孕妇血糖异常项数、孕期增重及其交互作用对妊娠不良结局的影响

The impact of the number of abnormal blood glucose items, gestational weight gain and their interaction on adverse pregnancy outcomes in pregnant women

摘要

目的 探讨妊娠期糖尿病(GDM)患者在24~28周口服75g葡萄糖耐量试验(OGTT)的血糖异常项数、孕期增重(GWG)及其交互作用对妊娠不良结局的影响。方法 选择2020年4月至2023年3月于中国人民解放军北部战区总医院定期产检并分娩的404例GDM孕妇为研究对象.按照OGTT血糖异常数量分1项、2项和3项异常,分别标记为Ⅰ组、Ⅱ组和Ⅲ组.根据美国医学研究所(IOM)的建议将GWG分为增重适宜、增重不足、增重过多组.比较不同组间孕妇临床资料的差异,采用Logistic回归及相乘相加模型,研究血糖异常项数和孕期增重对妊娠不良结局的影响是否存在交互作用。结果 多因素Logistic回归分析显示,2项或3项血糖异常均是发生妊娠期高血压疾病(HDP)、妊娠期甲减、剖宫产、早产和大于胎龄儿(LGA)的危险因素(aOR值介于3.417~8.444之间,P<0.05);3项血糖异常是导致巨大儿发生的危险因素(aOR=6.199,P<0.05);孕期增重不足是引起孕妇妊娠期甲减的危险因素(aOR=10.537,P<0.05);增重过多是孕妇发生HDP、剖宫产、早产、巨大儿、LGA的危险因素(aOR值介于2.587~6.948之间,P<0.05).亚组分析显示,Ⅰ组孕妇中孕期增重不足是引起妊娠期甲减、早产的危险因素,孕期增重过多是发生HDP、剖宫产的危险因素(aOR值介于4.609~41.366之间,P<0.05);Ⅱ组孕妇中孕期增重不足是发生剖宫产的危险因素,孕期增重过多是发生早产的危险因素(aOR值分别为8.878、12.722,P<0.05);Ⅲ组孕妇中孕期增重过多是孕妇发生剖宫产的危险因素(aOR=38.666,P<0.05);相乘、相加交互模型的结果提示,血糖异常项数≥2项和孕期不合理增重对妊娠不良结局无交互作用。结论 孕妇OGTT血糖异常项数的增多及孕期不合理增重均会增加不良妊娠结局的发生风险,且随着OGTT异常项数的增多,孕期不合理增重对不良妊娠结局的影响作用逐渐减弱.血糖异常项数2项及以上、孕期不合理增重对妊娠不良结局的发生无相乘相加交互作用.

Abstract

Objective To investigate the impact of the number of abnormal blood glucose items in the 24-28 week 75g oral glucose tolerance test (OGTT), gestational weight gain (GWG), and their interaction on adverse pregnancy outcomes in patients with gestational diabetes mellitus (GDM). Methods A total of 404 pregnant women with GDM who underwent regular prenatal examinations and delivered at the General Hospital of Northern Theater Command from April 2020 to March 2023 were selected as the study subjects. According to the number of abnormal blood glucose items in the OGTT, the subjects were divided into groups with 1, 2, and 3 abnormal items, labeled as group Ⅰ, group Ⅱ, and group Ⅲ, respectively. According to the recommendations of the Institute of Medicine (IOM) in the United States, GWG was categorized into appropriate weight gain, insufficient weight gain, and excessive weight gain groups. Differences in clinical data among the groups were compared. Logistic regression and multiplicative and additive models were used to study whether there was an interaction between the number of abnormal blood glucose items and GWG on adverse pregnancy outcomes. Results Multivariate logistic regression analysis showed that 2 or 3 abnormal blood glucose items were risk factors for hypertensive disorders of pregnancy (HDP), hypothyroidism during pregnancy, cesarean section, preterm birth, and large for gestational age (LGA) infants (aOR=3.417-8.444, P<0.05); Three abnormal blood glucose items were risk factors for macrosomia (aOR=6.199, P<0.05); Insufficient GWG was a risk factor for hypothyroidism during pregnancy (aOR=10.537, P<0.05); Excessive GWG was a risk factor for HDP, cesarean section, preterm birth, macrosomia, and LGA (aOR=2.587-6.948, P<0.05). Subgroup analysis showed that, in group Ⅰ, insufficient GWG was a risk factor for hypothyroidism and preterm birth, while excessive GWG was a risk factor for HDP and cesarean section (aOR=4.609-41.366, P<0.05); In group Ⅱ, insufficient GWG was a risk factor for cesarean section, and excessive GWG was a risk factor for preterm birth (aOR=8.878 and 12.722, P<0.05); In group Ⅲ, excessive GWG was a risk factor for cesarean section (aOR=38.666, P<0.05); The multiplicative and additive interaction models indicated no interaction between ≥2 abnormal blood glucose items and unreasonable GWG on adverse pregnancy outcomes. Conclusion An increasing number of abnormal blood glucose items in the OGTT and unreasonable GWG both increase the risk of adverse pregnancy outcomes. As the number of abnormal OGTT items increases, the impact of unreasonable GWG on adverse pregnancy outcomes gradually decreases. There is no multiplicative or additive interaction between ≥2 abnormal blood glucose items and unreasonable GWG on the occurrence of adverse pregnancy outcomes.

关键词

妊娠期糖尿病 / 75克葡萄糖耐量试验 / 孕期增重 / 妊娠结局 / 交互作用

Key words

gestational diabetes mellitus / 75g oral glucose tolerance test / gestational weight gain / pregnancy outcomes / interaction

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