| PrefaceGDM (gestational diabetes mellitus) is the glucose untolerance appeared or first detected during pregnancy. It is a common complication for women of peripartum, which incidence rate is 1%-14% all over the world. GDM is caused by many factors, which takes many unfavorable effects to the mothers, fetus and newborns. What's more, properties of diabetes mellitus of the pregnancy women and newborns becomes higher and a series of complications and sequela happen. It is important to recognize, know the affecting effectors of GDM so as to prevent,early diagnose,and treat to improve the life quality of the pregnant women and the fetus.Nearly all the studies of GDM today is single factor study, which lacks of multiple factor study, so lots of factors affecting GDM need to be confirmed by multiple factor study.In this lecture, we choose some GDM patients in shenyang as case group, at the same time, take the healthy pregnancy women as control group, to detect the multiple factors affecting GDM and to provide some conference for the etiological study of GDM.Subjects and Methods1．The selection of subjects and Diagnosis standard(l)Selection of subjects The suspected pregnancy women with GDM are screened in the basic women and children health station in the five blocks and counties of shenyang with the method of plasma-glucose oxygenase (Japanese OLYMPUS-AU1000 type completed automobile biochemical analyst machine) to test the blood glucose levels of fasting plasma one hour and two hour after dinner. Refer to the diagnostic standard of GDM of ADA in 2002 (the reference levels of 75g OGTT: FPG(?)5．3mmol/L, 1h glucose(?)10．0mmol/L, 2h glucose(?)8．6mmol/L, two or more than two abnormal results can diagnose the GDM). The 74 diagnostic GDM patients (average age is 28．92(?)4．27 years old) are chosen into the patients group excluding the patients with the DM history.(2) The selection of the control groupsThe 76 patients, (average age is 27．17 (?) 3．36 years old), which are chosen randomly from the non-GDM (more than twice glucose levels tested normal) in the same hospital at the same time, are chosen into the control groups.2．Investigational contents and methodsWith the method of asking and measuring to fill the investigational table, the investigational contents include the common condition, body condition, life condition, family history, past history, pregnancy complication and psychological state of the pregnancy women.3．Statistical methods After the quality examination and date putting into SPSS 12．0 of the investigational findings, the quantity date and frequency date which the investigational table including analyzed by special date analysis software with the methods of base-line described analysis, monofactorial analysis, X test and multiple-factor Logistic Regression. A 2-sided value of a = 0．05 was regarded as statistically significant.Resultsl.The comparison of age, pregnant weeks between case group and control group.In case group, the maximum age is 38 and the minimum one is 18, while in control group, the maximum age is 37 and the minimum one is 21．The average age of case group is larger than control group, and there is significant difference between the two groups (P<0．05) . The maximum pregnant weeks of case group is 40 weeks and the minimum one is 12 weeks, while the maximum pregnant weeks is 38 weeks and the minimum one is 13 weeks. The mean and median of case group is larger than that of control group, and there is significant difference between the two groups (P<0．05) .2．Monovariate analysis for the influent factors of GDM(1) Monovariate analysis of continuous variableThere is significant difference between case group and control group in the pregnant age of this time, weight before pregnant, BMI before pregnant, present weight and pregnant weeks (P<0．05) . The gestational age at present is one of the risky factors of GDM (OR=1．12, 95%C.I: 1．03(?)1．23) ; Weight before pregnancy is one risky factor of GDM (OR=1．07, 95%C.I: 1．02(?)1．11) ; body mass index(BMI) before pregnant is one risky factor of GDM (OR=1．25, 95%C.I:1．11(?)1．42) ; present weight is also one of the risk factors of GDM (OR=1．13, 95%C.I: 1．06(?)1．20) . We analyze the increase of gestational weight every week instead of weight before pregnancy and present weight, and the increase of gestational weight every week doesn't show significant difference between the two groups.(2) Monovariate analysis of classific variationThe following factors such as family history of diabetes, pregnancy with fatness, pregnancy with hypertension, worrying about fetus health and amount of milk eaten before and after pregnancy, have remarkable differences between gestational diabetes mellitus group and control group(p<0．05) . It is dangerous factor that either father or mother has diabetes (OR=4．26, 95%C.I: 1．744(?)12．255) ; Pregnancy with fatness is the dangerous factor of gestational diabetes mellitus (OR=15．20, 95%C.I: 3．78(?)68．386) ; Pregnancy with hypertension is the dangerous factor of GDM (OR=7．53, 95%C.I: 0．881(?)64．248) ; Worrying about fetus health is also the dangerous factor of GDM(OR=3．09, 95%C.I: 1．137(?)8．402) . Amount of milk eaten before pregnancy is protect factor of GDM (OR=0．57, 95%C.I: 0．348(?)0．930) ; Amount of fruits eaten after pregnancy is the protective factor (OR=0．51,95%C.I: 0．318(?)0．821) .3．Dose-effect test of many classific variationAfter single factor analysis is taken in many classific variation, EPI is applied to test tendency X test, analysis dose-effect relationship find that, it has remarkable difference between case group and control group that amount of milk eaten before pregnancy, amount of milk eaten after pregnancy(p<0．05) . As the increase taking of milk and fruits after pregnancy, OR is decreasing, it explains that with the milk intaking before or after pregnancy and fruits eaten after pregnancy increasing, the possibility of GDM is decreasing. However, the difference between the case group and control group is not evident (P>0．05) on the history of taking meat or fish, or the drinks like coffee before pregnancy, and the sleep quality after pregnancy. But, with the increase of intaking mea,fish,drinks like coffee as well as sleep improvement, OR has the tendency to decrease.4．Multivariate analysis concerned with GDMBase on the single factors analysis, we use multivariate factors Logistic synchronism tropics to analysis the relationship between several single factors and gestation diabetes mellitus, the factors must be in the case of p<0．01．The four factors, weight index pre-pregnancy, family factors diabetes, pregnancy associate with obesity and the quantity of fruits taking, come to my modes. Among above factors, the weight index before pregnancy, family history of diabetes and pregnancy complied with obesity are the dangerous factors(OR are 1．317, 4．531, 15．139; 95%C.I are 1．094(?) 1．584, 1．065(?)19．284, 2．910(?)78．765) . The quantity of fruits taking after pregnancy is the protect factor (OR=0．472,95%C.I: 0．241(?)0．926) . DiscussionMoses RG, Solarnon CG who studied the influential factors of GDM occurrencefrom 1996, argued that gestational diabetes mellitus (GDM) is probably concerned withdiabetes mellitus family history,GDM history,low birth weight of pregnant women,race,gynecology factors,pregnant time as well as gestational,complication with highblood pressure,smoking,family economic status and so on. Zhaowei in civil alsostudied the influential factors of GDM occurrence and thought BMI, first pregnant age,DM family history are concerned with GDM. But there are some uncertain influentialfactors. Recently, some scholars found that the psychological health of pregnant womenall had some relationship with the occurrence of GDM. The incidence of the GDM inthe Middle pregnant period is higher to 25．6%, especially the mideme of anxiety andlevel are both significantly higher than normal pregnant women. The possiblyinfluential factors are not tested by element analysis and the occurrence of risk are notsure, either.The study founds there is significant difference between cases group and controlgroup in BMI before pregnant, DM family history, gestation complied with fatness(P?0．05) , which is consistent with many scholars. But the difference on fruit eating afterpregnancy between cases group and control group lack of relative literature.Circumstances, age, economy, education level, eating structure and so on areassociated with fatness, which increases the of GDM increase significantly. The resultof this study showed BMI is the risky factor during pregnancy(OR=1．304, 95%C.I:1．102(?)1．544) , The conclusion is same to the one of Zhaowei civily.The study shows that the incidence of GDM of pregnant obesity group issignificantly higher than normal weight group(RR=18．0482; 95%CI 6．2437(?)52．1704) .The result of this study shows pregnancy complied with obesity is the risky factor ofGDM(OR=15．370, 95%C.I: 2．938(?)80．397) , the incidence of GDM of pregnantobesity group is significantly 15．37 times of normal weight group. This indicated thatpregnancy complied with obesity is probably one of most important risky factors. So people may control weight through diet and sports to control fast weight growth, so asto decrease the incidence of pregnancy complied with obesity to decrease the incidenceof GDM.The opportunity of subjecting to GDM which has diabetes family history is 1．55times of non-diabetes family history. The diabetes family history in stair relatives risesto 2．89 time. Zhang Meihua studied 244 cases pregnant women in abnormal glucosemetabolision and 244 cases of normal ones. The differences are 38．1% in diabeteshistory and 17．6% in non-diabetes history, which showed the more diabetes relatives,the easier opportunities to have pregnant diabetes (P<0．001) ; if the parents havediabetes at same time, the possibility to have GDM in pregnant women will increase9．3 times. The study result shows the diabetes family history is the risky factor forGDM(OR=5．651, 95%C.I: 1．329(?)24．117) , the opportunity will increase 5．65 times onone side of diabetes parents.The study also finds a protective factor in GDM, the amount of fruit eating afterpregnancy. It indicates the more fruits to have, the less opportunity to getGDM(OR=0．442, 95%C.I: 0．225(?)0．871) . The conclusion now lacks same literature tobe compared and tested, but it indicates that the researchers can decrease theoccurrence of GDM by pubic education to increase the pregnant women's intaking offruits.ConclusionsIt shows pregnancy complied with obesity, BMI before pregnant and gestationalfamily history are probably the risky factors for GDM. And intaking fruits afterpregnancy may be the protective factor for GDM.
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