妊娠糖尿病的危險因子與懷孕結果

研究背景：台灣2001年至2006年之妊娠糖尿病發生率高達7.4%。罹患妊娠糖尿病不只造成母體與子代的健康影響，也增加醫療成本。然而，很多懷孕婦女尚未覺察她們身處的健康風險，錯失早期預防的機會。若能充分了解台灣婦女發生妊娠糖尿病的危險因子及懷孕結果，有助於臨床護理人員即早評估危險因子，並適時進行衛教與健康促進管理計畫以及後續追蹤，以落實持續性的健康照護。研究目的：本研究目的為探討婦女罹患妊娠糖尿病的危險因子及懷孕結果。研究方法：本研究為病歷對照研究，研究對象來自南部某醫學中心1997年至2011年出院診斷碼為妊娠糖尿病（648.0）、妊娠葡萄醣耐量試驗異常者（648.8）與完全正常生產者（650）。依據美國國家糖尿病資料組的妊娠糖尿病診斷標準判定，研究對象所屬組別為妊娠糖尿病組（病例組）或妊娠葡萄糖耐受正常組（對照組）。收集其年齡、教育程度、工作狀態、糖尿病家族史、孕產次、生產史、身高、懷孕前身體質量指數、懷孕總增加體重、懷孕初期高血壓、抽菸等資料。利用接受操作特性曲線（receiver operating characteristic curve, ROC curve）找出年齡、懷孕前身體質量指數、身高與懷孕增加總體重之最佳分界點，再利用多變項邏輯斯回歸分析探討多重因子與妊娠糖尿病的相關性。另外，收集母體生產結果與子代出生狀況資料，以獨立樣本t檢定或卡方檢定分析妊娠糖尿病與懷孕結果之相關性。研究結果：在比較106位妊娠糖尿病與406位妊娠葡萄糖耐受正常的孕婦後發現，懷孕年齡超過33歲（OR: 2.72, p = .001）、教育程度為高中或以下（OR: 5.04, p < .001）、有糖尿病家族史（OR: 8.66, p < .001）、身高小於160公分（OR: 1.84, p = .037）、懷孕前身體質量指數超過22.3 kg/m2（OR: 4.25, p < .001）與懷孕總增加體重超過10.5公斤（OR: 2.11, p = .010）為妊娠糖尿病危險因子。妊娠糖尿病婦女發生早產、剖腹產與妊娠高血壓的風險皆較妊娠葡萄糖耐受正常婦女高。妊娠糖尿病婦女之新生兒為巨嬰、第一分鐘與第五分鐘的阿帕嘉新生兒評分（Apgar score）得分未滿7分與入住加護病房的風險，皆較妊娠葡萄糖耐受正常婦女之新生兒高。結論：懷孕年齡超過33歲、教育程度為高中或以下、有糖尿病家族史、身高小於160公分、懷孕前身體質量指數超過22.3 kg/m2以及懷孕增加體重超過10.5公斤，皆為罹患妊娠糖尿病的重要危險因子。妊娠糖尿病婦女與其新生兒出現不良懷孕結果的風險，較妊娠葡萄糖耐受正常婦女高。健康照護人員應於孕婦首次產檢時注意評估妊娠糖尿病危險因子外，更應積極的宣導其接受妊娠糖尿病篩檢。對罹患妊娠糖尿病之孕婦，護產人員應協助其孕期的生理及心理照護，密切評估孕婦與其胎兒的健康狀況，並提供完善的周產期照護，以維持母親與子代的健康。

關鍵字

妊娠糖尿病；危險因子；懷孕結果

並列摘要

Background: From 2001 to 2006, the incidence of gestational diabetes mellitus (GDM) was 7.4%. GDM not only suffered the mother and offspring, but also increase health care costs. However, many pregnant women have not aware the health risks of GDM, lack of early prevention. If we can fully understand the risk factors and pregnancy outcomes of women suffered from GDM, it will contribute to health professionals early detected risk factors, and provided health education and follow-up program to implement continuous care. Purpose: The purpose of this study was to identify the risk factors and pregnancy outcomes of GDM. Method: This was a retrospective case-control study design. The subjects who discharged at a medical center in Southern Taiwan from 1997 to 2011 and whose International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) code were diabetes mellitus complicating pregnancy childbirth or the puerperium (648.0), abnormal glucose tolerance of mother complicating pregnancy childbirth or the puerperium (648.8), and normal delivery (650) were reviewed. According to National Diabetes Data Group diagnostic criteria for diabetes, subjects were divided into groups of GDM (case group) or normal glucose tolerance group (control group). Maternal age, educational attainment, work status, family history of diabetes, gravida, para, reproductive history, height, pre-pregnancy body mass index (pre-pregnancy BMI), total pregnancy weight gain, high blood pressure during early pregnancy, smoking and pregnancy outcomes were reviewed. For determination of a cut-off value for age, pre-pregnancy BMI, height, and total pregnancy weight gain, the coordinate of a receiver operating characteristic (ROC) curve indicating the greatest sensitivity and specificity was chosen. Multivariate logistic regression was used to explore the relationship between risk factors and diagnosis of GDM. Furthermore, univariate logistic regression was performed to explore GDM contributing to differentiation of two groups about pregnancy outcomes. Result:106 women with GDM and 406 women with normal glucose tolerance participated in this study. The risk factors of GDM were maternal age over 33 years (OR: 2.72, p = .001), education completed and/or under high school (OR: 5.04, p < .001), family history of diabetes (OR: 8.66, p < .001), height below 160cm (OR: 1.84, p = .037), pre-pregnancy BMI over 22.3 kg/m2 (OR: 4.25, p < .001) and gestational weight gain over 10.5kg (OR: 2.11, p = .010). The risk of preterm delivery, caesarean section and pregnancy induced hypertension was increased in women with GDM. The infants' mothers with GDM were at high risk of being macrosomia, Apgar score under 7 at 1 minute and at 5 minutes and need for neonatal intensive care. Conclusion: Age, education attainment, family history of diabetes, height, pre-pregnancy BMI and gestational weight gain are important risk factors for GDM. Women with GDM and Infants born to mothers with GDM have higher risk for poor pregnancy outcomes than women with normal glucose tolerance and their infants. Healthcare providers should assess these risk factors of GDM for pregnant women while routine prenatal visit and encourage them to perform the screening for GDM. In conclude, healthcare professionals not only provided physiological and psychological care during three trimesters of GDM women, but also carefully assess maternal and neonatal health risk of the mothers and their offspring.