| Objective:Gestational diabetes mellitus(GDM)is the most common metabolic disease in pregnancy.At present,the diagnostic criteria for GDM vary from place to place around the world.This study is mainly aimed at pregnant women in the suburbs of Qingdao,in accordance with the new GDM diagnostic criteria introduced by IAPPSG in 2010.After the general OGTT screening of pregnant women,figuring out in Qingdao rural residents and urban residents GDM pregnant women prevalence and complications,and the related risk factors were statistically analyzed.Methods:The pregnant women who were registered,pregnant and delivered in the Pingdu City Maternal and Child Health Hospital and the People's Hospital of Pingdu City in the suburbs of Qingdao from December 2016 to December 2018 were selected as subjects.All the selected cases were full-term single-pregnancy,and were systematically examined before pregnancy.The age distribution was 18-45 years old.They were voluntarily investigated and signed with relevant informed consent to exclude diabetes,twin or multiple pregnancies and those with other serious diseases of the system.75 g glucose tolerance test(OGTT test)was performed on all pregnant women at 24 to 28weeks gestation.Grouping of GDM patients and related indicators were conducted according to the following study design.The total and basic information of the pregnant women were obtained from the records of the obstetrics and gynecology examination at the same time in both hospitals.The subjects of the study have lived in cities above the county level for two years or more in the past three years.The respondents have lived in rural areas below the county level for two years or more in the past three years.Finally,the incidence was calculated based on the total sample size and the sample size diagnosed as GDM.The patients with GDM were divided into three levels according to the number of excess blood glucose values at three time points detected by OGTT test:one abnormal GDM1,two abnormal GDM2,and three abnormal GDM3.In addition,the prevalence of GDM was correlated with maternal and fetal complications,as well as maternal age,weight,meditation time,fasting blood glucose during early pregnancy,blood lipids,and coagulation parameters.Result:The total sample size of maternal samples in this study was 6,235,and 5,403 effective cases,the effective rate was 85.42%.There were 1709 cases in the case group(GDM)and 3694 in the non-GDM control group.Among them,the total number of rural residents was 2,755,accounting for50.99%of the total number of surveys,and the total number of urban residents was 2,648,accounting for 49.01%of the total number of surveys.Total of 1709 cases of GDM were diagnosed.The total prevalence of GDM in pregnant women was 31.63%.The prevalence of GDM in rural residents was 29.66%,and the prevalence of GDM in urban residents was 33.69%.There was a significant difference in prevalence of GDM in urban and rural maternal(?~2=10.14,p=0.001).GDM1 in GDM was 66%,GDM2 was 28.50%and GDM3 was 5.50%.The percentage of GDM1 and GDM2 was not significantly different in rural and urban areas(p>0.05),and the percentage of GDM3 was higher than that in rural areas(?~2=5.66,p=0.017).Comparison of pregnancy outcomes and neonatal complications between normal pregnant women and GDM pregnant women showed that the incidence of postpartum hemorrhage in the GDM group was significantly higher than that in the control group(?~2=74.41,p=0.000).The incidence of macrosomia in GDM group was significantly higher than that in control group(?~2=17.29,p=0.000).There was no significant difference between the two groups in the incidence of cesarean section,premature rupture of membranes and hyperhydramnios(p>0.05).GDM grading comparison:From GDM1 to GDM3,the incidence of postpartum hemorrhage and macrosomia increased in turn,and the difference was statistically significant(?~2=17.32,p=0.000;?~2=35.83,p=0.000).Fibrinogen and D-dimer in GDM group were significantly higher than those in normal group in the third trimester(t=3.21,p=0.001and t=9.43,p=0.000).Statistical analysis of relevant factors of GDM occurrence shows that:With the increase of maternal age,the incidence of gestational diabetes increased gradually(?~2=81.41,p=0.000),and the prevalence of GDM was lower than 20%for those less than 25 years old.Between 25 and 35 years old,the incidence of GDM was29.84-30.95%.The number of people over 35 years old was as high as 40.27%.The higher the maternal body mass index was,the higher the incidence of gestational diabetes was(?~2=414.55,p=0.000).The prevalence of GDM was 33.61%in the BMI group of18.5-24.9.The prevalence of GDM was 67.25%in BMI 25 group.The higher the weight gain during pregnancy,the higher the incidence of gestational diabetes(?~2=772.95,p=0.000),the weight gain<20%,the prevalence of GDM is 11.22%,and the weight gain is between 20-40%.The morbidity rate increased to 37.90%;the weight gain exceeded40%,and the prevalence of GDM was as high as 95.98%.The prevalence of GDM was less than 11.02%in the sedation time less than 5h group and 38.06%in the?5h group,the difference was significant(?~2=332.65,p=0.000).In addition,the incidence of GDM is also related to the fasting blood glucose level in the first trimester,the blood lipid index in the third trimester,and the blood coagulation index.As the fasting blood glucose level increased,the incidence of GDM also increased(?~2=325.472,p=0.000).In addition to TC,there were significant differences in TG,HDL-C and LDL-C between the GDM group and the normal group(t=11.68,p=0.000;t=12.91,p=0.000;t=4.85,p=0.000),and there were significant differences between GDM 1,2,and 3(F=17.21,p=0.000;F=16.21,p=0.000;F=1.0,p=0.000).The coagulation index in the third trimester of GDM group was significantly higher than that in the normal group.Conclusion:The prevalence of maternal GDM in the suburbs of Qingdao is 31.63%,among which the prevalence of GDM in rural residents is 29.66%,and the prevalence of GDM in urban residents is 33.69%.The incidence of postpartum hemorrhage of GDM,the incidence of macrosomia,the changes of blood coagulation indexes in the third trimester were all higher than those in the normal group.The incidence of GDM is closely related to the age of pregnant women,BMI before pregnancy,weight gain during pregnancy,sitting time,fasting blood glucose level and blood lipid level.The incidence of GDM among rural and urban residents in Qingdao is significantly higher than the existing reports,and enough attention should be paid to the prevention and control measures as early as possible. |
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