of child were collected. Relative factors of GDM and relationship between GDM and pregnancy outcomes and birth outcomes were analyzed by binary Logistic regression. Results From January 2013 to December 2017, a total of 50 895 maternity women underwent childbirth. There were 6 230 cases of GDM among them. Annual incidence of GDM in five years was 8.5%, 8.9%, 13.3%, 12.4%, 15.6%, respectively, showing an uprising trend, and differences had statistic significance(χ~2=248.47, P<0.001). Among risk factors of GDM, through binary Logistic multivariate regression analysis, there were six items entering regression model, which were pre-pregnancy hypertension(OR=2.454), number of infants(B>1)(OR=1.494), abortion history(OR=1.148), history of stillbirth(OR=1.682), senior age(OR=1.135), and IVF pregnancy(OR=1.402). Single factor analysis showed that risk of GDM of women>35 years was 3.219 times that of women aged ≤ 35 years(95% CI:3.012-3.441) and risk of GDM in pregnant women increased with increase in number of pregnancy and childbirth(χ~2/F value was 157.634 and 180.456, respectively, both P<0.01). According to the effects of GDM on maternal and fetal outcomes analyzed with binary Logistic multivariate regression,the risk of incidence of cesarean section, pregnancy-induced hypertension, preeclampsia, hydramnion, premature delivery, postpartum hemorrhage, postpartum transfer to intensive care unit of pregnant women with GDM was 1.909, 1.851, 1.523, 2.115, 1.777, 1.248 and 2.291 times that of normal pregnant women(all P<0.05). Risks of adverse outcomes including small for gestational age infant, low birth weight infant, macrosomia, neonatal dyspnea and neonatal hypoglycemia of offspring of GDM pregnant women were higher than those of normal pregnant women(OR value was 1.163, 1.563, 1.374, 1.435 and 4.859, respectively, all P<0.05). Risk of neonatal hypoglycemia of GDM pregnant women was highest, which was 4.859 times that of normal pregnant women and higher than other risks. Conclusion From 2013 to 2017, GDM incidence has shown a rising trend in Foshan. Advanced age, infant number>1, IVF pregnancy, pre-pregnancy hypertension, history of adverse pregnancy(abortion, stillbirth) are risk factors of GDM. GDM might be related with gestational hypertension, intrahepatic cholestasis during pregnancy, preeclampsia, hydramnios, and it is influencing factor of premature birth, cesarean section, postpartum hemorrhage, postpartum transfer to intensive care unit, average length of stay in hospital, stillbirth, low birth weight infants, macrosomia, neonatal hypoglycemia, and neonatal birth weight.
引文
[1]娜仁其木格,李冬梅,米林香,等.中国妊娠期糖尿病患病率的Meta分析[J].中国循证医学杂志,2018,(3):280-285.
[2]傅小英,叶朝辉.200例妊娠期糖尿病孕妇围产结局分析[J].中国现代医生,2018,(2):50-53.
[3]Eades C E,Cameron D M,Jmm E.Prevalence of gestational diabetes mellitus in Europe:A meta-analysis[J].Diabetes Res Clin Pract,2017,129:173-181.
[4]曹娟,蒙晶.不同妊娠方式所致双胎母婴并发症的临床分析[J].中国儿童保健杂志,2015,23(5):526-529.
[5]陈星,徐勇,车可可.慢性 HBV感染与妊娠期糖尿病关系的 Meta分析[J].中国妇幼健康研究,2015,26(4):685-688.
[6]Yuhong X,Shutong S,Lizhou S,et al.Metabolic syndrome risk after gestational diabetes:a systematic review and meta-analysis[J].Plos One,2014,9(1):e87863.
[7]袁春燕.分析妊娠期糖尿病对产妇及其新生儿的影响[J].中外女性健康研究,2016,(14):230-230.
[8]Spencer S J.Early life programming of obesity:the impact of the perinatal environment on the development of obesity and metabolic dysfunction in the offspring[J].Current Diabetes Reviews,2012,8(1):55-68.
[2]傅小英,叶朝辉.200例妊娠期糖尿病孕妇围产结局分析[J].中国现代医生,2018,(2):50-53.
[3]Eades C E,Cameron D M,Jmm E.Prevalence of gestational diabetes mellitus in Europe:A meta-analysis[J].Diabetes Res Clin Pract,2017,129:173-181.
[4]曹娟,蒙晶.不同妊娠方式所致双胎母婴并发症的临床分析[J].中国儿童保健杂志,2015,23(5):526-529.
[5]陈星,徐勇,车可可.慢性 HBV感染与妊娠期糖尿病关系的 Meta分析[J].中国妇幼健康研究,2015,26(4):685-688.
[6]Yuhong X,Shutong S,Lizhou S,et al.Metabolic syndrome risk after gestational diabetes:a systematic review and meta-analysis[J].Plos One,2014,9(1):e87863.
[7]袁春燕.分析妊娠期糖尿病对产妇及其新生儿的影响[J].中外女性健康研究,2016,(14):230-230.
[8]Spencer S J.Early life programming of obesity:the impact of the perinatal environment on the development of obesity and metabolic dysfunction in the offspring[J].Current Diabetes Reviews,2012,8(1):55-68.