Zhang Jiani, Xu Tingting, Cao Qi, Mao Chihui, Zhou Fan, Wang Xiaodong
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, China.
Matern Fetal Med. 2024 Oct 11;6(4):236-242. doi: 10.1097/FM9.0000000000000252. eCollection 2024 Oct.
To evaluate the impact of pregestational and gestational characteristics on postpartum glucose follow-up screening (PGFS) compliance in women diagnosed with gestational diabetes mellitus (GDM) in southwest China.
This retrospective cohort study was conducted in West China Second Hospital, Sichuan University. Pregestational and gestational factors were extracted from hospital records and compared between women who completed PGFS and those who did not. The screening method chosen was the 75 g oral glucose tolerance test (OGTT), performed 4-12 weeks postpartum. Univariate analysis, logistic regression analysis, and Cochran-Armitage test were used to assess associations between maternal characteristics and PGFS compliance.
A total of 3047 women with GDM were included, with a PGFS completion rate of 47.2%. Of those who completed PGFS, 430 women (29.9%) presented abnormal results: 1.8% with impaired fasting glucose (IFG), 24.1% with impaired glucose tolerance (IGT), 2.2% with both IFG and IGT, and 1.8% with suspected diabetes. Independent factors associated with non-compliance to PGFS included higher pregestational BMI (odds ratio (): 0.952; 95% confidence interval (): 0.922, 0.984), multipara (: 0.721; 95% : 0.593, 0.877), use of assisted reproduction technology (ART) (: 1.427; 95% : 1.080, 1.885), excessive gestational weight gain (: 0.956; 95% : 0.936, 0.977), elevated fasting plasma glucose (FPG) prior to delivery (: 0.909; 95% : 0.835, 0.988), and undergoing cesarean section (: 1.232; 95% : 1.017, 1.492). PGFS completion rates significantly decreased with increasing pregestational BMI and earlier gestational age ( < 0.001).
Establishing dedicated postpartum follow-up teams and targeting women with higher pregestational BMI, multiparity, ART use, excessive gestational weight gain, elevated pre-delivery FPG, and those undergoing cesarean section are critical to improving postpartum GDM management.
评估孕前和孕期特征对中国西南部地区诊断为妊娠期糖尿病（GDM）的女性产后血糖随访筛查（PGFS）依从性的影响。
本回顾性队列研究在四川大学华西第二医院开展。从医院记录中提取孕前和孕期因素，并在完成PGFS的女性与未完成PGFS的女性之间进行比较。所选用的筛查方法为产后4 - 12周进行的75克口服葡萄糖耐量试验（OGTT）。采用单因素分析、逻辑回归分析和 Cochr an - Armitage检验来评估孕产妇特征与PGFS依从性之间的关联。
共纳入3047例GDM女性，PGFS完成率为47.2%。在完成PGFS的女性中，430例（29.9%）结果异常：空腹血糖受损（IFG）占1.8%，糖耐量受损（IGT）占24.1%，IFG和IGT均有的占2.2%，疑似糖尿病的占1.8%。与PGFS不依从相关的独立因素包括孕前较高的体重指数（比值比（OR）：0.952；95%置信区间（CI）：0.922，0.984）、经产妇（OR：0.721；95%CI：0.593，0.877）、使用辅助生殖技术（ART）（OR：1.427；95%CI：1.080，1.885）、孕期体重过度增加（OR：0.956；95%CI：0.936，0.977）、分娩前空腹血糖（FPG）升高（OR：0.909；95%CI：0.835，0.988）以及剖宫产（OR：1.232；95%CI：1.017，1.492）。PGFS完成率随着孕前体重指数的增加和孕周的提前而显著降低（P < 0.001）。
建立专门的产后随访团队，并针对孕前体重指数较高、经产、使用ART、孕期体重过度增加、分娩前FPG升高以及行剖宫产的女性，对于改善产后GDM管理至关重要。
