本文關(guān)鍵詞：妊娠期糖代謝異常的危險(xiǎn)因素及對(duì)母嬰結(jié)局的影響研究　出處：《中南大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

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【摘要】：目的：了解湖南瀏陽地區(qū)妊娠期糖代謝異常的發(fā)生情況,探討與妊娠期糖代謝異常發(fā)生相關(guān)的危險(xiǎn)因素及妊娠期糖代謝異常對(duì)母嬰結(jié)局的影響。 方法：采用整群隨機(jī)抽樣的方法,從湖南省瀏陽市37個(gè)鄉(xiāng)鎮(zhèn)中隨機(jī)抽取14個(gè)鄉(xiāng)鎮(zhèn),以抽樣鄉(xiāng)鎮(zhèn)婦幼部門2010年1月至2011年12月間登記建冊(cè)的所有同意參加本研究的孕產(chǎn)婦為研究對(duì)象。對(duì)符合要求的研究對(duì)象在孕早、孕中、孕晚、分娩各期進(jìn)行隨訪跟蹤,并追蹤其妊娠結(jié)局。現(xiàn)場(chǎng)隨訪資料由經(jīng)過培訓(xùn)的調(diào)查員填入孕產(chǎn)婦保健手冊(cè),并結(jié)合產(chǎn)婦的分娩病歷作為補(bǔ)充資料來源。采用單因素x2檢驗(yàn)和多因素非條件logistic逐步回歸分析妊娠期糖代謝異常的危險(xiǎn)因素及妊娠期糖代謝異常對(duì)母嬰結(jié)局的影響。 結(jié)果：①在2010年1月至2012年12月期間,最終共4693例納入分析,共計(jì)檢出妊娠期糖代謝異�；颊�145例,妊娠期糖代謝異常發(fā)生率為3.09%。其中妊娠期糖尿病(GDM)患者102例(2.17%)；妊娠期糖耐量受損(GIGT)患者43例(0.92%)。②危險(xiǎn)因素分析：多因素分析顯示,年齡(RR=1.571)、初診BMI(RR=1.734)、孕期體重增加(RR=1.261)及糖尿病家族史(RR=5.488)是影響糖代謝異常發(fā)生的主要危險(xiǎn)因素。③對(duì)母嬰結(jié)局的影響：Logistic回歸分析結(jié)果顯示,妊娠期糖代謝異常會(huì)增加早產(chǎn)兒(GIGT組RR=4.699,GDM組RR=5.434)、巨大兒(GIGT組RR=3.280,GDM組RR=3.413)的發(fā)生風(fēng)險(xiǎn),且巨大兒發(fā)生率隨著妊娠期糖代謝異常程度的增加而增高。此外,GDM組發(fā)生妊娠期高血壓(RR=3.004)、剖宮產(chǎn)(RR=1.487)的風(fēng)險(xiǎn)均較對(duì)照組高,控制混雜因素后GDM組發(fā)生產(chǎn)后出血的風(fēng)險(xiǎn)也較高(RR=2.294)。 結(jié)論：①湖南瀏陽地區(qū)妊娠期糖代謝異常的發(fā)生率為3.09%,其中妊娠期糖尿病(GDM)發(fā)生率為2.17%,妊娠期糖耐量受損(GIGT)發(fā)生率為0.92%。②高齡、孕期體重增加過度、初診BMI高、糖尿病家族史是影響妊娠期糖代謝異常發(fā)生的獨(dú)立危險(xiǎn)因素。應(yīng)對(duì)具備這些高危因素者加強(qiáng)早期篩檢管理與健康教育,及時(shí)發(fā)現(xiàn)與診斷。③妊娠期糖代謝異常會(huì)增加巨大兒、早產(chǎn)兒的發(fā)生風(fēng)險(xiǎn),此外GDM孕婦發(fā)生妊娠期高血壓、產(chǎn)后出血、剖宮產(chǎn)的風(fēng)險(xiǎn)也比正常孕婦大。④雖然GIGT還沒有達(dá)到GDM的標(biāo)準(zhǔn),但GIGT同樣會(huì)影響母嬰的圍生期健康,應(yīng)該引起重視。對(duì)GDM與GIGT患者應(yīng)視情況予以合理的治療干預(yù),控制好血糖,盡量減少不良妊娠結(jié)局的發(fā)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.
【學(xué)位授予單位】：中南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.256

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