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背景妊娠期糖尿病(GDM)围产期并发症较多,且在产后数年内易患包括高血压在内的代谢综合征和产后糖尿病,严重影响围产妇及围产儿的健康,而妊娠早期血压增高是否影响GDM的发病,人们了解甚少。目的探讨妊娠早期血压轻度增高对GDM发病的影响。方法 2007-2010年在四川省科学城医院妇产科产前检查并分娩单胎活产的孕妇1221例。根据妊娠早期血压水平,分为正常血压(血压<120/80 mm Hg)组[n=605,年龄(28.6±2.8)岁]、正常高值血压[收缩压120~139 mm Hg,和(或)舒张压80~89 mm Hg]组[n=494,年龄(28.3±2.6)岁]及血压轻度增高[收缩压140~149 mm Hg和(或)舒张压90~99 mm Hg]组[n=122,年龄(28.8±2.8)岁]。组间GDM检出率比较用卡方检验和卡方分割法检验,影响GDM事件的因素用Logistic回归分析。结果 GDM 97例(7.9%)。血压轻度增高组、正常高值血压组及正常血压组的GDM检出率分别为24.6%、9.1%及3.6%。卡方检验显示各组GDM总体检出率不等或不全相等,差异有统计学意义(χ2=62.493,P<0.01),而卡方分割法检验显示各组GDM总体检出率不等(血压轻度增高组比正常血压组,χ2=67.122;血压轻度增高组比正常高值血压组,χ2=21.928;正常高值血压组比正常血压组,χ2=14.229,均P<0.01)。Logistic回归分析显示:妊娠早期血压(OR=2.1)、妊娠早期体质量指数(OR=2.6)及孕妇母亲2型糖尿病史(OR=3.5)是妊娠期糖尿病发病的危险因素(χ2=103.298,P<0.01)。结论妊娠早期血压水平越高,妊娠期糖尿病患病率越高。因此,早期发现并干预妊娠期高血压可能对减少妊娠期糖尿病发病有益。
Background Gestational diabetes mellitus (GDM) is associated with more perinatal complications and predisposes to metabolic syndrome including hypertension and postpartum diabetes within a few years postpartum, with serious consequences for perinatal and perinatal morbidity and increased blood pressure in early gestation Whether it affects the incidence of GDM, little is known. Objective To investigate the effect of slight increase of blood pressure in early pregnancy on the incidence of GDM. Methods From 2007 to 2010, 1221 pregnant women with single live birth were examined and prenatally performed at Department of Obstetrics and Gynecology, Science City Hospital, Sichuan Province. According to the level of blood pressure during the first trimester of pregnancy, the patients were divided into two groups: normotensive (BP <120/80 mm Hg) [n = 605, age 28.6 ± 2.8], normal high BP [systolic BP 120 ~ 139 mm Hg, ) Diastolic blood pressure of 80-89 mm Hg] group (n = 494, age (28.3 ± 2.6) years] and slight increase of blood pressure [systolic blood pressure 140-149 mm Hg and / or diastolic blood pressure 90-99 mm Hg] n = 122, age (28.8 ± 2.8) years]. The detection rate of GDM between groups was compared by chi-square test and chi-square test, and the factors influencing GDM events were analyzed by Logistic regression. Results GDM 97 cases (7.9%). The detection rates of GDM were 24.6%, 9.1% and 3.6% respectively in those with mild hypertension, normal high blood pressure and normal blood pressure. Chi-square test showed that the overall detection rate of GDM in each group was equal or not equal, the difference was statistically significant (χ2 = 62.493, P <0.01), while the chi-square test showed that the overall detection rate of GDM in each group (blood pressure Compared with normotensive group, normotensive group had a significantly higher chi2 = 67.122; mildly increased normotensive group than normal normotensive group (χ2 = 21.928; χ2 = 14.229, P <0.01). Logistic regression analysis showed that the blood pressure (OR = 2.1), body mass index (OR = 2.6) in early pregnancy and the history of type 2 diabetes in mothers and mothers during pregnancy (OR = 3.5) were the risk factors of gestational diabetes mellitus (χ2 = 103.298, P <0.01). Conclusion The higher the level of blood pressure in early pregnancy, the higher the prevalence of gestational diabetes. Therefore, early detection and intervention of gestational hypertension may reduce the incidence of gestational diabetes.