| Objective:To explore the early prevention of gestational diabetes by analyzing the effects of interaction between weight gain and other risk factors in early pregnancy on the pathogenesis of gestational diabetes.Methods:Selected pregnant women who were pregnant during the period from May2017 to May 2018 in Linyi People's Hospital of Shandong Province,and 24-28 weeks pregnant women undergoing glucose tolerance test as the study subjects,collected the pre-pregnancy body weight,and the weight of 12+1 weeks of pregnancy,height,age,family history of diabetes,history of previous pregnancy,etc.And measured liver function,renal function,thyroid function,blood routine,blood lipids and other indicators,tracking to the end of maternal childbirth.According to whether GDM occurred after pregnancy,301 cases of pregnant women included in the study were divided into normal group(200cases)and GDM group(101 cases),conduct a case-control study.Results:(1)The results of single factor?~2 test showed that excessive weight gain in early pregnancy,advanced pregnancy,overweight or obesity before pregnancy,and family history of diabetes were risk factors for GDM.Among them,in the GDM group,the proportion of pregnant women aged?35 years was 53.5%,and that of the control group was 26%;the proportion of pregnant women<35 years old in the gestational diabetes group was 46.5%,and in the control group was 74%(P<0.05).Pre-pregnancy body mass index 25kg/m2 was used as the boundary value.Pre-pregnancy overweight or obese women accounted for 38.6%of the GDM group and 24.5%in the control group.For pregnant women with pre-pregnancy BMI<25 kg/m~2,the proportion in the gestational diabetes group was 61.4%,and in the control group was 75.5%(P<0.05).In the GDM group and the control group,the proportion of pregnant women with weight gain>2 kg in early pregnancy was 51.5%and 34.5%,respectively,while that in pregnant women with early weight gain?2 kg was 48.5%and 65.5%,respectively(P<0.05).The family history of diabetes in the GDM group and the control group were 17.8%and 8%,respectively(P<0.05).(2)After controlling for confounding factors,multivariate logistic analysis showed that the risk of excessive weight gain in early pregnancy,advanced preg-nancy,pre-pregnancy overweight or obesity,and family history of diabetes in GDM group were 2.120 times,3.441 times,1.875 times,2.388 times the sum of the control group,respectively.Both were statistically significant.(3)The results of interaction analysis showed that there was an interaction between excessive weight gain in early pregnancy and overage pregnancy,pre-pregnancy overweight or obesity,and family history of diabetes.The RERI of premature weight gain>2kg and age?35 years old,pre-pregnancy BMI?25kg/m~2,family history of diabetes were 12.57,3.478,9.555,respectively(95%CI is 6.755-18.385,0.962-5.995,2.76-16.35),indicating the prevalence of GDM caused by the interaction of two risk factors is 12.57 times,3.478 times,and9.555 times of other unmeasured factors.The AP were 0.734,0.537,and 0.731,respectively,indicating that the proportion of gestational diabetes mellitus in the presence of two factors was 73.4%,53.7%,and 73.1%,respectively.The Synergy Index were 4.528,2.742,and 4.806,respectively(95%CI is 2.26-9.072,1.211-6.208,1.836-12.583),indicating that the simultaneous effect of the two factors was 4.528 times,2.742 times,and 4.806 times the sum of the individual effects.Conclusion:(1)Early pregnancy weight gain>2kg,gestational age?35 years,DM family history,pre-pregnancy BMI?25kg/m2 are risk factors for GDM.(2)There was an additive interaction between early weight gain>2 kg and gestational age?35 years,DM family history,and pre-pregnancy BMI?25 kg/m ~2. |
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