孕早期预测妊娠期糖尿病的高危因素分析和模型构建

doi:10.3760/cma.j.cn441417-20250428-22022

摘要/Abstract

摘要： 目的　分析孕早期影响妊娠期糖尿病（GDM）发病的高危因素，并构建风险预测模型。方法　纳入2022年1月至2024年6月在西北妇女儿童医院进行定期产检并分娩的326例孕妇临床资料，年龄21～46岁。根据妊娠24～28周75 g口服葡萄糖耐量试验（OGTT）结果分为GDM组（62例）和非GDM组（264例）。采用t检验、χ²检验比较两组基本资料及孕早期（10～12周）实验室指标，通过多因素logistic回归筛选GDM发病影响因素，并建立孕早期GDM预测模型，应用受试者操作特征曲线（ROC）检验模型预测效能。结果　326例孕早期孕妇中有62例（19.02%）发生GDM。单因素和logistic多因素回归显示：年龄≥35岁、孕前体重指数（BMI）≥24.0 kg/m²，以及孕早期FPG、HbA1c、C反应蛋白（CRP）升高均是GDM独立危险因素；孕早期HDL-C、ADPN升高均为保护因素（均P<0.05）。构建GDM预测模型，该模型AUC为0.909（95%CI 0.865～0.952），最佳预测值>13.98时，对应灵敏度为79.03%，特异度为92.75%，约登指数为71.78%。结论　基于孕妇年龄、孕前BMI、孕早期FPG、HbA1c、CRP、HDL-C和ADPN建立的风险预测模型可为GDM的早期预警提供参考。

关键词: 妊娠期糖尿病, 孕早期, 高危因素, 预测模型

Abstract: Objective　To analyze the high-risk factors influencing the onset of gestational diabetes mellitus (GDM) in the early stage of pregnancy and to construct a risk prediction model. Methods　The clinical data of 326 pregnant women who underwent regular prenatal check-ups and gave birth at Northwest Women and Children's Hospital from January 2022 to June 2024 were included. They were 21 to 46 years old. Based on the results of the 75 g oral glucose tolerance test (OGTT) conducted at 24-28 weeks of pregnancy, the subjects were divided into a GDM group (62 cases) and a non-GDM group (264 cases). t-test and χ² test were used to compare the basic data and laboratory indicators of the two groups during the early pregnancy (10-12 weeks). Through multivariate logistic regression, the influencing factors of GDM onset were screened, and a prediction model for GDM in early pregnancy was established. The predictive efficacy of the model was tested using the receiver operating characteristic curve (ROC). Results　Among the 326 pregnant women in the early stage of pregnancy, 62 cases (19.02%) developed GDM Univariate and logistic multivariate regression analyses showed that age ≥35 years, pre-pregnancy body mass index (BMI) ≥24.0 kg/m², and elevated fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), and C-reactive protein (CRP) levels in the early pregnancy were all independent risk factors for GDM. The elevation of HDL-C and ADPN in the early pregnancy stage were both protective factors (both P<0.05). The GDM prediction model was constructed. The AUC of this model was 0.909 (95%CI 0.865-0.952). When the optimal prediction value was greater than 13.98, the corresponding sensitivity was 79.03%, the specificity was 92.75%, and the Youden index was 71.78%. Conclusion　The risk prediction model established based on the pregnant woman's age, pre-pregnancy BMI, FPG in the early pregnancy, HbA1c, CRP, HDL-C, and ADPN can provide references for the early warning of GDM.

Key words: Gestational diabetes mellitus, Early pregnancy, High risk factors, Prediction model

刘晶刘静王剑鹰王艳霞. 孕早期预测妊娠期糖尿病的高危因素分析和模型构建[J]. 国际医药卫生导报, 2025, 31(22): 3809-3814.

Liu Jing, Liu Jing, Wang Jianying, Wang Yanxia. High risk factors analysis and model construction of early pregnancy prediction of gestational diabetes[J]. International Medicine and Health Guidance News, 2025, 31(22): 3809-3814.

参考文献

[1] 唐艺,查红英,孙璐,等. 妊娠期糖尿病患者口服葡萄糖耐量试验不同时间点血糖特征与妊娠结局相关性的研究[J]. 中国糖尿病杂志,2023,31(7):491-499. DOI:10.3969/j.issn.1006-6187.2023.07.003.
[2] Moon JH, Jang HC. Gestational diabetes mellitus: diagnostic approaches and maternal-offspring complications[J]. Diabetes Metab J,2022,46(1):3-14. DOI: 10.4093/dmj.2021.0335.
[3] Malaza N, Masete M, Adam S, et al. A systematic review to compare adverse pregnancy outcomes in women with pregestational diabetes and gestational diabetes[J]. Int J Environ Res Public Health, 2022,19(17):10846. DOI: 10.3390/ijerph191710846.
[4] 陆文茜, 于祥田, 罗明娟, 等. 妊娠期糖尿病不良妊娠结局的危险因素和代谢组学联合分析[J]. 中华糖尿病杂志, 2021, 13(6): 578-583.DOI:10.3760/cma.j.cn115791-20210329-00182.
[5] Zehravi M, Maqbool M, Ara I. Correlation between obesity, gestational diabetes mellitus, and pregnancy outcomes: an overview[J]. Int J Adolesc Med Health, 2021, 33(6):339-345. DOI: 10.1515/ijamh-2021-0058.
[6] 王颖,张丽君,辛佳芮,等. 孕前体重指数异常与孕期高血脂水平的交互作用对妊娠期糖尿病发病的影响[J]. 中国医学科学院学报,2022,44(1):1-8. DOI:10.3881/j.issn.1000-503X.14018.
[7] Lee SM, Hwangbo S, Norwitz ER, et al. Nonalcoholic fatty liver disease and early prediction of gestational diabetes mellitus using machine learning methods[J]. Clin Mol Hepatol, 2022, 28(1):105-116. DOI: 10.3350/cmh.2021.0174.
[8] 中华医学会妇产科学分会产科学组,中华医学会围产医学分会,中国妇幼保健协会妊娠合并糖尿病专业委员会. 妊娠期高血糖诊治指南(2022)[第一部分][J]. 中华妇产科杂志,2022,57(1):3-12. DOI:10.3760/cma.j.cn112141-20210917-00528.
[9] 屈宁宁,李可基. 国际体力活动问卷中文版的信度和效度研究[J]. 中华流行病学杂志,2004,25(3):265-268. DOI:10.3760/j.issn:0254-6450.2004.03.021.
[10] 中国营养学会. 中国居民膳食指南(2022)[M]. 北京:人民卫生出版社, 2022:13.
[11] 路桃影,李艳,夏萍,等. 匹兹堡睡眠质量指数的信度及效度分析[J]. 重庆医学,2014,43(3):260-263. DOI:10.3969/j.issn.1671-8348.2014.03.002.
[12] Fishel Bartal M, Lindheimer MD, Sibai BM. Proteinuria during pregnancy: definition, pathophysiology, methodology, and clinical significance[J]. Am J Obstet Gynecol, 2022,226(2S):S819-S834. DOI: 10.1016/j.ajog.2020.08.108.
[13] 肖江波,诸清逸,石中华. 妊娠期糖尿病孕妇正常范围糖化血红蛋白与不良妊娠结局的相关性[J]. 现代妇产科进展,2022,31(4):265-268. DOI:10.13283/j.cnki.xdfckjz.2022.04.006.
[14] Li R, Yuan K, Yu X, et al. Construction and validation of risk prediction model for gestational diabetes based on a nomogram[J]. Am J Transl Res, 2023,15(2):1223-1230.
[15] Kang M, Zhang H, Zhang J, et al. A novel nomogram for predicting gestational diabetes mellitus during early pregnancy[J]. Front Endocrinol (Lausanne), 2021, 12:779210. DOI: 10.3389/fendo.2021.779210.
[16] Guleroglu FY, Ozmen AB, Bakirci IT, et al. Fetal pancreas size and maternal serum biomarkers glycated albumin and insulin-regulated aminopeptidase provide no potential for early prediction of gestational diabetes mellitus[J]. Arch Gynecol Obstet, 2023,308(5):1505-1514. DOI: 10.1007/s00404-022-06860-2.
[17] 舒强,熊华利,于均梅,等. 吸烟与肥胖对糖尿病前期患病的交互作用[J]. 现代预防医学,2023,50(11):1939-1944. DOI:10.20043/j.cnki.MPM.202211197.
[18] Alwash S, McIntyre D, Mamun A. The pre-pregnancy fasting blood glucose, glycated hemoglobin and lipid profiles as blood biomarkers for gestational diabetes mellitus: evidence from a multigenerational cohort study[J]. J Matern Fetal Neonatal Med, 2023,36(1):2195524. DOI: 10.1080/14767058.2023.2195524.
[19] 张先锋,刘盾. 孕早期孕妇糖化血红蛋白、晚期糖基化终末产物肽、脂联素水平预测妊娠糖尿病的价值分析[J]. 中国性科学,2022,31(11):45-49. DOI:10.3969/j.issn.1672-1993.2022.11.012.
[20] 辛鹏,李静,李昌昆,等. 脂质比值TC/HDL-C、TG/HDL-C和LDL-C/HDL-C与胰岛素抵抗、糖尿病及糖尿病前期的关联性[J]. 中华疾病控制杂志,2022,26(5):535-540. DOI:10.16462/j.cnki.zhjbkz.2022.05.008.
[21] Moyce Gruber BL, Dolinsky VW. The role of adiponectin during pregnancy and gestational diabetes[J]. Life (Basel), 2023, 13(2):301. DOI: 10.3390/life13020301.
[22] 杨旭博,滕越,姜珊,等. 妊娠期糖尿病高危孕妇孕前体质指数与孕早期糖脂代谢的关系[J]. 卫生研究,2023,52(2):193-197,212. DOI:10.19813/j.cnki.weishengyanjiu.2023.02.004.
[23] Liu W, Huang Z, Tang S, et al. Changes of serum sex hormone-binding globulin, homocysteine, and hypersensitive crp levels during pregnancy and their relationship with gestational diabetes mellitus[J]. Gynecol Obstet Invest, 2021, 86(1-2):193-199. DOI: 10.1159/000515085.
[24] Nadeem A, Sadiqa A, Saeed M. Effect of vitamin-D on glycemic parameters and Adiponectin in gestational diabetes[J]. Pak J Med Sci, 2024, 40(8):1786-1790. DOI: 10.12669/pjms.40.8.9308.
[25] Akbari H, Monemi F, Notej A, et al. Hs-CRP and TNF-α effects on postnatal umbilical coiling: impact assessment of the gestational diabetes mellitus[J]. Med J Islam Repub Iran, 2023, 37:56. DOI: 10.47176/mjiri.37.56.
[26] Muntean M, Săsăran V, Luca ST, et al. Serum levels of adipolin and adiponectin and their correlation with perinatal outcomes in gestational diabetes mellitus[J]. J Clin Med, 2024, 13(14):4082. DOI: 10.3390/jcm13144082.
[27] 曹译丹,李海滟,余夏妍,等. 孕早期血常规炎症指标对妊娠期糖尿病预测作用的前瞻性队列研究[J]. 现代预防医学,2023,50(14):2547-2554. DOI:10.20043/j.cnki.MPM.202302076.
[28] 王崇丹,李彩丽,魏海玲,等. 基于孕早期母体相关指标的孕中期妊娠期糖尿病发病风险预测模型构建与验证[J]. 山东医药,2022,62(14):50-53. DOI:10.3969/j.issn.1002-266X.2022.14.011.