孕中期糖、脂水平与妊娠期糖尿病及新生儿体质量相关性分析

Correlation analysis of blood glucose and lipid levels in the second trimester with GDM and neonatal weight

目的:探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者孕中期血糖、血脂水平与新生儿体质量的关系及巨大儿发生的相关危险因素。方法:选取2017-06～2018-06我院妇产中心分娩的729例产妇为研究对象,根据GDM诊断标准及纳入标准,其中152例为GDM组,并以同期正常妊娠267例产妇为对照组。根据出生体质量将新生儿分为巨大儿(体质量≥4000g,52例)和正常体质量儿(体质量<4000g,367例)。分别分析比较GDM组与对照组、巨大儿与正常体质量儿母体孕中期血糖、血脂水平以及产妇年龄、孕前体质量指数(body mass index,BMI)、孕期体质量增加、孕中期血糖、血脂与新生儿体质量的相关性。结果:GDM组孕中期血清总胆固醇(total cholesterol,TC)、总甘油三酯(total glyceride,TG)、空腹血糖(fasting blood glucose,FPG)、餐后1h血糖(1hour postprandial blood glucose,1hPBG)、餐后2h血糖(2hour postprandial blood glucose,2hPBG)、糖化血红蛋白(glycosylated hemoglobin,HbAlc)均明显高于对照组,差异有统计学意义(P<0.05或P<0.01)。GDM组年龄、孕前BMI、孕期体质量增加、新生儿体质量均高于对照组,差异有统计学意义(P<0.05或P<0.01)。GDM组孕中期高密度脂蛋白(high density lipoprotein-c,HDL-C)低于对照组,差异有统计学意义(P<0.01)。GDM组孕中期低密度脂蛋白(low density lipoprotein-c,LDL-C)与对照组比较,差异无统计学意义(P>0.05)。巨大儿母体孕中期TC、TG、LDL-C、FPG、1hPBG、HbAlc、孕前BMI及孕期体质量增加量均高于正常体质量儿母体,差异有统计学意义(P<0.05);巨大儿母体孕中期HDL-C低于正常体质量儿母体,差异有统计学意义(P<0.05),巨大儿母体2hPBG高于正常体质量儿母体,但差异无统计学意义(P>0.05)。孕妇孕中期TC、TG、LDL-C、FPG、1hPBG、HbAlc、孕前BMI及孕期体质量增加均与新生儿体质量存在显著正相关(P<0.05)。结论:GDM孕妇孕中期糖、脂代谢明显紊乱,并且影响新生儿体质量。孕前BMI过高、孕期体质量增加过多、血糖及血脂异常均为分娩巨大儿的危险因素。

Objective:To explore the relationship between blood glucose and lipid levels in the second trimester of pregnancy and neonatal weight,and the risk factors of macrosomia in gestational diabetes mellitus(GDM)patients.Methods:A total of 729 parturients in the maternity center of our hospital from June 2017 to June 2018 were selected as the study subjects.According to the diagnostic criteria of GDM and inclusion criteria,152 cases were selected as the GDM group,and 267 normal pregnant women in the same period as the control group.According to the neonatal weight,they were divided into macrosomia neonatal(neonatal weight≥4000 g,n=52)and normal weight neonatal(neonatal weight<4000 g,n=367).Blood glucose and lipid levels of pregnant women in the second trimester of pregnancy between GDM group and control group,macrosomia neonatal and normal weight neonatal were analyzed and compared.Meanwhile,the correlation between maternal age,body mass index(MBI)before pregnancy,weight gain during pregnancy,blood glucose,blood lipid and neonatal weight were analyzed.Results:Serum total cholesterol(TC),total triglyceride(TG),fasting blood glucose(FPG),1 hour postprandial blood glucose(1 hPBG),2 hours postprandial blood glucose(2 h PBG),glycosylated hemoglobin(HbAlc)in GDM group were higher than those in the control group during the second trimester of pregnancy(P<0.05 or P<0.01).The gestational age,BMI,gestational weight gain and neonatal weight in GDM group were significantly higher than those in control group(P<0.05 or P<0.01).High density lipoprotein-c(HDL-C)in GDM group was significantly lower than that in control group(P <0.01),while low density lipoprotein-c(LDL-C)in GDM group was not significantly different than that in control group(P>0.05).TC,TG,LDL-C,FPG,1 hPBG,HbAlc,BMI before pregnancy and weight gain during pregnancy in macrosomia neonatal were higher than those in normal weight neonatal,the difference was statistically significant(P <0.05).HDL-C in macrosomia neonatal was lower than that in normal weight neonatal,the difference was statistically significant(P<0.05).2 hPBG in macrosomia neonatal was higher than that in normal weight neonatal,but there was no significant difference in the normal weight neonatal(P>0.05).TC,TG,LDL-C,FPG,1 hPBG,HbAlc,BMI before pregnancy and weight gain during pregnancy were positively correlated with neonatal weight(P<0.05).Conclusion:GDM pregnant women in the second trimester of pregnancy,blood glucose and lipid metabolism disorder,and affect the weight of newborns.Excessive BMI before pregnancy,excessive weight gain during pregnancy,abnormal blood glucose and lipid levels were all risk factors for macrosomia.