The clustering of risk factors in gestational diabetes mellitus / 中国医师进修杂志

ABSTRACT

Objective To study the clinical features and the clustering of risk factors in gestational diabetes mellitus (GDM),and analyze the risk factors.Methods Two hundred and three gravida were selected.According to the result of 75 g oral glucose tolerance test,they were divided into 2 groupsGDM group(134 cases) and normal glucose tolerance (NGT) group (69 cases).Blood sugar,blood fat and insulin were measured,and the homeostasis model of assessment for insulin resistance index (HOMA-IR),pancreatic islet beta cell function index (HOMA-β) and insulin sensitivity index (ISI) were calculated.The relation was analyzed between the risk factors and GDM.Results The age,progestation body mass index (BMI),fasting blood glucose,fasting insulin,total cholesterol,triglyeride,low density lipoprotein-eholesterol (LDL-C),HOMA-IR and the positive rate of diabetes mellitus family history in GDM group were significantly higher than those in NGT group [(30.8 ±4.1) years vs.(28.7 ±3.9) years,(24.29 ±3.65) kg/m2 vs.(21.35 ±2.39) kg/m2,(5.22 ±1.26) mmol/L vs.(4.33 ±0.53) mmol/L,(9.27 ±3.55) mU/L vs.(4.75 ±2.73) mU/L,(5.54 ± 1.26) mmol/L vs.(3.74 ± 1.07) mmol/L,(2.63 ± 1.43) mmol/L vs.(1.73 ± 0.76) mmol/L,(3.02 ± 0.97) mmol/L vs.(2.10 ± 0.75) mtmol/L,0.67 ± 0.47 vs.0.43 ± 0.34,40.3％ (54/134) vs.26.1％(18/69)],there were statistical differences (P＜ 0.01 or ＜ 0.05).The HOMA-β and ISI in GDM group were significantly lower than those in NGT group (4.62 ± 0.72 vs.5.57 ± 1.30 and-3.79 ± 0.47 vs.-2.91 ± 0.48),there were statistical differences (P ＜ 0.01).Logistic regression analysis result showed that fasting blood glucose (OR =6.016,95％ CI1.603-22.585,P =0.008),total cholesterol (OR =2.823,95％ CI1.568-5.083,P=0.001),diabetes mellitus family history (OR =2.780,95％ CI1.168-6.617,P=0.021),fasting insulin(OR =1.954,95％ CI1.371-2.785,P=0.001),progestation BMI(OR =1.787,95％ CI1.124-2.839,P =0.014),age (OR =1.374,95％ CI1.087-1.737,P =0.008) and diastolic pressure (OR =1.184,95％ CI1.045-1.342,P =0.008) were the risk factors of GDM.Conclusions GDM has the clinical features of the clustering of risk factors and genetic susceptibility.The disorder of lipid metabolism and glycometabolism,genetic susceptibility and age are the main risk factors in the development of GDM.