Influencing factors of postpartum abnormal glucose metabolism outcomes among patients with gestational diabetes mellitus

doi:10.3877/cma.j.issn.1673-5250.2022.01.007

Objective

To explore postpartum abnormal glucose metabolism (AGM) outcomes and its influencing factors of patients with gestational diabetes mellitus (GDM).

Methods

From January to December 2019, a total of 1 175 GDM patients with singleton pregnancy who delivered in West China Second University Hospital, Sichuan University and screened glucose by performing 75 g oral glucose tolerance test (OGTT) from 4 to 12 weeks postpartum were selected as research subjects. According to whether their postpartum glucose metabolism was normal or not, they were divided into study group (n=361, with postpartum AGM) and control group (n=814, with normal postpartum glucose metabolism). Retrospective research methods were used to analyze clinical data during pregnancy, such as general information and 75 g OGTT results during pregnancy and 4-12 weeks postpartum, and so on. Independent-samples t test or chi-square test was used to conduct univariate analysis on influencing factors of postpartum AGM in GDM patients; and with combination of previous research results and clinical experience, as well as the above univariate analysis results, multivariate unconditional logistic regression analysis was further conducted to explore independent influencing factors of postpartum AGM in patients with GDM. This study was approved by the Ethics Committee of West China Second University Hospital, Sichuan University [Approval No. 2021(181)].

Results

①Results of 75 g OGTT at 24-28 gestational weeks showed that there were 639 cases (54.4%), 373 cases (31.7%) and 163 caes (13.9%) patients with 1, 2 and 3 elevated blood glucose values in FPG and OGTT 1 h and 2 h, respectively. ②Results of postpartum glucose from 4 to 12 weeks showed that patients with normal postpartum glucose metabolism accounted for 69.3% (814/1 175), while patients with AGM accounted for 30.7% (361/1 175), including 19 cases (1.6%) of impaired fasting glucose (IFG), 294 cases (25.0%) of impaired glucose tolerance (IGT), 23 cases (2.0%) of IFG+ IGT, and 25 cases (2.1%) of suspected type 2 diabetes mellitus (T2DM). ③Univariate analysis results of influencing factors of postpartum AGM in GDM patients showed that age, incidence of family history of diabetes, values of OGTT 1 h and 2 h glucose at 24-28 gestational weeks, proportions of patients with two glucose values (OGTT 1 h and 2 h glucose) increasing, and three glucose values (FPG, OGTT 1 h and 2 h glucose) increasing were statistically higher than those in control group, while proportion of patients with only one glucose value increasing (FPG or OGTT 1 h glucose) was statistically lower than that in control group, and all differences were statistically significant (P<0.05). ④Multivariate unconditional logistic regression analysis: results of model 1 adjusting age, family history of diabetes, and glucose values of 75 g OGTT at 24-28 gestational weeks revealed that family history of diabetes, OGTT 1 h and 2 h glucose values were independent risk factors of postpartum AGM in GDM patients (OR=1.693, 1.205, 1.355; 95%CI: 1.208-2.373, 1.088-1.335, 1.204-1.524; P=0.002, <0.001, <0.001). Results of model 2 adjusting age, family history of diabetes, and increasing glucose items of 75 g OGTT at 24-28 gestational weeks revealed that family history of diabetes, two glucose items increasing (OGTT 1 h and 2 h glucose), and three glucose items increasing were independent risk factors of postpartum AGM in GDM patients (OR=1.668, 1.421, 1.747; 95%CI: 1.192-2.333, 1.035-1.952, 1.195-2.553; P=0.003, 0.030, 0.004). Only FPG or OGTT 1 h glucose increasing were independent protective factors of postpartum AGM in GDM patients (OR=0.401, 0.646; 95%CI: 0.240-0.670, 0.418-0.997; P<0.001, =0.048).

Conclusions

For postpartum AGM in patients with GDM, clinical attention should be paid to indicators, such as age, family history of diabetes, and OGTT results during pregnancy. Targeting high-risk populations for continuous monitoring and standardized interventions for above indicators are critical steps in managing GDM from pre-pregnancy period to postpartum.

Key words: Diabetes, gestational, Glucose tolerance test, Postpartum period, Glucose metabolism disorders, Diabetes mellitus, type 2, Puerperant

表1 本组1 175例GDM患者24~28孕周75 g OGTT结果[例数(%)]

血糖指标		发生率	血糖指标		发生率
1项指标升高		639(54.4)	2项指标升高		373(31.7)
	FPG	143(12.2)		FPG与OGTT 1 h	40(3.4)
	OGTT 1 h	161(13.7)		FPG与OGTT 2 h	28(2.3)
	OGTT 2 h	335(28.5)		OGTT 1、2 h	305(25.9)
3项指标升高^a		163(13.9)

表1 本组1 175例GDM患者24~28孕周75 g OGTT结果[例数(%)]

血糖指标		发生率	血糖指标		发生率
1项指标升高		639(54.4)	2项指标升高		373(31.7)
	FPG	143(12.2)		FPG与OGTT 1 h	40(3.4)
	OGTT 1 h	161(13.7)		FPG与OGTT 2 h	28(2.3)
	OGTT 2 h	335(28.5)		OGTT 1、2 h	305(25.9)
3项指标升高^a		163(13.9)

表2 研究组与对照组GDM患者相关临床资料比较

组别	例数	年龄(岁，±s)	孕期胰岛素治疗[例数(%)]	分娩孕龄(周，±s)	孕次[例数(%)]				初产妇[例数(%)]
组别	例数	年龄(岁，±s)	孕期胰岛素治疗[例数(%)]	分娩孕龄(周，±s)	1次	2次	3次	≥4次	初产妇[例数(%)]
研究组	361	32.9±4.2	44(12.2)	38.7±1.7	127(35.2)	91(25.2)	76(21.1)	67(18.6)	222(61.5)
对照组	814	32.3±4.0	70(8.6)	38.9±1.5	289(35.5)	232(28.5)	138(17.0)	155(19.0)	511(62.8)
检验值		t＝2.363	χ²＝3.677	t＝-0.072	χ²＝3.332				χ²＝0.175
P值		0.018	0.055	0.346	0.343				0.676
组别	例数	ART[例数(%)]	PCOS[例数(%)]	慢性HBV感染[例数(%)]	GDM史[例数(%)]	糖尿病家族史[例数(%)]	原发性高血压家族史[例数(%)]	孕期体重增加值(kg，±s)	8~12孕周FPG(mmol/L，±s)
研究组	361	33(9.1)	17(4.7)	24(6.6)	15(4.2)	74(20.5)	71(19.7)	10.2±3.5	4.57±0.49
对照组	814	58(7.1)	21(2.6)	43(5.3)	30(3.7)	111(13.6)	149(18.3)	10.6±3.3	4.56±0.45
检验值		χ²＝1.423	χ²＝3.623	χ²＝0.867	χ²＝0.150	χ²＝8.878	χ²＝0.305	t＝-2.275	t＝0.457
P值		0.233	0.057	0.352	0.699	0.003	0.581	0.076	0.648
级别	例数	24~28孕周75 g OGTT
级别	例数	FPG(mmol/L，±s)	1 h血糖(mmol/L，±s)	2 h血糖(mmol/L，±s)	仅FPG升高[例数(%)]	仅1 h血糖升高[例数(%)]	仅2 h血糖升高[例数(%)]	仅1项指标升高[例数(%)]	FPG与1 h血糖升高[例数(%)]
对照组	814	4.73±0.46	9.62±1.46	8.49±1.28	122(15.0)	126(15.5)	238(29.2)	486(59.7)	25(3.1)
研究组	361	4.78±0.59	10.17±1.31	9.04±1.13	21(5.8)	35(9.7)	97(26.9)	153(42.4)	15(4.2)
检验值		t＝1.543	t＝6.416	t＝7.409	χ²＝19.676	χ²＝7.075	χ²＝0.688	χ²＝30.251	χ²＝0.893
P值		0.123	<0.001	<0.001	<0.001	0.008	0.407	<0.001	0.345
级别	例数	24~28孕周75 g OGTT[例数(%)]				32~37孕周FPG(mmol/L，±s)	分娩前收缩压(mmHg，±s)	分娩前舒张压(mmHg，±s)	分娩前FPG(mmHg，±s)
级别	例数	FPG与2 h血糖升高	1、2 h血糖升高	2项指标升高	3项指标均升高^a	32~37孕周FPG(mmol/L，±s)	分娩前收缩压(mmHg，±s)	分娩前舒张压(mmHg，±s)	分娩前FPG(mmHg，±s)
对照组	814	21(2.6)	190(23.3)	236(29.0)	92(11.3)	4.96±1.04	116.6±10.8	73.4±8.2	5.06±0.69
研究组	361	7(1.9)	115(31.9)	137(38.0)	71(19.7)	4.93±0.98	115.8±10.3	72.9±8.5	5.13±1.16
检验值		χ²＝0.441	χ²＝9.443	χ²＝9.261	χ²＝14.648	t＝-0.427	t＝-1.172	t＝-0.797	t＝0.874
P值		0.506	0.002	0.002	<0.001	0.670	0.241	0.425	0.383

表2 研究组与对照组GDM患者相关临床资料比较

组别	例数	年龄(岁，±s)	孕期胰岛素治疗[例数(%)]	分娩孕龄(周，±s)	孕次[例数(%)]				初产妇[例数(%)]
组别	例数	年龄(岁，±s)	孕期胰岛素治疗[例数(%)]	分娩孕龄(周，±s)	1次	2次	3次	≥4次	初产妇[例数(%)]
研究组	361	32.9±4.2	44(12.2)	38.7±1.7	127(35.2)	91(25.2)	76(21.1)	67(18.6)	222(61.5)
对照组	814	32.3±4.0	70(8.6)	38.9±1.5	289(35.5)	232(28.5)	138(17.0)	155(19.0)	511(62.8)
检验值		t＝2.363	χ²＝3.677	t＝-0.072	χ²＝3.332				χ²＝0.175
P值		0.018	0.055	0.346	0.343				0.676
组别	例数	ART[例数(%)]	PCOS[例数(%)]	慢性HBV感染[例数(%)]	GDM史[例数(%)]	糖尿病家族史[例数(%)]	原发性高血压家族史[例数(%)]	孕期体重增加值(kg，±s)	8~12孕周FPG(mmol/L，±s)
研究组	361	33(9.1)	17(4.7)	24(6.6)	15(4.2)	74(20.5)	71(19.7)	10.2±3.5	4.57±0.49
对照组	814	58(7.1)	21(2.6)	43(5.3)	30(3.7)	111(13.6)	149(18.3)	10.6±3.3	4.56±0.45
检验值		χ²＝1.423	χ²＝3.623	χ²＝0.867	χ²＝0.150	χ²＝8.878	χ²＝0.305	t＝-2.275	t＝0.457
P值		0.233	0.057	0.352	0.699	0.003	0.581	0.076	0.648
级别	例数	24~28孕周75 g OGTT
级别	例数	FPG(mmol/L，±s)	1 h血糖(mmol/L，±s)	2 h血糖(mmol/L，±s)	仅FPG升高[例数(%)]	仅1 h血糖升高[例数(%)]	仅2 h血糖升高[例数(%)]	仅1项指标升高[例数(%)]	FPG与1 h血糖升高[例数(%)]
对照组	814	4.73±0.46	9.62±1.46	8.49±1.28	122(15.0)	126(15.5)	238(29.2)	486(59.7)	25(3.1)
研究组	361	4.78±0.59	10.17±1.31	9.04±1.13	21(5.8)	35(9.7)	97(26.9)	153(42.4)	15(4.2)
检验值		t＝1.543	t＝6.416	t＝7.409	χ²＝19.676	χ²＝7.075	χ²＝0.688	χ²＝30.251	χ²＝0.893
P值		0.123	<0.001	<0.001	<0.001	0.008	0.407	<0.001	0.345
级别	例数	24~28孕周75 g OGTT[例数(%)]				32~37孕周FPG(mmol/L，±s)	分娩前收缩压(mmHg，±s)	分娩前舒张压(mmHg，±s)	分娩前FPG(mmHg，±s)
级别	例数	FPG与2 h血糖升高	1、2 h血糖升高	2项指标升高	3项指标均升高^a	32~37孕周FPG(mmol/L，±s)	分娩前收缩压(mmHg，±s)	分娩前舒张压(mmHg，±s)	分娩前FPG(mmHg，±s)
对照组	814	21(2.6)	190(23.3)	236(29.0)	92(11.3)	4.96±1.04	116.6±10.8	73.4±8.2	5.06±0.69
研究组	361	7(1.9)	115(31.9)	137(38.0)	71(19.7)	4.93±0.98	115.8±10.3	72.9±8.5	5.13±1.16
检验值		χ²＝0.441	χ²＝9.443	χ²＝9.261	χ²＝14.648	t＝-0.427	t＝-1.172	t＝-0.797	t＝0.874
P值		0.506	0.002	0.002	<0.001	0.670	0.241	0.425	0.383

表3 GDM患者产后AGM转归影响因素的多因素非条件logistic回归分析(模型1)

影响因素		B	SE	Wald值	P值	OR值	OR值95%CI
年龄		0.016	0.016	0.957	0.328	1.016	0.984~1.048
糖尿病家族史		0.526	0.172	9.335	0.002	1.693	1.208~2.373
24~28孕周OGTT血糖值
	1 h血糖值	0.187	0.052	12.753	<0.001	1.205	1.088~1.335
	2 h血糖值	0.304	0.060	25.403	<0.001	1.355	1.204~1.524

表3 GDM患者产后AGM转归影响因素的多因素非条件logistic回归分析(模型1)

影响因素		B	SE	Wald值	P值	OR值	OR值95%CI
年龄		0.016	0.016	0.957	0.328	1.016	0.984~1.048
糖尿病家族史		0.526	0.172	9.335	0.002	1.693	1.208~2.373
24~28孕周OGTT血糖值
	1 h血糖值	0.187	0.052	12.753	<0.001	1.205	1.088~1.335
	2 h血糖值	0.304	0.060	25.403	<0.001	1.355	1.204~1.524

表4 GDM患者产后AGM转归影响因素的多因素非条件logistic回归分析(模型2)

影响因素		B	SE	Wald值	P值	OR值	OR值95%CI
年龄		0.022	0.016	1.928	0.165	1.022	0.991~1.054
糖尿病家族史		0.511	0.171	8.915	0.003	1.668	1.192~2.333
24~28孕周OGTT血糖指标升高项目
	FPG升高	-0.914	0.262	12.133	<0.001	0.401	0.240~0.670
	1 h血糖升高	-0.438	0.222	3.898	0.048	0.646	0.418~0.997
	1、2 h血糖升高	0.352	0.162	4.723	0.030	1.421	1.035~1.952
	3项指标升高^a	0.558	0.194	8.293	0.004	1.747	1.195~2.553

表4 GDM患者产后AGM转归影响因素的多因素非条件logistic回归分析(模型2)

影响因素		B	SE	Wald值	P值	OR值	OR值95%CI
年龄		0.022	0.016	1.928	0.165	1.022	0.991~1.054
糖尿病家族史		0.511	0.171	8.915	0.003	1.668	1.192~2.333
24~28孕周OGTT血糖指标升高项目
	FPG升高	-0.914	0.262	12.133	<0.001	0.401	0.240~0.670
	1 h血糖升高	-0.438	0.222	3.898	0.048	0.646	0.418~0.997
	1、2 h血糖升高	0.352	0.162	4.723	0.030	1.421	1.035~1.952
	3项指标升高^a	0.558	0.194	8.293	0.004	1.747	1.195~2.553

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