高龄妊娠期糖尿病产妇糖耐量血糖特征与妊娠结局的关系

doi:10.20223/j.cnki.1000-8535.2025.07.017

摘要/Abstract

摘要： 目的探讨高龄妊娠期糖尿病（GDM）产妇糖耐量的特点及其与妊娠结局的关系。方法选择2020年1月1日—2024年12月31日在广州市第一人民医院规律产检并分娩的高龄产妇727例,包括高龄初产妇226例（GDM 78例）和高龄经产妇501例（GDM 131例）,按照75 g OGTT血糖异常项数进行分组：一项血糖异常产妇为GDM I组（高龄初产妇38例,高龄经产妇68例）;两项血糖异常产妇为GDM Ⅱ组（高龄初产妇26例,高龄经产妇51例）;三项血糖异常产妇为GDM Ⅲ组（高龄初产妇14例,高龄经产妇12例）;75 g OGTT正常高龄产妇为对照组。收集研究对象一般资料、75g OGTT血糖及相关妊娠结局进行分析比较。结果高龄初产妇GDM发生率（34.51%）较高龄经产妇GDM发生率（26.15%）高,差异具有统计学意义（P=0.021）;高龄初产妇GDM Ⅲ型宫内感染（28.57%）、产后出血（14.29%）发生率最高,差异具有统计学意义（P=0.037、0.039）;高龄初产妇GDM I型早产（23.68%）发生率最高,差异具有统计学意义（P=0.013）。高龄初产妇及经产妇GDM Ⅱ型的羊水过多、甲状腺功能减退、宫内感染、早产发生率均呈上升趋势。结论高龄妊娠糖尿病产妇随OGTT血糖异常项增多出现不良妊娠结局风险升高,其中高龄初产妇的早产、宫内感染及产后出血的发生率更高,因此,针对高龄初产妇,应更加注重孕期血糖及健康管理,以减少不良妊娠结局的发生。

关键词: 高龄, 血糖, 初产妇, 经产妇, 妊娠结局

Abstract: Objective To analyze glucose tolerance characteristics in elderly pregnant women with gestational diabetes mellitus（GDM）and relationship with pregnancy outcomes．Methods From January 1,2020,and December 31,2024,727 elderly pregnant women who underwent routine prenatal examinations and delivered in Guangzhou First People's Hospital were recruit． Among them,226 were elderly primiparas and 501 were elderly multiparas．GDM was diagnosed in 78 elderly primiparas and 131 elderly multiparas．Based on the results of the 75 g oral glucose tolerance test（OGTT）,GDM cases were classified as follows：GDM I（one abnormal glucose value;38 elderly primiparas,68 elderly multiparas）,GDM II（two abnormal values;26 elderly primiparas,51 elderly multiparas）,and GDM Ⅲ（three abnormal values;14 elderly primiparas,12 elderly multiparas）．Elderly pregnant women with normal OGTT results served as the control group．General clinical data and pregnancy outcomes were collected．The prevalence and characteristics of GDM in elderly primiparas and multiparas were analyzed．Results The incidence of GDM was significantly higher in elderly primiparas than in elderly multiparas（P=0.021）．The incidence of intrauterine infection and postpartum hemorrhage was highest in elderly primiparas with GDM Ⅲ（P=0.037,0.039）．The incidence of preterm birth was highest in elderly primiparas with GDM I（P=0.013）．The incidence of polyhydramnios,hypothyroidism,intrauterine infection,and preterm birth showed an increasing trend in both elderly primiparas and multiparas with GDM II．Conclusions Elderly primiparas with more severe glucose tolerance abnormalities are at a higher risk of adverse pregnancy outcomes．Enhanced blood glucose monitoring and comprehensive health management during pregnancy are crucial for reducing the incidence of adverse outcomes in this population．

Key words: advanced maternal age, blood glucose, primipara, multipara, pregnancy outcomes

陈爱月, 曾北蓝, 张玉洁, 杨娜, 杨宇. 高龄妊娠期糖尿病产妇糖耐量血糖特征与妊娠结局的关系[J]. 广州医药, 2025, 56(7): 968-974.

CHEN Aiyue, ZENG Beilan, ZHANG Yujie, YANG Na, YANG Yu. Pregnancy outcomes in elderly pregnant women with different types of gestational diabetes mellitus[J]. Guangzhou Medical Journal, 2025, 56(7): 968-974.

参考文献

[1] OAKLEY L,PENN N,PIPI M,et al.Risk of adverse obstetric and neonatal outcomes by maternal age:Quantifying individual and population level risk using routine UK maternity data[J].PLoS One,2016,11(10):e0164462.
[2] GOISIS A,REMES H,BARCLAY K,et al.Advanced maternal age and the risk of low birth weight and preterm delivery:A within-family analysis using Finnish population registers[J].Am J Epidemiol,2017,186(11):1219-1226.
[3] SHAN D,QIU P Y,WU Y X,et al.Pregnancy outcomes in women of advanced maternal age:A retrospective cohort study from China[J].Sci Rep,2018,8(1):12239.
[4] WALDENSTRÖM U,CNATTINGIUS S,VIXNER L,et al.Advanced maternal age increases the risk of very preterm birth,irrespective of parity:A population-based register study[J].BJOG,2017,124(8):1235-1244.
[5] SHAH P S.Parity and low birth weight and preterm birth:A systematic review and meta-analyses[J].Acta Obstet Gynecol Scand,2010,89(7):862-875.
[6] KALOGIANNIDIS I,MARGIOULA-SIARKOU C,PETOUSIS S,et al.Parity affects pregnancy outcomes in women 35 and older[J].Clin Exp Obstet Gynecol,2011,38(2):146-149.
[7] 罗金英,周进福,刘红清,等.高龄孕妇糖耐量血糖特征及其管理对妊娠结局的影响[J].中国糖尿病杂志,2021,29(1):25-29.
[8] 中华医学会围产医学分会,中华医学会妇产科学分会产科学组.高龄妇女孕期管理专家共识[J].中华围产医学杂志,2024,27(6):441-449.
[9] BAI J,WONG F W,BAUMAN A,et al.Parity and pregnancy outcomes[J].Am J Obstet Gynecol,2002,186(2):274-278.
[10] SWEETING A,HANNAH W,BACKMAN H,et al.Epidemiology and management of gestational diabetes[J].Lancet,2024,404(10448):175-192.
[11] GRECO E,CALANDUCCI M,NICOLAIDES K H,et al.Gestational diabetes mellitus and adverse maternal and perinatal outcomes in twin and singleton pregnancies:A systematic review and meta-analysis[J].Am J Obstet Gynecol,2024,230(2):213-225.
[12] 林静,刘含,刘欣梅,等.高龄初产妇与高龄经产妇的妊娠结局比较[J].上海交通大学学报(医学版),2020,40(1):58-63.
[13] SMITHSON S D,GREENE N H,ESAKOFF T F.Pregnancy outcomes in very advanced maternal age women[J].Am J Obstet Gynecol MFM,2022 ,4(1):100491.
[14] FREDERIKSEN L E,ERNST A,BRIX N,et al.Risk of adverse pregnancy outcomes at advanced maternal age[J].Obstet Gynecol,2018,131(3):457-463.
[15] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版)[J].中华糖尿病杂志,2021,13(4):315-409.
[16] CHATZAKIS C,ELEFTHERIADES A,DEMERTZIDOU E,et al.Pregnancy outcomes in the different phenotypes of gestational diabetes mellitus based on the oral glucose tolerance test.A systematic review and meta-analysis[J].Diabetes Res Clin Pract,2023(204):110913.
[17] 陈爱月,李婕,李珠玉,等.妊娠期糖尿病孕妇不同血糖指标异常与甲状腺功能变化的关系[J].中山大学学报(医学科学版),2017,38(3):443-447.
[18] DODD J M,GRIVELL R M,DEUSSEN A R,et al.Metformin for women who are overweight or obese during pregnancy for improving maternal and infant outcomes[J].Cochrane Database Syst Rev,2018,7(7):CD010564.
[19] 党文珊,张慧君,王艺讳,等.基于计划行为理论的妊娠期糖尿病患者自我管理行为意向的质性研究[J].广州医药,2024,55(10):1215-1219.
[20] 高若瑄,屈梦君,赵红.微信平台路径健康宣教在妊娠期糖尿病患者中的应用[J].国际医药卫生导报,2024,30(11):1928-1932.
[21] ZHAO H,XIE Y,ZHAO M,et al.Effects of moderate-intensity resistance exercise on blood glucose and pregnancy outcome in patients with gestational diabetes mellitus:A randomized controlled trial[J].J Diabetes Complications,2022 ,36(5):108186.
[22] MALAZA N,MASETE M,ADAM S,et al.A systematic review to compare adverse pregnancy outcomes in women with pregestational diabetes and gestational diabetes[J].Int J Environ Res Public Health,2022,19(17):10846.
[23] TANGREN J S,WAN MD ADNAN WAH,POWE C E,et al.Risk of preeclampsia and pregnancy complications in women with a history of acute kidney injury[J].Hypertension,2018,72(2):451-459.
[24] 李阳,向雨欣,陈佳林,等.妊娠间隔与经产妇妊娠并发症的相关性[J].中华围产医学杂志,2023,26(5):416-422.
[25] MCINTYRE H D,CATALANO P,ZHANG C,et al.Gestational diabetes mellitus[J].Nat Rev Dis Primers,2019(5):47.
[26] UGWUDIKE B,KWOK M.Update on gestational diabetes and adverse pregnancy outcomes[J].Curr Opin Obstet Gynecol,2023,35(5):453-459.
[27] 中国研究型医院学会糖尿病学专业委员会.中国妊娠期糖尿病母儿共同管理指南(2024版)[J].中华糖尿病杂志,2024,16(12):1324-1345.
[28] 中华医学会妇产科学分会产科学组,中华医学会围产医学分会,中国妇幼保健协会妊娠合并糖尿病专业委员会.妊娠期高血糖诊治指南(2022)[J].中华妇产科杂志,2022,57(1):3-12.