关键词: 糖尿病, 妊娠早期, 血糖, 筛查, 高危因素

Abstract: Background　The incidence of gestational diabetes mellitus is increasing，especially among pregnant women at high risk of diabetes mellitus.Early screening and early prevention are very important.However，at present，the methods and diagnostic criteria of early gestational diabetes mellitus screening are still not uniform.Objective　To study the blood glucose of high-risk pregnant women with diabetes mellitus in early pregnancy and to analyze the effect of related high-risk factors on early hyperglycemia.Methods　Collect the data of high-risk pregnant women with diabetes who were enrolled in the maternity clinic of Daxing Teaching Hospital of Capital Medical University from July 2017 to December 2018，and oral glucose tolerance test （OGTT） was used for diabetes screening before 14 weeks of gestation.Results　A total of 596 pregnant women with high-risk diabetes were screened for blood glucose in the first trimester of pregnancy，including 374 cases （62.75%） with normal blood glucose，190 cases （31.88%） with impaired glucose regulation （IGR）and 32 cases （5.37%） with pre-gestational diabetes mellitus （PGDM）．In the IGR group，4 cases （2.11%） only had elevated fasting plasma glucose （FPG） level，177 cases （93.16%） only had higher 2 hours plasma glucose（2 hPG） level，9 cases （4.73%） had elevated FPG and OGTT 2 hPG level.In the PGDM group，6 cases （18.75%） only had elevated FPG，24 cases （75.00%） had only elevated OGTT 2 hPG level，2 cases （6.25%） had elevated FPG and OGTT 2 hPG.There were significant differences in age，height，weight，body mass index （BMI） before pregnancy，number of pregnancy，number of births，neck circumference，waist circumference，proportions of first-degree relatives with diabetes mellitus，previous gestational diabetes mellitus （GDM） history and hypertension among three groups（P<0.05）.The results of multivariate Logistic regression showed that age 〔OR=1.087，95%CI（1.043，1.132）〕，neck circumference 〔OR=1.126，95%CI（1.049，1.207）〕 and first-degree relatives with diabetes 〔OR=1.763，95%CI（1.209，
2.572）〕 were independent influencing factors of IGR （P<0.05）；age 〔OR=1.131，95%CI（1.040，1.230）〕，waist circumference 〔OR=1.063，95%CI（1.030，1.099）〕，GDM history 〔OR=5.260，95%CI（1.641，16.864）〕 and hypertension 〔OR=6.246，95%CI（1.336，29.188）〕 were independent influencing factors of PGDM （P<0.05）．Conclusion　The incidence of IGR and PGDM in the early pregnancy in high-risk diabetic women is high，and glucose screening only with FPG in early pregnancy would lead to a higher rate of missed diagnosis of IGR and PGDM.Advanced age，neck circumference enlargement，and first-degree relatives with diabetes are independent determinants of IGR.Advanced age，waist circumference enlargement，hypertension，and GDM history are independent determinants of PGDM.

Key words: Diabetes, First trimester, Blood glucose, Screening, High risk factors