目的：探讨妊娠期糖代谢异常发病的高危因素，为制定有效干预措施提供科学依据。方法采用前瞻性对照研究方法，收集2011年4至9月在珠海市妇幼保健院产科门诊行产前检查诊断的糖代谢异常孕妇（研究组）共108例，其中妊娠期糖尿病（GDM）75例、妊娠糖耐量异常（GIGT）33例；收集同期糖代谢正常孕妇91例（对照组），对两组孕妇的临床资料进行单因素及多因素回归分析，探讨各因素对妊娠期糖代谢异常发病的影响。结果一般情况分析显示，糖代谢异常孕妇年龄、孕前身体质量指数（ BMI）、孕期体重增长、孕次及产次均大于正常孕妇（ t 值分别为-6．567、-4．818、-1．929、-3．231、-3．270，均P＜0．05）；糖代谢异常孕妇高中以下文化程度的比例较对照组高，差异有统计学意义（χ2＝5．642，P＜0．05）。单因素分析发现，孕次、产次、文化程度、年龄≥30岁、孕前BMI≥24kg/m2、糖尿病家族史、不良孕产史、高脂血症、反复发生霉菌性阴道炎（ VCC）、孕期大量甜食、孕期大量水果、孕期锻炼等因素与糖代谢异常的发生相关。多因素Logistic回归分析表明，孕期大量甜食、孕期大量水果、糖尿病家族史、孕前BMI≥24kg/m2、VCC、年龄≥30岁、孕期锻炼7个因素进入主效应模型，其中孕期锻炼为保护性因素，其他为危险因素。结论不合理饮食、糖尿病家族史、孕前超重、年龄≥30岁、反复发生霉菌性阴道炎为影响妊娠期糖代谢异常发生的高危因素，孕期锻炼为保护性因素。对存在高危因素的妇女在产前检查时应加强监护和指导。%Objective To explore the risk factors of abnormal glucose metabolism during pregnancy , so as to provide evidence for effective intervention .Methods A prospective case-control study was performed among 108 women with abnormal glucose metabolism [ study group , including 75 cases with gestational diabetes mellitus (GDM) and 33 with gestational impaired glucose tolerance (GIGT)] and 91 normal pregnant women ( control group ) recruited from April to September of 2011 in Zhuhai Maternity and Child Health Hospital .Univariate analysis and multivariate logistic regression analysis were conducted to identify risk factors of abnormal glucose metabolism during pregnancy .Results The mean age , body mass index ( BMI ) before pregnancy , maternal weight gains during pregnancy , gravidity and parity were significantly different between study group and control group ( t value was -6.567, -4.818, -1.929, -3.231 and-3.270, respectively, all P<0.05).The proportion of study group with lower education than senior high school was significantly higher than that of control group (χ2 =5.642,P<0.05).Univariate analysis showed that many factors were related with abnormal glucose metabolism, including gravidity, parity, education background, age≥30 years, BMI≥24kg/m2 before pregnancy, diabetes family history, bad pregnancy or reproduction history , hypertriglyceridemia , recurrent vulvovaginal candidiasis ( VVC) history, craving for sweets , large amount of fruits and exercise during pregnancy .Multivariate logistic regression showed that seven factors came into main effect model , including craving for sweets during pregnancy , craving for fruits during pregnancy , diabetes family history , BMI≥24kg/m2 before pregnancy, VCC, age≥30 years and exercise during pregnancy .All were risk factors except exercise.Conclusion Poor eating habits, family history of diabetes , over weight before gestation , maternal age≥30 and recurrent VCC are high risk factors for gestational abnormal glucose metabolism .Exercise during pregnancy is protective factor .More guidance should be provided for the pregnant women with the above high risk factors during antenatal care visits .
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