【作者】 刘卫华；

【导师】 杜玉开；

【作者基本信息】 华中科技大学 ， 儿少卫生与妇幼保健学， 2009， 博士

【摘要】 目的探讨妊娠期糖尿病发病的多因素影响，为妊娠合并糖尿病的病因学研究提供依据，为GDM筛查降低漏诊率和减少经济负担提供可靠的高危人群，并为临床开展有针对性的防治提供依据；同时，为孕产期妇女提供保健和提高围产儿生存质量提供依据。方法选取1999年1月至2008年12月在深圳市公明社区的全部患GDM的孕产妇作为病例组。按年代选取同期同社区的孕产妇(排除GDM、妊娠糖耐量异常(GIGT)及孕前患糖尿病(DM)的孕产妇作为对照组。查阅研究对象的病历，并使用统一设计的调查表从病历上提取相关有效信息，将所得数据输入电脑，采用SPSS15．0对GDM可能的危险因素进行单因素分析和多因素Logistic回归分析。结果1．共收集245例GDM孕产妇作为病例组，和245名符合条件的孕产妇作为对照。2．病例组和对照组在孕产妇妊娠年龄、月经初潮年龄、月经周期紊乱病史、孕次、产次、自然流产病史、自然流产次数、异位妊娠病史、初育年龄、多囊卵巢综合征(PCOS)病史、糖尿病家族史、父亲患糖尿病、以及产前焦虑的方面，两组间存在有统计学显著性差异。3．经多因素Logisic回归分析，妊娠年龄、月经初潮年龄、月经周期紊乱病史、自然流产次数、糖尿病家族史、及产前焦虑六个危险因素进入模型，OR(95％CI)值分别为1．50(95％CI 1．14～2．04)，0．36(95％CI 0．16～0．84)，3．85(95％CI 1．59～9．36)，3．00(95％CI 1．56～5．77)，6．54(95％CI2．42～17．69)，3．89(95％CI 1．15～13．17)。结论1．经过多因素Logistic回归分析显示，糖尿病家族史、肥胖、高龄产妇、妊娠期感染、高血压史、妊娠期焦虑六项因素是GDM的危险因素(P＜0．10)。2．孕次、产次、月经初潮年龄、月经周期紊乱病史、自然流产次数肿瘤、畸形儿等因素没能进入模型，可能是GDM的混杂因素。3．早期筛查妊娠期糖尿病的危险因素对提高孕产妇的健康保健和围产儿的生存质量有着重要的意义。更多还原

【Abstract】 Objective: To determine the risk factors of Gestational diabetes mellitus (GDM), and to provide scientific basis of GDM etiology research, prevention, screen and treatment; so to provided healthcare measures to pregnant women and improve the living quality of fetus.Methods: We collected all the pregnant women who were tested GDM in prenatal diagnosis and in obstetrics ward used as case group from January 1999 to December 2008 in Gongming community in Shenzhen city, and control group were pregnant women who were synchronization childbirth without GDM, GIGT and DM before pregnancy; unified questionnaires was applied to extracting information from case files. All date input into computer, SPSS 15.0 were used to statistics analysis. Used x~2-test and t-test to compare the difference between the two groups, used Logistic regression analysis to explore the risk factors of GDM.Results: 1. There were 245 case files and 245 control files during the past 10 years included in our study.2. x~2- test shows pregnant age, menarche age, irregular menstrual history, gravidity, parity, spontaneous abortion history, spontaneous abortion frequency, ectopic pregnancy history, first fertility age, PCOS history, DM family history, Paternal DM family history and antepartum anxiety are the possible risk factors.3. Logistic regression analysis shows pregnant age, obesity, infection during gestation period, spontaneous abortion frequency, hypertension history, DM family history, and antepartum anxiety were risk factors of GDM; OR(95%CI) were 1.50 (1.14～2.04), 0.36 (0.16～0.84), 3.85 (1.59～9.36), 3.00 (1.56～5.77), 6.54 (2.42～17.69), 3.89 (1.15～13.17) respectively.Conclusions: 1. Logistic regression analysis shows pregnant age, obesity, infection during gestation period, hypertension history, DM family history, and antepartum anxiety were risk factors of GDM.2. Those factors as gravidity, oaf, parity, and so on which can not be entered into the model, they may be the confounding factors to GDM.3. Early to screen the risk factors of pregnant women is not only effective way of improving the healthcare of women, but also to improve the living quality of perinatal infants.更多还原