关键词: 糖尿病, 妊娠；经产；年龄因素；肥胖症

Abstract: Background　In China，with the implementation of the universal two-child policy，the prevalence of pregnancy in multiparae has risen dramatically，followed by an increase in the incidence of adverse pregnancy outcomes.Multiparae are at higher risk for developing gestational diabetes mellitus （GDM） than primiparas.Objective　To investigate the risk factors of GDM in multiparae，to establish a risk prediction model of GDM for this population.Methods　This prospective study was conducted in a cohort of women（including multiparae and primiparas） who delivered a singleton baby in Beijing Obstetrics and Gynecology Hospital，Capital Medical University，between January and September 2017.Basic personal information，history of pregnancy and childbirth，history of GDM，family history of diabetes，physical parameters，fasting plasma glucose （FPG），and fasting plasma lipids during the first trimester were collected.75-g OGTT was conducted at 24-28 weeks of gestation，and the results were stratified.GDM was diagnosed following the IADPSG 2010 criteria.The above-mentioned parameters and incidence of GDM were compared between multiparae and primiparas.Influencing factors of GDM in multiparae were identified with univariate and multivariate analyses，and were used to establish a risk prediction model of GDM.Results　A total of 5 110 cases were included，and 34.8% （1 779/5 110）of them were multiparae.Compared with primiparas，multiparae had an older age，more pregnancies，higher prepregnancy BMI，TG，and FPG levels，higher percentages of history of adverse pregnancy and childbirth outcomes，history of GDM，and junior college or below education level，and higher GDM incidence （P<0.05）．Among the multiparae，those with GDM showed an older age，more pregnancies，higher prepregnancy BMI，TG， LDL-C and FPG levels，lower HDL-C levels, and higher percentages of history of GDM，and of family history of diabetes than those without （P<0.05）．Logistic regression analysis showed that age，history of GDM，prepregnancy BMI，and FPG in early pregnancy were the influencing factors of GDM in multiparae （P<0.05）．The established Logistic regression model was as follows：PGDM=1/{1+exp〔-（-8.305 3+0.075 2×age+0.530 0×history of GDM+0.125 2×prepregnancy BMI+0.398 4×PFG）〕}.ROC analysis indicated that the AUC of the predictive model was 0.704，the corresponding sensitivity，specificity and Youden's index were 65.84%，68.90% and 0.347 respectively.Conclusion　Multiparae，especially those with glycemic abnormalities during the previous pregnancy，have a high risk of developing GDM，and a population should be intervened in priority.GDM risk prediction model established with variables of age，prepregnancy BMI and FPG in early pregnancy，can provide a theoretical basis for early screening，monitoring，and intervention of GDM in high-risk pregnant women.

Key words: Diabetes, gestational；Multiparity；Age factors；Obesity