妊娠期代谢综合征及其主导危险因素与出生缺陷分析

Metabolic syndrome and its leading risk factors and birth defects analysis during pregnancy

目的研究分析妊娠期代谢综合征(GMS)及其主导危险因素血糖、血脂、体重、血压影响新生儿出生缺陷的发生情况。方法收集2014年1月至2016年12月在杭州市妇产科医院定期产检并分娩的851例不同主导危险因素的妊娠期代谢综合征孕妇,其中246例妊娠期糖尿病(GDM)孕妇为GDM组;263例妊娠合并高脂血症、高胆固醇血症为高血脂组;198例妊娠合并肥胖为肥胖组;144例妊娠高血压为高血压组;995例健康孕妇为对照组,统计各危险因素组别的临床资料及新生儿出生缺陷发生的情况。结果 851例GMS孕妇发生新生儿出生缺陷14例,发生率达1.65%;GDM组出生缺陷5例,比例2.03%,其中先天性心脏病3例,肾缺如1例,短臂1例;高血脂组出生缺陷2例,比例0.76%,其中颜面血管瘤1例,隐睾1例;肥胖组出生缺陷4例,比例2.02%,其中先天性心脏病1例,尿道下裂1例,多趾1例,外耳畸形1例;高血压组出生缺陷3例,比例2.08%,其中先天性心脏病1例,唇裂1例,并趾1例;对照组出生缺陷2例,比例0.20%,先天性髋关节发育不良1例,多指1例。GMS孕妇(GDM组、肥胖组、高血压组、高血脂组)出生缺陷均高于对照组,比较具有统计学意义(P<0.05),GDM组、肥胖组、高血压组高于高血脂组,比较具有统计学意义(P<0.05)。16例新生儿出生缺陷中先天性心脏病排位第一,占比31.25%;泌尿生殖道及手指脚趾畸形排列第二,各占18.75%。结论以高血糖、肥胖、高血压为主导风险因素的GMS会增加新生儿出生缺陷的发生率,尤其是先天性心脏病。提示我们应积极防制妊娠期代谢综合征及其危险因素,以减少新生儿出生缺陷的发生。

Objective：To study the effects of blood glucose,blood lipid,body weight and blood pressure on the birth defects of neonates in GMS and its leading risk factors. Methods：A total of 851 pregnant women with gestational metabolic syndrome with different leading risk factors were collected from January 2014 to December 2016 at the Gynecology and Obstetrics and Gynecology Hospital in Hangzhou,and 246 pregnant women with gestational diabetes mellitus（GDM）were GDM 26 cases of pregnancy with hyperlipidemia,hypercholesterolemia were hyperlipidemia group;198 cases of pregnancy with obesity as obese group;144 cases of pregnancy-induced hypertension;hypertensive group;995 cases of healthy pregnant women as the control group,the statistical risk The clinical data of the factor group and the occurrence of neonatal birth defects. Results：85 cases of neonatal birth defects occurred in 851 cases of GMS,the incidence of 1.65%;GDM group 5 cases of birth defects,the proportion of 2.03%,of which 3 cases of congenital heart disease,1 case of renal deficiency,1 case of short arm;1 case of facial hemangioma,1 case of cryptorchidism;4 cases of obesity group birth rate,the proportion of 2.02%,of which 1 case of congenital heart disease,1 case of hypospadias,and more than 1 case of hyperplasia group,the proportion of 0.76% 1 case of external ear deformity in 1 case;hypertensive group of birth defects in 3 cases,the proportion of 2.08%,of which 1 case of congenital heart disease,1 case of cleft lip and 1 toe;control group 2 cases of birth defects,the proportion of 0.20% Sexual hip dysplasia in 1 case,more than 1 case.（GDM group,obese group,hypertensive group and hyperlipidemia group）were higher than those in the control group（P 〈0.05）. GDM group,obese group and hypertensive group were higher than those of hyperlipidemia group,Which was statistically significant（P〈 0.05）. 16 cases of neonatal birth defects in congenital heart disease ranked first,accounting for 31.25%;urogenital tract and finger toe deformity ranked second,each accounted for 18.75%. Conclusion：GMS with high blood glucose,obesity and hypertension as the leading risk factor will increase the incidence of neonatal birth defects,especially congenital heart disease. Suggesting that we should actively control the metabolic syndrome and its risk factors in pregnancy to reduce the occurrence of neonatal birth defects.