Cypryk Katarzyna, Szymczak Wiesław, Czupryniak Leszek, Sobczak Małgorzata, Lewiński Andrzej
Department of Diabetology and Metabolic Diseases, Medical University of Lódź, Polish Mother's Memorial Hospital -- Research Institute (RI PMMH), Lódź.
Endokrynol Pol. 2008 Sep-Oct;59(5):393-7.
Gestational diabetes mellitus (GDM) is associated with an increased frequency of gestational, perinatal and neonatal complications. The aim of the study was to evaluate risk factors for GDM and their predictive value.
The group studied consisted of 510 pregnant women with GDM diagnosed according to World Health Organization (WHO) criteria (GDM). The controls were 1160 pregnant women with normal glucose tolerance (NGT). Multifactorial analysis was performed and odds ratios (OR) were calculated for each risk factor identified.
The GDM patients were significantly older than the NGT subjects (30.1 vs. 27.2 years; p < 0.0001), had a greater tendency towards obesity before pregnancy (BMI 25.0 vs. 21.6 kg/m2; p < 0.0001), more often had relatives with diabetes (40.0 vs. 25.7%; p < 0.01), had greater parity (third or subsequent pregnancy: 33.6 vs. 16.0%; p < 0.001) and more often experienced adverse perinatal outcomes (21.4 vs. 13.7%; p < 0.01). Multivariate analysis revealed the following risk factors for GDM: BMI > 25 kg/m2 (OR 4.14), a history of macrosomia (OR 2.72), being pregnant for the third time or more (OR 1.8), a family history of diabetes (OR 1.76) and age at gestation > 25 years (OR 1.34). No risk factors were present in 12% of GDM subjects, and at least one risk factor was found in 74.1% of subjects with NGT. No risk factor cluster was found which could be used easily in everyday practice to identify reliably subjects at increased risk of GDM.
Age, overweight and obesity, diabetes in the family, parity, macrosomia and a history of perinatal complications were identified as risk factors for GDM. As no reliable method of identifying subjects at increased GDM risk was found, we suggest that all pregnant women should undergo laboratory screening for GDM.
妊娠期糖尿病（GDM）与妊娠、围产期及新生儿并发症的发生频率增加相关。本研究的目的是评估GDM的危险因素及其预测价值。
研究组由510例根据世界卫生组织（WHO）标准诊断为GDM的孕妇组成（GDM组）。对照组为1160例糖耐量正常（NGT）的孕妇。进行多因素分析，并计算每个确定的危险因素的比值比（OR）。
GDM患者明显比NGT受试者年龄大（30.1岁对27.2岁；p<0.0001），孕前肥胖倾向更大（BMI 25.0对21.6 kg/m²；p<0.0001），糖尿病亲属更多见（40.0%对25.7%；p<0.01），产次更多（第三次或以后妊娠：33.6%对16.0%；p<0.001），围产期不良结局更常见（21.4%对13.7%；p<0.01）。多变量分析揭示了以下GDM的危险因素：BMI>25 kg/m²（OR 4.14）、巨大儿病史（OR 2.72）、第三次及以上妊娠（OR 1.8）、糖尿病家族史（OR 1.76）和妊娠年龄>25岁（OR 1.34）。12%的GDM受试者不存在危险因素，74.1%的NGT受试者至少存在一个危险因素。未发现可在日常实践中轻松用于可靠识别GDM风险增加受试者的危险因素聚类。
年龄、超重和肥胖、家族糖尿病史、产次、巨大儿和围产期并发症史被确定为GDM的危险因素。由于未发现识别GDM风险增加受试者的可靠方法，我们建议所有孕妇均应接受GDM的实验室筛查。
