目的 探讨试管婴儿孕妇妊娠期糖尿病(GDM)的高危因素及对妊娠结局的影响,为临床防治试管婴儿孕妇合并GDM提供科学依据。方法 选取2017年1月至2019年9月在上海市浦东新区妇幼保健院产检并分娩的试管婴儿孕妇648例为研究对象,包括合并GDM 112例,非GDM 536例,应用多因素Logistics回归分析试管婴儿孕妇GDM的危险因素。试管婴儿孕妇合并GDM的妊娠结局分析以106例试管婴儿孕妇合并GDM作为研究组,选取同期120例试管婴儿孕妇非GDM和120例自然受孕GDM孕妇作为对照组;研究组从纳入的112例试管婴儿合并GDM孕妇中选取,排除资料不全病例,最终纳入研究组共106例;按照实验对照1:1:1原则,排除年龄、双胎等因素对妊娠结局的干扰,对照组试管婴儿孕妇非GDM、自然受孕GDM组分别纳入了120例,分析三组妊娠结局、并发症的差异。结果 试管婴儿孕妇的GDM发生率为17.3%,Logistics回归分析显示,高龄(OR=1.65, 95% CI:1.06～2.58)、孕前BMI≥24 kg/m2(OR=1.55,95% CI:1.004～2.38)、多囊卵巢综合征(PCOS;OR=2.25,95% CI:1.40～3.61)史、糖尿病家族史(OR=2.96,95% CI:1.61～5.44)、接受胚胎移植次数≥3次(OR=2.25,95% CI:1.40～3.60)、睡眠时间≤6 h(OR=1.94,95% CI:1.14～3.31)均为试管婴儿孕妇GDM的独立危险因素,日活动量≥1 h(OR=0.55,95% CI:0.35～0.86)为试管婴儿孕妇GDM的保护因素。试管婴儿孕妇合并GDM的剖宫产率、妊娠期高血压、胎儿生长受限、早产发生率明显高于试管婴儿非GDM、自然受孕GDM孕妇,差异具有统计学意义。结论 试管婴儿孕妇及早控制体重,适当运动,保持足够睡眠,能有效预防GDM的发生;试管婴儿孕妇合并GDM产生多种不良妊娠结局,需加强孕期监护。
Abstract
Objective To investigate the risk factors and pregnancy outcomes of gestational diabetes mellitus (GDM) in pregnant women with in vitro fertilization(IVF)and provide scientific basis for the prevention and treatment of IVF-pregnant women complicated with GDM.Methods From January 2017 to September 2019, a total of 648 IVF-pregnant women were delivered in Shanghai Pudong Maternal and Children Health care hospital, including 112 women with GDM and 536 without GDM. Of the 112 IVF-pregnant women with GDM, 106 had complete information and were regarded as the case group; 120 IVF-pregnant women without GDM and another 120 naturally conceived women with GDM, matched roughly in a ratio of 1:1:1 to cases according to maternal age, number of fetus, and some other factors, were selected as the control group. The risk factors of GDM in pregnant with IVF were explored by using multivariate logistic regression, and the differences in the pregnancy outcomes and gestational complications among the three groups were also examined by using Chi-square test.Results The incidence of GDM in IVF-pregnant women was 17.3%. Logistic regression analysis showed that advanced age (OR=1.65, 95% CI:1.06-2.58), pre-pregnancy BMI≥24(OR=1.55,95% CI:1.004-2.38), history of PCOS (OR=2.25,95% CI:1.40-3.61), family history of diabetes(OR=2.96,95% CI:1.61-5.44), times of embryo transfer≥3(OR=2.25,95% CI:1.40-3.60), sleep time≤6 hours(OR=1.94,95% CI:1.14-3.31)were independent risk factors of GDM in IVF pregnant women. Daily activity≥1 hour(OR=0.55,95% CI:0.35-0.86)was the protective factor of GDM in IVF pregnant women. The rate of cesarean section and the incidence of pregnancy hypertension, fetal growth restriction, and premature birth in IVF-pregnant with GDM were significantly higher than those of IVF-pregnant without GDM and naturally conceived women with GDM.Conclusion Appropriate exercise and weight control and adequate sleep may be helpful in reducing the occurrence of GDM in IVF-pregnant women. IVF-pregnant women complicated with GDM are at a higher risk of a variety of adverse pregnancy outcomes, indicating a need for close monitoring of their health during the whole pregnancy.
关键词
试管婴儿 /
妊娠期糖尿病 /
影响因素 /
妊娠结局
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Key words
in vitro fertilization(IVF) /
gestational diabetes mellitus /
high risk factors /
pregnancy outcomes
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