妊娠期糖代谢异常的危险因素及对母婴结局的影响研究

发布时间：2018-01-14 12:14

本文关键词：妊娠期糖代谢异常的危险因素及对母婴结局的影响研究　出处：《中南大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：了解湖南浏阳地区妊娠期糖代谢异常的发生情况,探讨与妊娠期糖代谢异常发生相关的危险因素及妊娠期糖代谢异常对母婴结局的影响。方法：采用整群随机抽样的方法,从湖南省浏阳市37个乡镇中随机抽取14个乡镇,以抽样乡镇妇幼部门2010年1月至2011年12月间登记建册的所有同意参加本研究的孕产妇为研究对象。对符合要求的研究对象在孕早、孕中、孕晚、分娩各期进行随访跟踪,并追踪其妊娠结局。现场随访资料由经过培训的调查员填入孕产妇保健手册,并结合产妇的分娩病历作为补充资料来源。采用单因素x2检验和多因素非条件logistic逐步回归分析妊娠期糖代谢异常的危险因素及妊娠期糖代谢异常对母婴结局的影响。结果：①在2010年1月至2012年12月期间,最终共4693例纳入分析,共计检出妊娠期糖代谢异常患者145例,妊娠期糖代谢异常发生率为3.09%。其中妊娠期糖尿病(GDM)患者102例(2.17%)；妊娠期糖耐量受损(GIGT)患者43例(0.92%)。②危险因素分析：多因素分析显示,年龄(RR=1.571)、初诊BMI(RR=1.734)、孕期体重增加(RR=1.261)及糖尿病家族史(RR=5.488)是影响糖代谢异常发生的主要危险因素。③对母婴结局的影响：Logistic回归分析结果显示,妊娠期糖代谢异常会增加早产儿(GIGT组RR=4.699,GDM组RR=5.434)、巨大儿(GIGT组RR=3.280,GDM组RR=3.413)的发生风险,且巨大儿发生率随着妊娠期糖代谢异常程度的增加而增高。此外,GDM组发生妊娠期高血压(RR=3.004)、剖宫产(RR=1.487)的风险均较对照组高,控制混杂因素后GDM组发生产后出血的风险也较高(RR=2.294)。结论：①湖南浏阳地区妊娠期糖代谢异常的发生率为3.09%,其中妊娠期糖尿病(GDM)发生率为2.17%,妊娠期糖耐量受损(GIGT)发生率为0.92%。②高龄、孕期体重增加过度、初诊BMI高、糖尿病家族史是影响妊娠期糖代谢异常发生的独立危险因素。应对具备这些高危因素者加强早期筛检管理与健康教育,及时发现与诊断。③妊娠期糖代谢异常会增加巨大儿、早产儿的发生风险,此外GDM孕妇发生妊娠期高血压、产后出血、剖宫产的风险也比正常孕妇大。④虽然GIGT还没有达到GDM的标准,但GIGT同样会影响母婴的围生期健康,应该引起重视。对GDM与GIGT患者应视情况予以合理的治疗干预,控制好血糖,尽量减少不良妊娠结局的发生。
[Abstract]:Objective: to investigate the incidence of abnormal glucose metabolism during pregnancy in Liuyang, Hunan Province, and to explore the risk factors associated with abnormal glucose metabolism during pregnancy and the influence of abnormal glucose metabolism during pregnancy on the outcome of mother and child. Methods: by cluster random sampling, 14 out of 37 villages and towns in Liuyang City, Hunan Province were randomly selected. From January 2010 to December 2011, all pregnant women who agreed to take part in the study were selected. The subjects who met the requirements were pregnant, pregnant, and late pregnant. All stages of delivery were followed up and their pregnancy outcomes were tracked. Field follow-up data were filled in by trained investigators in the Maternal Health Manual. Univariate x2 test and multivariate logistic stepwise regression analysis were used to analyze the risk factors of abnormal glucose metabolism in pregnancy and the difference of glucose metabolism in pregnancy. Often affect the outcome of mother and child. Results from January 2010 to December 2012, a total of 4693 cases were included in the analysis. A total of 145 cases of abnormal glucose metabolism in pregnancy were detected. The incidence of abnormal glucose metabolism during pregnancy was 3.09. 102 cases of GDMpatients with gestational diabetes mellitus (GDM) were diagnosed as GDM (2.17%). Analysis of risk factors in 43 GIGT patients with impaired glucose tolerance during pregnancy: multivariate analysis showed that age was 1.571). BMIA RRN 1.734). Weight gain during pregnancy (RRR 1.261) and Family History of Diabetes Mellitus (RRN 5.488). It is the main risk factor that affects the abnormal glucose metabolism. 3. The effect of 3. 3 on the outcome of mother and child. The result of Logistic regression analysis showed that. Abnormal glucose metabolism in pregnancy increased RR=3.280 in preterm infants with GIGT (4.699ngm) and macrosomia (GIGT). The risk of RRN 3.413) in GDM group and the incidence of macrosomia increased with the increase of abnormal degree of glucose metabolism during pregnancy. The risk of hypertension complicating pregnancy in GDM group was higher than that in control group. The risk of postpartum hemorrhage was also higher in GDM group after controlling for confounding factors. Conclusion the incidence of abnormal glucose metabolism during pregnancy in Liuyang area of Hunan Province is 3.09, and the incidence of GDM in gestational diabetes mellitus is 2.17%. The incidence of GIGT in gestational impaired glucose tolerance was 0.92. 2 years old. The gestational weight gain was excessive and BMI was high at first visit. Family history of diabetes mellitus is an independent risk factor that affects the occurrence of abnormal glucose metabolism in pregnancy. The early screening management and health education should be strengthened for those with these high risk factors. Timely detection and diagnosis of abnormal glucose metabolism during pregnancy will increase the risk of macrosomia, premature infants, in addition to GDM pregnant women with gestational hypertension, postpartum hemorrhage. The risk of cesarean section is also higher than that of normal pregnant women. Although GIGT is not up to the standard of GDM, GIGT also affects the perinatal health of mothers and infants. The patients with GDM and GIGT should be treated with reasonable intervention according to the situation to control the blood sugar and reduce the occurrence of adverse pregnancy outcome as far as possible.
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.256

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