Analysis Of Risk Factors And Adverse Pregnancy Outcomes Of Gestational Diabetes Mellitus

Objective:In this study,we retrospectively analyzed the clinical datas of pregnant women who establish cards and periodically do prenatal check-up and delivery and perinatal infants and pregnant women’s 75g oral glucose tolerance test(OGTT)results of the Affiliated Hospital of North Sichuan Medical College.To explore the risk factors of gestational diabetes mellitus(GDM)and its influence on pregnancy outcomes,and to provide references for GDM prevention and prenatal care of pregnant women in Northeast Sichuan.Methods:This study selected 1871 pregnant women who establish cards,periodically do prenatal check-up and delivery in the Affiliated Hospital of North Sichuan Medical College from July 1,2018 to September 30,2019,rule out 9 cases of pregestational diabetes mellitus,32 cases of prepregnancy thyroid dysfunction,3 cases of cardiovascular disease,2 cases of liver disease,3 cases of blood system disease,22 cases of incomplete data,and ultimately enrolled in 1800 cases.According to the GDM diagnostic standard formulated by the International Association of Diabetes and Pregnancy Study Groups(IADPSG)in 2010,pregnant women were given 75g OGTT at 24 to 28 weeks of gestation,the diagnosis of GDM is made when any of the following plasma glucose values are exceeded:fasting plasma glucose(FPG)≥ 5.1mmol/L or 1 hour plasma glucose(1hPG)≥10.0mmol/L or 2 hour plasma glucose(2hPG)≥ 8.5mmol/L;if they are lower than the above criteria,they will be diagnosed as normal glucose tolerance(NGT).And divided them into two groups:GDM group(537 cases)and NGT group(1263 cases).Recording datas such as delivery age,menarche age,residence,education level,height,prenatal body mass index(BMI),polycystic ovary syndrome(PCOS),hepatitis B surface antigen(HBSAg),hypertensive disorders of pregnancy(HDP),thyroid function during pregnancy,scar uterus,in vitro fertilization(IVF),miscarriage history,delivery history,twin pregnancy,cesarean section(CS),intrahepatic cholestasis of pregnancy(ICP),postpartum hemorrhage(PPH),premature delivery,premature rupture of membranes(PROM),urogenital tract infection,macrosomia,full-term low birth weight infants,fetal distress,neonatal asphyxia,etc.The risk factors of GDM and its influence on pregnancy outcomes were analyzed by single factor and binary logistic regression analysis.Results:1.Among the 1800 pregnant women included from July 2018 to September 2019,537 cases were diagnosed with GDM,and the detection rate was 29.83%.Where the 75g OGTT FPG abnormal 304 cases(56.6%),1hPG abnormal 262 cases(48.79%),2hPG abnormal 250 cases(46.55%).25(4.66%)pregnant women with GDM who used insulin to control blood glucose.2.Delivery age,place of residence,prenatal BMI,PCOS,HBSAg(+),HDP,thyroid dysfunction during pregnancy,scar uterus,IVF,miscarriage history and delivery history,these differences between the two groups were statistically significant(P<0.05);menarche.age,education level,height and twin pregnancy,these differences between the two groups were not statistically significant(P>0.05).After used binary logistic regression analysis,we found that the independent risk factors of GDM were delivery age,place of residence,prenatal BMI,PCOS,HBSAg(+),HDP,thyroid dysfunction during pregnancy,IVF and miscarriage history.3.Comparison of adverse pregnancy outcomes between two groups of pregnant women:CS,HDP,ICP,PPH and preterm delivery,these differences between the two groups were statistically significant(P<0.05);PROM and urogenital infection,these differences between the two groups were not statistically significant(P>0.05).The results of binary logistic regression analysis showed that GDM was an independent risk factor for CS,HDP,ICP and PPH after adjusting for these influences of delivery age,PCOS,IVF,HDP,ICP,thyroid dysfunction during pregnancy,twin pregnancy,etc.4.Comparison of perinatal infants’ outcomes between two groups:premature infants and macrosomia,these differences between the two groups were statistically significant(P<0.05);full-term low birth weight infants,fetal distress and neonatal asphyxia,these differences between the two groups were not statistically significant(P>0.05).After adjusting for confounding factors,GDM was an independent risk factor for macrosomia.Conclusion:1.From July 2018 to September 2019,the detection rate of GDM in Affiliated Hospital of North Sichuan Medical College was 29.83%.2.Delivery age≥ 35years old,living in the city,BMI≥28kg/m2,PCOS,HBSAg(+),HDP,thyroid dysfunction during pregnancy,IVF and miscarriage history may be risk factors for GDM.3.The risk of adverse pregnancy outcomes such as CS,HDP,ICP,PPH,and macrosomia in pregnant women with GDM may increase.4.Strengthen eugenics health education,prepregnancy GDM risk assessment and screening,recommend age-appropriate pregnancy,cultivate healthy lifestyles,prepregnancy weight management and reduce abortion,to reduce GDM risk,GDM pregnant women establish cards and receive manage to reduce adverse outcomes of mothers.and children.