青岛地区妊娠期糖尿病发病率及临床资料分析

摘要

目的 探讨青岛地区妊娠期糖尿病的发病率及对妊娠结局的影响,以指导临床早期干预及治疗妊娠期糖尿病,减少母婴并发症.方法 选取2014年3月至2015年5月在青岛大学附属医院东区分娩的孕产妇,孕妇24-28周空腹血糖≥5.1 mmol/L或行75g葡萄糖耐量试验(OGTT)任意一点血糖异常即诊断为妊娠糖尿病(GDM).收集到病例组(GDM组)670人,其中OGTT结果 仅1项血糖异常为GDM A组,2项血糖异常为GDM B组,3项血糖异常为GDM C组,随机选择同期非妊娠期糖尿病孕产妇727例作为对照组,对不同组间的妊娠结局进行分析.结果 ①GDM的患病率为24.17%;②GDM组的年龄、孕次及产次、孕前后体重及孕前后BMI均高于对照组(t值分别为5.545、2.990、2.782、4.494、3.930、5.355、4.980,均P<0.05);③GDM组孕产妇胎膜早破、早产、剖宫产、妊娠期高血压的发生率均高于对照组(χ2值分别为3.928、5.181、26.788、4.975,均P<0.05);④GDM组新生儿巨大儿、胎儿窘迫的发生率均高于对照组(χ2值分别为6.363、4.299,均P<0.05);GDM组新生儿出生孕周小于对照组(t=-2.844,P<0.05);GDM组新生儿出生体重高于对照组(t=3.664,P<0.05);⑤GDM C组在胎膜早破、剖宫产、巨大儿的发生率较对照组均显著升高(χ2值分别为9.984、8.809、22.971,均P<0.01);而GDM A组和GDM B组仅剖宫产率较对照组升高(χ2值分别为11.749、21.691,均P<0.01);除了巨大儿发生率在GDM A组与GDM C组、GDM B组与GDM C组之间差异有统计学意义(χ2值分别为14.474、7.461,均P<0.01)之外,其他各组之间妊娠结局差异无统计学意义.结论 GDM与年龄、孕产史及孕前后体重和BMI有关,OGTT多项血糖异常的孕妇,母婴并发症的发生率更高,应加强对此类孕妇预防保健,减少母婴并发症.%Objective To explore the incidence of gestational diabetes mellitus (GDM) and its influence on pregnancy outcomes, so as to guide early intervention and treatment of GDM and to reduce maternal and infant complications.Methods All women who delivering in East Branch of Affiliated Hospital of Qingdao University during the period of March 2014 to May 2015 were selected.Fasting plasma glucose≥5.1mmol/L or any abnormal results in 75g oral glucose tolerance test ( OGTT) at 24 -28 gestational weeks was diagnosed as GDM. Fasting plasma glucose detection or 75g oral glucose tolerance test ( OGTT) were performed at 24 -28 gestational weeks.Totally 670 pregnancy women were collected in case group ( GDM group) .GDM group was divided into group GDM A, GDM B and GDM C.Group GDM A included cases with one abnormal blood glucose of OGTT result, group GDM B with two abnormal blood glucose of OGTT results, and group GDM C with three abnormal blood glucose of OGTT results.Meanwhile 727 cases of non-GDM pregnancy women were selected in control group.Maternal and infant outcomes of each group were compared.Results The morbidity of GDM was 24.17%.The age, gravidity and parity, prenatal and postpartum weight, prenatal and postpartum BMI of GDM group were higher than those of the control group (t value was 5.545, 2.990, 2.782, 4.494, 3.930, 5.355 and 4.980, respectively, all P<0.05).In GDM group, the incidence of premature rupture of membrane, premature delivery, cesarean section and gestational hypertension was higher than that of the control group (χ2 value was 3.928, 5.181, 26.788 and 4.975, respectively, all P<0.05).The rates of macrosomia and fetal distress in GDM group were higher than those of the control group (χ2 value was 6.363 and 4.299, respectively, both P<0.05).Birth gestational week of GDM group was less than the control group (t=-2.844, P<0.05).Neonatal birth weight of GDM group was higher than the control group (t=3.664, P<0.05).Compared with the control group, group GDM C had significantly higher incidences of premature rupture of membrane, caesarean section and macrosomia (χ2 value was 9.984, 8.809 and 22.971, respectively, all P<0.01) .Group GDM A and GDM B had significantly higher rates of caesarean section than the control group (χ2 value was 11.749 and 21.691, respectively, both P<0.01).There was statistical significance between group GDM A and group GDM C, between group GDM B and group GDM C in rate of macrosomia (χ2 value was 14.474 and 7.461, respectively, both P<0.01), but there was no statistically significant difference in maternal and infant outcomes among each groups.Conclusion The age, gravidity and parity, prenatal and postpartum weight, prenatal and postpartum BMI have correlation with GDM.Pregnant women with more abnormal OGTT results have higher incidence of maternal and infant complications.Prevention and health care should be strengthened for those women to reduce maternal and infant complications.