Study Of Risk Factors For Gestational Diabetes Mellitus And Health Management During Pregnancy

Object As change of modern life style, backward movement of reproductive age, and altering of diagnosis standard of gestational diabetes mellitus(GDM), the incidence of GDM increases year by year. To investigate the prevalence of GDM in pregnant women in Anqing, the risk factors of fasting blood-glucose levels in pregnant women, and to provide evidence-based theory for prevention and standardized management, we performed this study.Methods The screening of GDM proceed in two phases. First, fasting plasma-glucose(FPG) was measured in 4724 pregnant women with first prenatal examination. GDM was diagnosed with FPG≥5.1 mmol/L. In addition, the impact factors of FPG were also measured within subgroups of different age, gestational weeks, and body mass index(BMI). Second, oral glucose tolerance test(OGTT) were conducted in 136 pregnant women during 24 weeks to 28 weeks of pregnancy. Individual diet and exercise guide were designed for 78 pregnant women with GDM to control the blood glucose.Results(1) Screening results of FPG in pregnant women: none diabetes mellitus were found in 4724 pregnant women. The average level of FPG was 4.59±0.56mmol/L, while the maximum level was 12.20 mmol/L and the minimum level was 2.65 mmol/L. The FPG level in 9 pregnant women exceeded 7 mmol/L, who were diagnosed with pregestational diabetes mellitus(PGDM). The FPG level in 699 pregnant women exceeded 7 mmol/L, who were diagnosed with GDM.(2) Impact factors on FPG of pregnant women: Age: the age of the 4724 pregnant women was between 16 to 55, ①and the average was 27.01. While the subjects were divided into groups by age, the women in age 30 to 55 had the highest level of FPG(4.72±0.54 mmol/L), the women in age 16 to 20 had the lowest level of FPG(4.48±0.38 mmol/L), and the results between groups were different significantly(F =17.082,P <0.001). ② Gestation weeks: the subjects were grouped into three subgroups by gestation weeks, namely 6-; 14-; 28-42 weeks, and the FPG levels were 4.67±0.50 mmol/L, 4.58±0.55mmol/L, 4.59±0.61 mmol/L, respectively. The results between groups were also different significantly(F =3.734,P =0.024). ③BMI: while the subjects were divided into groups by BMI, the women(BMI 10.41-) had the lowest level of FPG(4.50±0.50 mmol/L), the women(BMI 27-36.44) had the highest level of FPG(4.83±0.60 mmol/L), and the results between groups were different significantly(F =32.879,P <0.001).(3) The screening results of OGTT: abnormal results were found in 136 subjects. There were 26 cases whose FPG exceeded 5.1 mmol/L; 8 cases whose plasma glucose exceeded 10.0 mmol/L 1h after oral test; 6 cases whose plasma glucose exceeded 8.1 mmol/L 2h after oral test. And we found 40 cases with GDM.(4) Health management: Among pregnant women with GDM, there were 78 mild cases with moderately high FPG, who did not need Insulin therapy. After intervence, the mean FPG level was 4.54±1.03 mmol/L, while that was 6.18±0.38mmol/L before intervence, and the difference was significant. However, none adverse pregnant outcomes were found in them.Conclusion Considering the risk factors of GDM, women in childbearing age should choose the appropriate pregnant age and exercise manners, and keep healthy body weight to prevent the development of GDM. The FPG measurement should conducted in the first pregnant examination. The 75 g OGTT should be measured in subjects whose FPG level exceeded 5.1 mmol/L. If the results of OGTT were normal, the repeated OGTT was recommended in gestation 32 weeks. Early screening and diagnosis should be taken into consideration to prevent GDM. Besides, standardized treatment on GDM was also necessary. Through individual nutrition and exercise direction, the adverse pregnant outcomes in most moderate cases can be avoided.