Predictive values of first trimester red blood cell parameters on gestational diabetes mellitus in non-anemic pregnant women

doi:10.3877/cma.j.issn.1673-5250.2017.06.009

Objective

To explore the correlation between first trimester red blood cell parameters and gestational diabetes mellitus (GDM) in non-anemic pregnant women, and to provide references for early clinical prediction of GDM.

Methods

A total of 3 617 cases of non-anemic pregnant women from October 2016 to February 2017 in West China Second University Hospital, Sichuan Universtiy who met the inclusion criteria in this study were selected as research subjects. The retrospective analysis was conducted in general clinical data, and first trimester (10-14 gestational weeks) hemoglobin (Hb) levels, red blood cell count (RBC) and hematocrit (HCT) of all subjects. According to the quartile method, Hb levels, RBC and HCT of all subjects were divided into four ranges: A (<P₂₅), B (≥P₂₅-P₅₀), C (≥P₅₀-P₇₅), D (≥P₇₅), respectively. Incidence of GDM in subjects with different ranges of Hb levels, RBC, HCT were compared, respectively. Multivariate unconditional logistic regression analysis was performed on the influencing factors of GDM in non-anemic pregnant women.

Results

①There were statistical differences in GDM incidences in subjects with different ranges of Hb levels, RBC and HCT (χ²=15.499, P=0.001; χ²=20.342, P<0.001; χ²=26.566, P<0.001). Multiple comparison results showed that the incidence of GDM in subjects with D range of Hb levels was higher than those in subjects with A and B ranges of Hb levels; the incidences of GDM in subjects with C and D ranges of RBC were higher than that in subjects with A range of RBC, the incidence of GDM in subjects with D range of RBC was higher than that in subjects with B range of RBC; the incidences of GDM in subjects with B, C and D ranges of HCT were higher than that in subjects with A range of HCT, and all the differences were statistically significant (χ²=13.540, P<0.001; χ²=8.199, P=0.004; χ²=7.841, P=0.005; χ²=10.437, P=0.001; χ²=13.903, P<0.001; χ²=17.953, P<0.001; χ²=23.490, P<0.001). ②Multivariate unconditional logistic regression analysis of GDM influencing factors in non-anemic pregnant women results showed that first trimester Hb level and HCT were independent influencing factors of GDM in non-anemic pregnant women (OR=2.297, 2.097; 95%CI: 1.121-7.265, 1.019-5.874; P=0.033, 0.019).

Conclusions

In non-anemic pregnant women, the first trimester levels of red blood cell related parameters are closely related to the occurrence of GDM, in which the first trimester Hb levels and RBC are independent influencing factors of GDM. Because this study is a retrospective study, whether clinicians can monitor the high-risk groups of GDM according to the levels of first trimester red blood cell parameters of non-anemic pregnant women or not, it still needs multi-center, large scale, prospective and randomized trial to further confirmed.

Key words: Diabetes, gestational, Red blood cell parameters, Hemoglobins, Erythrocyte count, Hematocrit, Pregnancy trimester, first, Pregnant women

表1 不同早孕期红细胞参数范围的非贫血孕妇妊娠期糖尿病发生率比较结果

不同早孕期红细胞参数范围	早孕期Hb水平			早孕期RBC			早孕期HCT
不同早孕期红细胞参数范围	Hb水平(g/L)	例数	GDM发生率[例数(%)]	RBC(×10¹²/L)	例数	GDM发生率[例数(%)]	HCT	例数	GDM发生率[例数(%)]
A(<P₂₅)	<122	884	150(17.0)	<3.97	885	143(16.1)	<0.380	879	122(13.9)
B(≥P₂₅～P₅₀)	≥122～130	948	176(18.6)	≥3.97～4.25	921	162(17.6)	≥0.380～0.405	947	194(20.5)
C(≥P₅₀～P₇₅)	≥130～137	912	177(19.4)	≥4.25～4.51	895	191(21.3)	≥0.405～0.424	920	198(21.5)
D(≥P₇₅)	≥137	873	210(24.1)	≥4.51	916	217(23.7)	≥0.424	871	199(22.8)
χ²值	?	?	15.449	?	?	20.342	?	?	26.566
P值	?	?	0.001	?	?	<0.001	?	?	<0.001

表1 不同早孕期红细胞参数范围的非贫血孕妇妊娠期糖尿病发生率比较结果

不同早孕期红细胞参数范围	早孕期Hb水平			早孕期RBC			早孕期HCT
不同早孕期红细胞参数范围	Hb水平(g/L)	例数	GDM发生率[例数(%)]	RBC(×10¹²/L)	例数	GDM发生率[例数(%)]	HCT	例数	GDM发生率[例数(%)]
A(<P₂₅)	<122	884	150(17.0)	<3.97	885	143(16.1)	<0.380	879	122(13.9)
B(≥P₂₅～P₅₀)	≥122～130	948	176(18.6)	≥3.97～4.25	921	162(17.6)	≥0.380～0.405	947	194(20.5)
C(≥P₅₀～P₇₅)	≥130～137	912	177(19.4)	≥4.25～4.51	895	191(21.3)	≥0.405～0.424	920	198(21.5)
D(≥P₇₅)	≥137	873	210(24.1)	≥4.51	916	217(23.7)	≥0.424	871	199(22.8)
χ²值	?	?	15.449	?	?	20.342	?	?	26.566
P值	?	?	0.001	?	?	<0.001	?	?	<0.001

表2 非贫血孕妇妊娠期糖尿病发生影响因素的多因素非条件logistic回归分析的变量含义及其赋值

自变量/因变量	变量名	赋值
是否发生GDM	y	y＝0表示未发生GDM，y＝1表示发生GDM
年龄	x₁	x₁＝0表示年龄≤40岁，x₁＝1表示年龄>40岁
BMI	x₂	x₂＝0表示BMI≤24.0 kg/m²，x₂＝1表示BMI>24.0 kg/m²
早孕期Hb水平	x₃	x₃＝0表示早孕期Hb水平<122 g/L，x₃＝1表示早孕期Hb水平≥122 g/L
早孕期RBC	x₄	x₄＝0表示早孕期RBC<3.97×10¹²/L，x₄＝1表示早孕期RBC≥3.97×10¹²/L
早孕期HCT	x₅	x₅＝0表示早孕期HCT<0.380，x₅＝1表示早孕期HCT≥0.380

表2 非贫血孕妇妊娠期糖尿病发生影响因素的多因素非条件logistic回归分析的变量含义及其赋值

自变量/因变量	变量名	赋值
是否发生GDM	y	y＝0表示未发生GDM，y＝1表示发生GDM
年龄	x₁	x₁＝0表示年龄≤40岁，x₁＝1表示年龄>40岁
BMI	x₂	x₂＝0表示BMI≤24.0 kg/m²，x₂＝1表示BMI>24.0 kg/m²
早孕期Hb水平	x₃	x₃＝0表示早孕期Hb水平<122 g/L，x₃＝1表示早孕期Hb水平≥122 g/L
早孕期RBC	x₄	x₄＝0表示早孕期RBC<3.97×10¹²/L，x₄＝1表示早孕期RBC≥3.97×10¹²/L
早孕期HCT	x₅	x₅＝0表示早孕期HCT<0.380，x₅＝1表示早孕期HCT≥0.380

表3 非贫血孕妇妊娠期糖尿病发生影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
年龄	0.152	0.249	2.147	0.139	1.006	0.713～1.048
BMI	0.201	0.245	3.409	0.064	1.224	0.998～1.518
早孕期Hb水平	0.413	0.798	6.135	0.033	2.297	1.121～7.265
早孕期RBC	0.524	0.301	5.875	0.019	2.097	1.019～5.874
早孕期HCT	0.331	0.297	3.794	0.051	1.080	0.987～1.168

表3 非贫血孕妇妊娠期糖尿病发生影响因素的多因素非条件logistic回归分析结果

影响因素	B	SE	Wald值	P值	OR值	OR值95%CI
年龄	0.152	0.249	2.147	0.139	1.006	0.713～1.048
BMI	0.201	0.245	3.409	0.064	1.224	0.998～1.518
早孕期Hb水平	0.413	0.798	6.135	0.033	2.297	1.121～7.265
早孕期RBC	0.524	0.301	5.875	0.019	2.097	1.019～5.874
早孕期HCT	0.331	0.297	3.794	0.051	1.080	0.987～1.168

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