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
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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
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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。

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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

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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

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