Please wait a minute...
浙江大学学报（医学版）
浙江大学学报（医学版）  2021, Vol. 50 Issue (3): 329-334    DOI: 10.3724/zdxbyxb-2021-0193
专题报道     
糖尿病家族史对妊娠糖尿病孕妇血糖、血脂及妊娠结局的影响
周雨梅1(),谢妮2,张丽霞1,陈丹青1,*()
1.浙江大学医学院附属妇产科医院产科，浙江 杭州 310006
2.浙江省杭州市采荷街道卫生服务中心，浙江 杭州 310018
Impact of family history of diabetes on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus
ZHOU Yumei1(),XIE Ni2,ZHANG Lixia1,CHEN Danqing1,*()
1. Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China;
2. Caihe Community Health Service Center, Hangzhou 310018, China
 全文: PDF(2153 KB)   HTML( 5 )
摘要：

目的：探究糖尿病家族史对妊娠糖尿病（GDM）孕妇血糖、血脂以及妊娠结局的影响。方法：通过1∶4匹配回顾性分析2019年1—12月在浙江大学医学院附属妇产科医院产科分娩的GDM孕妇1265例，其中有糖尿病家族史组253例，无糖尿病家族史组1012例。两组间血脂、血糖水平及妊娠结局（大于胎龄儿、小于胎龄儿、巨大儿、剖宫产、子痫前期、早产、产后出血、胎儿窘迫）差异采用?t?检验和χ2检验，糖尿病家族史与妊娠结局相关性分析采用二元Logistic回归分析。结果：有糖尿病家族史组孕晚期高密度脂蛋白水平低于无糖尿病家族史组（P<0.05），空腹血糖、口服葡萄糖耐量试验（OGTT）1?h血糖、OGTT?2?h血糖及糖化血红蛋白水平较无糖尿病家族史组更高（均P<0.01）。糖尿病家族史是GDM孕妇子痫前期的独立危险因素（OR=3.27，95%CI：1.39~7.68）。结论：有糖尿病家族史的GDM孕妇高密度脂蛋白水平更低、血糖水平更高。糖尿病家族史是GDM孕妇发生子痫前期的独立危险因素。
关键词： 妊娠糖尿病;  家族史;  血脂;  血糖;  子痫前期;  危险因素    
Abstract:

Objective: To investigate the impact of family history of diabetes (FHD) on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus (GDM). Methods:A total of 1265 GDM women who gave childbirth in Women’s Hospital, Zhejiang University School of Medicine during January to December 2019 were enrolled in the study, including 253 women with FHD and 1012 women without FHD. The t-test or χ2 test were used to compare the blood lipid, blood glucose levels and perinatal outcomes including large for gestational age infant, small for gestational age infant, macrosomia, cesarean delivery, preeclampsia, preterm labor, postpartum hemorrhage, fetal distress. The correlation between FHD and perinatal outcomes were estimated by Logistic regression analysis. Results: The high density lipoprotein level at third-trimester was significantly lower in GDM women with FHD (P<0.05); and the women with FHD also had higher fasting blood glucose oral glucose tolerance test (OGTT)1?h, OGTT?2?h and glycosylated hemoglobin level (allP<0.01). In GDM women, FHD was an independent risk factor for preeclampsia (OR=3.27, 95%CI: 1.39–7.68).Conclusions: GDM women with FHD have lower high density lipoprotein and higher glucose levels. FHD is an independent risk factor for preeclampsia in GDM women.
Key words: Gestational diabetes mellitus    Family history    Blood lipid    Blood glucose    Preeclampsia    Risk factor
收稿日期: 2021-04-29 出版日期: 2021-08-16
CLC:  R714.256  
基金资助: 国家自然科学基金（81873839）；浙江省重点研发计划（2018C03010）
通讯作者: 陈丹青     E-mail: zym1780@zju.edu.cn;chendq@zju.edu.cn
作者简介: 周雨梅，住院医师，主要从事产科学研究；E-mail：zym1780@zju.edu.cn；https：//orcid.org/0000-0002-3237-0677
服务　　
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章　　
周雨梅
谢妮
张丽霞
陈丹青

引用本文:

周雨梅,谢妮,张丽霞,陈丹青. 糖尿病家族史对妊娠糖尿病孕妇血糖、血脂及妊娠结局的影响[J]. 浙江大学学报（医学版）, 2021, 50(3): 329-334.

ZHOU Yumei,XIE Ni,ZHANG Lixia,CHEN Danqing. Impact of family history of diabetes on blood glucose, lipid levels and perinatal outcomes in pregnant women with gestational diabetes mellitus. J Zhejiang Univ (Med Sci), 2021, 50(3): 329-334.

链接本文:

http://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0193    或    http://www.zjujournals.com/med/CN/Y2021/V50/I3/329

组 别

n

年龄（岁）

孕次

产次

孕前BMI（kg/m2）

孕期增重（kg）

分娩孕周（周）

初产妇

经产妇

有糖尿病家族史组

253

30.9±3.7

2.0±1.2

176（69.6）

77（30.4）

21.6±3.0

13.5±3.9

38.79±1.52

无糖尿病家族史组

1012

30.5±3.5

1.9±1.1

735（72.6）

277（27.4）

21.3±2.7

13.8±4.1

38.82±1.45

t/χ2值

—

–1.649

–0.507

0.942

–1.647

0.937

0.317

P值

—

>0.05

>0.05

>0.05

>0.05

>0.05

>0.05
表 1  有无糖尿病家族史妊娠糖尿病孕妇一般情况比较

组别

n

孕中期

孕晚期

总胆固醇

甘油三酯

高密度脂蛋白

低密度脂蛋白

总胆固醇

甘油三酯

高密度脂蛋白

低密度脂蛋白

有糖尿病家族史组

253

6.14±1.04

2.43±1.04

2.33±0.55

3.34±0.84

6.50±1.33

4.01±2.23

1.98±0.49

3.45±1.01

无糖尿病家族史组

1012

6.18±1.10

2.32±0.84

2.34±0.51

3.40±0.91

6.59±1.39

3.77±1.99

2.07±0.58

3.54±1.05

t值

—

0.412

–1.685

0.321

0.854

0.967

–1.640

2.209

1.264

P值

—

>0.05

>0.05

>0.05

>0.05

>0.05

>0.05

<0.05

>0.05
表 2  有无糖尿病家族史妊娠糖尿病孕妇孕期血脂水平比较

组别

n

血糖水平（mmol/L）

OGTT异常项数

血糖异常类型

空腹

OGTT?1?h

OGTT?2?h

糖化血红蛋白

一项异常

二项异常

三项异常

空腹血糖异常

服糖后血糖异常

前两者均异常

有糖尿病家族史组

253

4.9±0.6

10.4±1.6

8.9±1.4

5.2±0.6

114（45.1）

99（39.1）

40（15.8）

30（11.9）

162（64.0）

61（24.1）

无糖尿病家族史组

1012

4.8±0.6

9.9±1.4

8.3±1.4

5.1±0.3

692（68.4）

265（26.2）

55（5.4）

165（16.3）

730（72.1）

117（11.6）

t/χ2值

—

–2.697

–4.743

–5.933

–3.680

58.075

27.134

P值

—

<0.01

<0.01

<0.01

<0.01

<0.01

<0.01
表 3  有无糖尿病家族史妊娠糖尿病孕妇孕期血糖水平比较

组别

LGA

SGA

巨大儿

子痫前期

剖宫产

早产

胎儿窘迫

产后出血

有糖尿病家族史组

63（24.9）

6（2.4）

27（10.7）

11（4.3）

128（50.6）

17（6.7）

15（5.9）

3（1.2）

无糖尿病家族史组

201（19.9）

28（2.8）

88（8.7）

15（1.5）

447（44.2）

51（5.0）

64（6.3）

12（1.2）

OR值

1.34

0.88

1.25

3.27

1.21

1.28

0.93

0.86

95%CI

0.96~1.89

0.36~2.16

0.78~2.01

1.39~7.68

0.91~1.62

0.72~2.27

0.52~1.67

0.23~3.28

P值

>0.05

>0.05

>0.05

<0.01

>0.05

>0.05

>0.05

>0.05
表 4  有无糖尿病家族史妊娠糖尿病孕妇妊娠结局比较
1 METZGERB E, GABBES G, PERSSONB, et al.International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy[J]Diabetes Care, 2010, 33( 3): 676-682.
doi: 10.2337/dc09-1848
2 DAMMP, HOUSHMAND-OEREGAARDA, KELSTRUPL, et al.Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark[J]Diabetologia, 2016, 59( 7): 1396-1399.
doi: 10.1007/s00125-016-3985-5
3 MCINTYREH D, CATALANOP, ZHANGC, et al.Gestational diabetes mellitus[J]Nat Rev Dis Primers, 2019, 5( 1): 47.
doi: 10.1038/s41572-019-0098-8
4 GAOC, SUNX, LUL, et al.Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta-analysis[J]J Diabetes Investig, 2019, 10( 1): 154-162.
doi: 10.1111/jdi.12854
5 LEEK W, CHINGS M, RAMACHANDRANV, et al.Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis[J]BMC Pregnancy Childbirth, 2018, 18( 1): 494.
doi: 10.1186/s12884-018-2131-4
6 AYD?NH, ?ELIK?, YAZ?C?D, et al.Prevalence and predictors of gestational diabetes mellitus: a nationwide multicentre prospective study[J]Diabet Med, 2019, 36( 2): 221-227.
doi: 10.1111/dme.13857
7 DAHLMANI, RYDENM, ARNERP. Family history of diabetes is associated with enhanced adipose lipolysis: Evidence for the implication of epigenetic factors[J]Diabetes Metab, 2018, 44( 2): 155-159.
doi: 10.1016/j.diabet.2017.10.010
8 VORNANENM, KONTTINENH, K??RI?INENH, et al.Family history and perceived risk of diabetes, cardiovascular disease, cancer, and depression[J]Prev Med, 2016, 177-183.
doi: 10.1016/j.ypmed.2016.06.027
9 JENSEND M, KORSHOLML, OVESENP, et al.Adverse pregnancy outcome in women with mild glucose intolerance: is there a clinically meaningful threshold value for glucose?[J]Acta Obstet Gynecol Scand, 2008, 87( 1): 59-62.
doi: 10.1080/00016340701823975
10 FERRARAA, WEISSN S, HEDDERSONM M, et al.Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below the National Diabetes Data Group thresholds for gestational diabetes mellitus, are related to the risk of neonatal macrosomia, hypoglycaemia and hyperbilirubinaemia[J]Diabetologia, 2007, 50( 2): 298-306.
doi: 10.1007/s00125-006-0517-8
11 , The HAPO Study Cooperative Research Group.Hyperglycemia and adverse pregnancy outcomes[J]N Engl J Med, 2008, 358( 19): 1991-2002.
doi: 10.1056/NEJMoa0707943
12 MOOSAZADEHM, ASEMIZ, LANKARANIK B, et al.Family history of diabetes and the risk of gestational diabetes mellitus in Iran: a systematic review and meta-analysis[J]Diabetes Metab Syndr, 2017, S99-S104.
doi: 10.1016/j.dsx.2016.12.016
13 KAAJAR. Lipid abnormalities in pre-eclampsia: implications for vascular health[J]Clin Lipidol, 2011, 6( 1): 71-78.
doi: 10.2217/clp.10.82
14 NELSONT, PEREZA, ALCARAZJ, et al.Family history of diabetes, acculturation, and the metabolic syndrome among Mexican Americans: proyecto SALSA[J]Metab Syndr Relat Disord, 2007, 5( 3): 262-269.
doi: 10.1089/met.2006.0035
15 LIH, ISOMAAB, TASKINENM R, et al.Consequences of a family history of type 1 and type 2 diabetes on the phenotype of patients with type 2 diabetes[J]Diabetes Care, 2000, 23( 5): 589-594.
doi: 10.2337/diacare.23.5.589
16 INOUEK, MATSUMOTOM, MIYOSHIY, et al.Elevated liver enzymes in women with a family history of diabetes[J/OL]Diabetes Res Clin Pract, 2008, 79( 3): e4-e7.
doi: 10.1016/j.diabres.2007.10.032
17 MOONJ H, ROHE, OHT J, et al.Increased risk of metabolic disorders in healthy young adults with family history of diabetes: from the Korea National Health and Nutrition Survey[J]Diabetol Metab Syndr, 2017, 9( 1): 16.
doi: 10.1186/s13098-017-0210-8
18 LEEY H, SHINM H, NAMH S, et al.Effect of family history of diabetes on hemoglobin A1c levels among individuals with and without diabetes: the dong-gu study[J]Yonsei Med J, 2018, 59( 1): 92-100.
doi: 10.3349/ymj.2018.59.1.92
19 ELIRAQIG M, VISTISEND, LAURITZENT, et al.Intensive multifactorial treatment modifies the effect of family history of diabetes on glycaemic control in people with Type 2 diabetes: a post hoc analysis of the ADDITION-Denmark randomized controlled trial[J]Diabet Med, 2015, 32( 8): 1085-1089.
doi: 10.1111/dme.12764
20 BENNETL, FRANKSP W, Z?LLERB, et al.Family history of diabetes and its relationship with insulin secretion and insulin sensitivity in Iraqi immigrants and native Swedes: a population-based cohort study[J]Acta Diabetol, 2018, 55( 3): 233-242.
doi: 10.1007/s00592-017-1088-5
21 KIMC, NEWTONK M, KNOPPR H. Gestational diabetes and the incidence of type 2 diabetes: a systematic review[J]Diabetes Care, 2002, 25( 10): 1862-1868.
doi: 10.2337/diacare.25.10.1862
22 KWAKS H, CHOIS H, JUNGH S, et al.Clinical and genetic risk factors for type 2 diabetes at early or late post partum after gestational diabetes mellitus[J/OL]J Clin Endocrinol Metab, 2013, 98( 4): E744-E752.
doi: 10.1210/jc.2012-3324
23 SLADEKR, ROCHELEAUG, RUNGJ, et al.A genome-wide association study identifies novel risk loci for type 2 diabetes[J]Nature, 2007, 445( 7130): 881-885.
doi: 10.1038/nature05616
24 ZEGGINIE, WEEDONM N, LINDGRENC M, et al.Replication of genome-wide association signals in UK samples reveals risk loci for type 2 diabetes[J]Science, 2007, 316( 5829): 1336-1341.
doi: 10.1126/science.1142364
25 SCOTTL J, MOHLKEK L, BONNYCASTLEL L, et al.A genome-wide association study of type 2 diabetes in Finns detects multiple susceptibility variants[J]Science, 2007, 316( 5829): 1341-1345.
doi: 10.1126/science.1142382
26 SAXENAR, VOIGHTB F, LYSSENKOV, et al.Genome-wide association analysis identifies loci for type 2 diabetes and triglyceride levels[J]Science, 2007, 316( 5829): 1331-1336.
doi: 10.1126/science.1142358
27 LAUENBORGJ, GRARUPN, DAMMP, et al.Common type 2 diabetes risk gene variants associate with gestational diabetes[J]J Clin Endocrinol Metab, 2009, 94( 1): 145-150.
doi: 10.1210/jc.2008-1336
28 CHOY M, KIMT H, LIMS, et al.Type 2 diabetes-associated genetic variants discovered in the recent genome-wide association studies are related to gestational diabetes mellitus in the Korean population[J]Diabetologia, 2009, 52( 2): 253-261.
doi: 10.1007/s00125-008-1196-4
29 EGELANDG M, KLUNGS?YRK, ?YENN, et al.Preconception cardiovascular risk factor differences between gestational hypertension and preeclampsia[J]Hypertension, 2016, 67( 6): 1173-1180.
doi: 10.1161/HYPERTENSIONAHA.116.07099
30 LEVYA, WIZNITZERA, HOLCBERGG, et al.Family history of diabetes mellitus as an independent risk factor for macrosomia and cesarean delivery[J]J Matern-Fetal Neonatal Med, 2010, 23( 2): 148-152.
doi: 10.3109/14767050903156650
31 SEGALP, HAMILTONJ K, SERMERM, et al.Maternal obesity and familial history of diabetes have opposing effects on infant birth weight in women with mild glucose intolerance in pregnancy[J]J Matern-Fetal Neonatal Med, 2008, 21( 1): 73-79.
doi: 10.1080/14767050701827148
[1] 陈云燕,吴琪,张丽霞,陈丹青,梁朝霞. 妊娠糖尿病孕妇孕中期口服葡萄糖耐量试验异常项数及孕期增重与不良妊娠结局的关系[J]. 浙江大学学报（医学版）, 2021, 50(3): 313-319.
[2] 徐恒,马燕,张丽霞,梁朝霞,陈丹青. 妊娠糖尿病患者孕前身体质量指数、孕期增重及血脂水平对妊娠结局的影响[J]. 浙江大学学报（医学版）, 2021, 50(3): 320-328.
[3] 吴懿,蒋巍亮,杨晓军,黎文华,万荣,陆伦根,樊军卫,卢战军. 肝移植受者术后早期血清甘油三酯变化规律及其对术后糖尿病的预测价值[J]. 浙江大学学报（医学版）, 2021, 50(2): 239-244.
[4] 付媛媛,姜晶鑫,陈述政,邱福铭. T1期乳腺癌患者发生同侧腋窝淋巴结转移风险列线图的建立[J]. 浙江大学学报（医学版）, 2021, 50(1): 81-89.
[5] 韩雪,蒋国军,石巧娟. 降血糖药对内皮祖细胞作用的研究进展[J]. 浙江大学学报（医学版）, 2020, 49(5): 629-636.
[6] 胡琳琳,张睿婷,王淑玥,洪慧,黄沛钰,张敏鸣. 心脑血管疾病高危因素对脑铁沉积影响的磁共振影像学研究[J]. 浙江大学学报（医学版）, 2019, 48(6): 644-650.
[7] 林静,陈志敏. 儿童重症腺病毒肺炎早期识别的研究进展[J]. 浙江大学学报（医学版）, 2019, 48(5): 567-572.
[8] 麦合木提江·穆扎帕,周敏. 腹主动脉瘤腔内修复术中髂内动脉封堵后盆腔缺血症状发生的危险因素[J]. 浙江大学学报（医学版）, 2019, 48(5): 546-551.
[9] 陶安阳, 王志敏, 陈红芳, 徐冬娟, 胡海芳, 吴承龙, 张晓玲, 马小董, 王亚仙, 胡海涛, 楼敏, 浙江省缺血性脑卒中静脉溶栓的临床行为干预研究协作组 . 合并心房颤动对缺血性脑卒中患者静脉溶栓后颅内出血转化的影响[J]. 浙江大学学报（医学版）, 2019, 48(3): 254-259.
[10] 陈栋,胡元军,武玉睿,李晓莺. 先天性膈疝患儿死亡危险因素分析[J]. 浙江大学学报（医学版）, 2019, 48(1): 83-88.
[11] 曹丽芹,施继敏. 异基因造血干细胞移植植入失败研究进展[J]. 浙江大学学报（医学版）, 2018, 47(6): 651-658.
[12] 李小勇,沈鹏,林鸿波,虞哲彬,陈坤,王建炳. 宁波社区2型糖尿病患者发生糖尿病肾病危险因素调查[J]. 浙江大学学报（医学版）, 2018, 47(2): 163-168.
[13] 蒋曦依,李璐,唐慧娟,陈天辉. 结直肠癌高危人群多因素风险预测模型及评价[J]. 浙江大学学报（医学版）, 2018, 47(2): 194-200.
[14] 李瑶,陈慧. 胰岛素瘤合并继发性肾上腺皮质功能不全一例[J]. 浙江大学学报（医学版）, 2017, 46(6): 662-665.
[15] 王结胜 等. 小檗碱抑制肠道二肽基肽酶-Ⅳ的降糖机制研究[J]. 浙江大学学报（医学版）, 2016, 45(5): 486-492.