Case Control Study Of Gestational Diabetes Mellitus Influential Factors And Maternal And Fetal Outcomes

GDM (gestational diabetes mellitus) is the first time appeared or detected in varying degrees of impaired glucose tolerance during pregnancy. In recent years, because of the rapid socio-economic development, people's lifestyle and dietary nutrition structure change, the incidence rate of GDM in our country increases year by year, which has become the common one of the important complications during pregnancy affecting the prognosis of pregnancy. Its incidence rate is 1%-14% all over the world and the current incidence rate of GDM in our country isGDM pathogenesis is unclear, which is mainly related to insulin resistance and insulin secretion disorder. At present, domestic epidemiological investigations related to GDM research carry out rarely. Various influential factors are more controversial, and studies show that family history, advanced age, pre-pregnancy obesity are major risk factors for GDM. In recent years, the prevalence of GDM related to both mother and infant groups, although through diet, adequate exercise and insulin injections can be effective in controlling this disease, the incidence rate of GDM is caused by a variety of factors, and it can give maternal and fetal, neonatal many adverse effects, Including gestational hypertension, polyhydramnios, premature labor, cesarean section, infection, macrosomia, fetal malformations, neonatal respiratory distress syndrome and so on, and more importantly, it brings about long-term mother-to-infant complications and sequelaes, such as increasing of T2DM and risk of offspring obesity happening. Early diagnosis and treatment of GDM, and timely termination of pregnancy, not only can improve the adverse pregnancy outcomes, but also will help to reduce the risk of mother-to-infant long-term complications. Thus in recent years, GDM has accquired a growing number of doctors and patients' attention.In this study, by collecting Shenyang Shengjing hospital GDM pregnant women as research subjects, normal pregnant women at the same time selected conduct case-control study, exploring the impact factors of the incidence of GDM, and separately from two aspects of the mother and infant explore GDM on pregnancy outcomes, the purpose of carrying out GDM early prevention has targeted and provide reference materials to assess the risk of mother-to-infant.Object and Method1. Research object(1) Selection of case groupBecause of insulin resistance in early pregnancy was not obvious, and at 24-28 pregnant weeks IR is noticeable, so this time is the best screening period, glucose challenge test (GCT) screening blood glucose≥7.8mmol / L is abnormal glucose screening, which carry out oral glucose tolerance test (OGTT).Domestic OGTT diagnostic criteria: fasting plasma glucose≥5.6mmol / L, one-hour postprandial blood glucose≥10.3mmol / L, two-hour postprandial blood glucose≥8.6mmol / L, three-hour postprandial blood glucose≥6.7mmol / L, the results have two or more met or exceeded the normal value, which is diagnosis of GDM.Through the above-mentioned method of GDM, diagnose 130 cases of pregnant women as a case group, patients with previous history of DM have to be ruled out.(2)Selection of control group Randomly select in Shenyang Shengjing hospital normal healthy pregnant women 195 cases treated at the same period (diagnosed by the hospital for non-gestational diabetes mellitus) as a control group.2. Research methodFill in "the general situation questionnaire during pregnancy " by trained investigators taking face-to-face, one-on-one, through face-to-face or telephone interviews to improve the questionnaire.3. Research contentDesign questionnaire in accordance with the relevant document on their own including: the general situation of pregnant women, GDM influencial factors, the pregnant complications and pregnancy outcomes, the general condition of the newborn and complications.Results1. GDM influential factors analysisSingle factor analysis showed that there was statistical significance between case group and control group in gravidas' pregnancy age, educational level, pre-pregnancy weight, BMI before pregnancy, weight late during pregnancy, pre-pregnancy exercise, getting up and sleeping time, sleep quality, taste before pregnancy, often drinking soft drinks before pregnancy, the history of abortion, progesterone times, DM family history, family history of hypertension, according to multivariate factors Logistic regression analysis, the five factors came into this regression model: gravidas' pregnancy age, BMI before pregnancy, DM family history, taste before pregnancy were risk factors for GDM (OR=2.490, 95%C.I. = 1.614-3.842; OR=1.432, 95%C.I. = 1.252-1.639; OR=12.079, 95%C.I.=4.991-29.235; OR=1.453, 95%C.I.= 1.193-1.768); educational level was a protective factor for GDM (OR=0.536; 95%C.I.=0.348-0.827).2. GDM influence on maternal and fetal outcomes There was statistical significance between case group and control group in gestational hypertention, polyhydramnios, preterm birth, cesarean section(χ~2 =31.597,P=0.000;χ~2=53.431, P=0.000;χ~2 =11.727, P=0.001;χ~2=25.920, P=0.000); there was statistical significance between case group and control group in birth week and birth weight(t=4.337, P=0.000; t=-3.993, P=0.000); there was statistical significance between case group and control group in macrosomia, newborn asphyxia, fetaldistress, hyperbilirubinemia, neonatal hypoglycemia, stillbirth(χ~2=54.584, P=0.000;χ~2 =17.297, P=0.000;χ~2 =14.490, P=0.000;χ~2 = 16.600, P=0.000;χ~2 =28.083, P=0.0 00;χ~2 =7.617, P=0.006).Conclusions1. Gravidas' pregnancy age, BMI before pregnancy, DM family history and taste before pregnancy were probably the risk factors for GDM; educational level is possibly the protective factor for GDM.2. GDM might be a influential factor of some maternal and fetal adverse outcomes (gestational hypertension, polyhydramnios, preterm birth, cesarean section, macro somia, fetal distress, asphyxia, hyperbilirubinemia, hypoglycemia, stillbirth).