2860 例妊娠糖尿病临床分析：单中心回顾性研究。
Clinical analysis of 2860 cases of diabetes in pregnancy: a single-center retrospective study.
机构信息
Department of Obstetrics, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510150, China.
Department of Obstetrics, Foshan Women and Children hospital, Foshan, 528000, China.
出版信息
BMC Pregnancy Childbirth. 2022 May 18;22(1):418. doi: 10.1186/s12884-022-04712-0.
BACKGROUND
To investigate the epidemiological, clinical characteristics and outcomes of diabetes in pregnancy (DIP).
METHODS
This single-center, retrospective study included 16,974 pregnant women hospitalized during 2018-2019. Among them, 2860 DIP patients were grouped according to diabetes type, glycemic status, and insulin use. Multivariate logistic regression analysis was conducted.
RESULTS
The incidence of DIP [17.10%; pregestational diabetes mellitus (PGDM), 2.00% (type I, 0.08%; type 2, 1.92%); gestational diabetes mellitus (GDM), 14.85% (GDM A1, 13.58%; GDM A2, 1.27%)] increased annually. Premature birth, congenital anomalies, large for gestational age (LGA), neonatal asphyxia, neonatal intensive care unit transfer, hypertension, and puerperal infection were more common in DIP than in healthy pregnancies. The most common comorbidities/complications were hypertension, thyroid dysfunction, cervical incompetence, intrahepatic cholestasis, premature membrane rupture, oligo/polyhydramnios, and fetal distress. GDM incidence at ages ≥35 and ≥ 45 years was 1.91 and 3.26 times that at age < 35 years, respectively. If only women with high-risk factors were screened, 34.8% GDM cases would be missed. The proportion of insulin use was 14.06% (PGDM, 55%; GDM, 8.53%). Mean gestational age at peak insulin dose in DIP was 32.87 ± 5.46 weeks. Peak insulin doses in PGDM and GDM were 3.67 and 2 times the initial doses, respectively. The risks of LGA, premature birth, cesarean section, and neonatal hypoglycemia in PGDM were 1.845, 1.533, 1.797, and 1.368 times of those in GDM, respectively. The risks of premature birth and neonatal hypoglycemia in women with poor glycemic control were 1.504 and 1.558 times of those in women with good control, respectively.
CONCLUSIONS
The incidence of adverse outcomes in DIP is high.
背景
研究妊娠糖尿病（DIP）的流行病学、临床特征和结局。
方法
本单中心回顾性研究纳入了 2018 年至 2019 年期间住院的 16974 名孕妇。其中，2860 名 DIP 患者根据糖尿病类型、血糖状态和胰岛素使用情况进行分组。采用多变量 logistic 回归分析。
结果
DIP 的发病率[17.10%；孕前糖尿病（PGDM）2.00%（I 型 0.08%；2 型 1.92%）；妊娠期糖尿病（GDM）14.85%（GDM A1 13.58%；GDM A2 1.27%）]呈逐年上升趋势。早产、先天畸形、巨大儿（LGA）、新生儿窒息、新生儿重症监护病房转科、高血压和产褥期感染在 DIP 中比在健康妊娠中更为常见。最常见的合并症/并发症是高血压、甲状腺功能障碍、宫颈机能不全、妊娠肝内胆汁淤积症、胎膜早破、羊水过少/过多和胎儿窘迫。年龄≥35 岁和≥45 岁的 GDM 发生率分别是年龄＜35 岁的 1.91 和 3.26 倍。如果仅对高危因素的妇女进行筛查，将漏诊 34.8%的 GDM 病例。胰岛素使用率为 14.06%（PGDM 55%；GDM 8.53%）。DIP 患者使用胰岛素的最高剂量的平均孕周为 32.87±5.46 周。PGDM 和 GDM 的最高胰岛素剂量分别是初始剂量的 3.67 和 2 倍。PGDM 的 LGA、早产、剖宫产和新生儿低血糖的风险分别是 GDM 的 1.845、1.533、1.797 和 1.368 倍。血糖控制不良的孕妇早产和新生儿低血糖的风险分别是血糖控制良好的孕妇的 1.504 和 1.558 倍。
结论
DIP 的不良结局发生率较高。
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