糖化血红蛋白水平对糖尿病孕妇妊娠结局的影响

Effect of Glycosylated Hemoglobin Levels on Pregnancy Outcome of Pregnant Women with Gestational Diabetes Mellitus

目的:研究糖化血红蛋白(HbAlc)水平对妊娠期糖尿病(GDM)孕妇妊娠结局的影响。方法:112例妊娠期糖尿病孕妇作为GDM组、再根据妊娠24~28周时GDM患者空腹血清HbAlc水平分为高水平组(HbAlc≥6.5%,n=43)和低水平组(HbAlc<6.5%,n=69),选取同期产检的95例正常孕妇作为对照组;比较对照组和GDM组孕妇妊娠24~28周时空腹HbAlc水平,GDM组孕妇给予以糖尿病饮食及运动指导干预,两周时再次检测HbAlc水平;分析不同HbAlc水平GDM孕妇早产、剖宫产、羊水过多、妊娠期高血压发生率、分娩孕周和产前体质指数(BMI),比较新生儿出生后1 min Apgar≤7分、巨大儿、低血糖、高胆红素血症患儿及新生儿体质量。结果:妊娠24~28周时,GDM组HbAlc水平高于对照组(t=9.95,P<0.05);妊娠24~28周时,两组GDM孕妇给予饮食及运动干预,HbAlc水平降低,与干预前比较,差异有统计学意义(t=9.66,P<0.05);干预后,HbAlc高水平GDM孕妇HbAlc恢复正常比例低于低水平GDM孕妇(χ~2=4.57,P=0.033);HbAlc高水平组GDM孕妇分娩时孕周比低水平组短,但早产、剖宫产、羊水过多及妊娠期高血压的发生率均高于低水平组孕妇(P<0.05);GDM高水平组新生儿体质量、新生儿出生后1 min Apgar≤7分、巨大儿、低血糖及高胆红素血症发生率显著高于低水平组(P<0.05)。结论:高表达HbAlc的GDM孕妇的妊娠期结局较差,新生儿的并发症发生率变高,可将HbAlc的监测作为血糖控制及避免产后新生儿并发症的重要指标。

Objective： To study the effect of glycosylated hemoglobin（ HbAlc） on pregnant outcome of women with gestational diabetes mellitus（ GDM）. Methods： A total of 112 pregnant women with gestational diabetes mellitus were selected as the GDM group,and according to HbAlc levels at 24 ~ 28 weeks of pregnancy,women in GDM group were divided into high level group（ HbAlc = 6. 5%,n =43） and low level group（ HbAlc 6. 5%,n = 69）. Ninety-five normal pregnant women were selected as control group. HbA1c levels were compared between the two groups at 24 ~ 28 weeks of pregnancy. Pregnant women in GDM group were given diabetes diet and exercise guidance,after two weeks,HbA1c levels were detected. Incidence of premature delivery,cesarean delivery,polyhydramnios,gestational hypertension,neonate＇ s Apgar score ≤7 points,macrosomia,neonatal hypoglycemia,hyperbilirubinemia of GDM women with different HbAlc levels were observed,and gestational weeks,BMI and neonate＇s body weight were compared. Results： HbAlc in GDM groups at 24 ~ 28 weeks of pregnancy was significantly higher than that in the control group（ P〈0. 05）. HbAlc levels in GDM group were significantly decreased after accepting diabetes diet and exercise guidance. HbAlc recovery ratio in high level group were lower than the low level group,and gestational weeks in high level group were shorter than the low level group（ P〈0. 05）. Neonate＇s body weight and incidence of premature delivery,cesarean delivery,polyhydramnios,gestational hypertension,neonate＇ s Apgar score ≤ 7 points,macrosomia,neonatal hypoglycemia,hyperbilirubinemia in high level group were higher than the low level group（ P〈0. 05）. Conclusion： The high levels of HbAlc in GDM pregnant women has a greater risk of bad pregnancy outcomes and neonatal complications. Therefore,HbAlc monitoring can be used in blood glucose control and as an important indicators to avoid postpartum neonatal complications.