| (Part 1: A 1:2 Matched Case-control Study on the Risk Factors for the Patientswith Gestational Diabetes Mellitus)Background: Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable severity with onset or first recognition during pregnancy. Women with GDM are at increased risk for the development of diabetes, while her offspring are at risk of fetal macrosomia, neonatal hypoglycemia, glucose intolerant, etc. Therefore, it is of significance to control or reduce risk factors to prevent GDM from occurrence.Objecticve: To investigate the relationship of risk factors in environment, social-psychological, heredity aspects with the development of GDM in Tianjin pregnancies. To put forward some evidences for the prevention of GDM in high-risk women.Methods: 72 GDM patients and 144 controls with 1:2 age-matched (?yrs) who were from the same or neighborhood community, were interviewed with epidemiology questionnaires during the Dec. 2002 to Dec. 2003. All patients and controls were screened for GDM with 50 g GCT during 24th-28th weeks of the pregnancy and all patients with GDM were diagnosed by the ADA criteria. Data on demographic, menstrual, reproductive, contraception, personal disease history, family history of diabetes, hypertension, obesity, etc., dietary habits and intakes during pregnancy or before, characters, and anthropometrical items were collected, and then, was analyzed with conditional logistic regression model.Results: Univariables conditional logistic analysis results showed that main risk factors for GDM development included WHR (ration of waist/hip circumferences) which OR was 19.101 (95%CI 5.862-62.24), the body weight increment in 2nd pregnant phases (OR 1.516, 95%CI 1.249-1.840), GCK exon6 mutation (4.571, 1.881-11.112), GCK exon7 (4.000, 1.501-10.658), abnormal menses (2.375, 1.221-4.618), family history of DM (4.239, 2.079-8.645), high in take of animal fat (1.855, 1.093-3.150), fateful life events happened during 1 year (4.000, 1.367-11.70); pre-pregnant BMI (2.827, 1.567-5.102), ratio of waist circumference to body height (1.744, 1.216-2.503). The protective factors were rational intake of coarse- and refined grains with OR 0.403 (95%CI 0.234-0.696), intake of dark-color vegetables (0.502, 0.303-0.834), labor actions (OR 0.471, 0.291-0.763) and long term exercise, OR 0.794 (0.757-0.651). The multivariable conditional logistic analysis showed that WHR before pregnancy, BW increment in the 2nd pregnant phases, GCK eon6 and exon 7 mutations were the main independent risk factors for GDM development and their OR & 95%CI were respectively 3.686(9.087~210.023)s 1.604(1.264-2.035). 7.852 (1.532-40.259) And 7.008 (1.387-35.411) .Conclusions: It is multi-factors including internal & external environment, social-psychology, and hereditary aspects that attributed to GDM. Some proposal was recommended to pregnant women: persisting in exercise everyday, having a balanced diet, controlling the increment of body weight during pregnancy, be active to face the fatal events and taking part in the screening for GDM.
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