动态HbAlc水平与妊娠糖尿病患者妊娠结局的关系

Study on relationship between dynamic level of Hbalc and fetal outcomes in pregnant women with gestational diabetes mellitus

目的探讨动态糖化血红蛋白(glycosylated hemoglobin,HbAlc)水平与妊娠糖尿病(gestational diabetes mellitus,GDM)患者妊娠结局的关系,为防治GDM不良妊娠结局提供理论依据。方法本次研究对象为2014年6月—2017年6月于郑州市妇幼保健院收治的60例GDM患者,产前5%≤HbAlc<6%的32例患者设为达标组,28例6%≤HbAlc<7%设为超标组,另随机选择30例正常产妇设为对照组。比较3组产妇以及围产儿结局,并分析HbAlc水平与产妇身体质量指数(Body Mass Index,BMI)、产后1 min Apgar评分以及出生体重的相关性。结果 3组产妇妊娠结局中妊娠期高血压、羊水过多、子痫前期、胎膜早破、剖宫产发生率以及产前BMI差异均具有统计学意义(P<0.05),超标组均显著高于达标组与对照组,差异均具有统计学意义(P<0.05),3组孕周差异无统计学意义(P>0.05);三组围产儿结局中巨大儿、早产儿、新生儿低血糖、高胆红素血症发生率以及新生儿体重、1 min Apgar评分差异均具有统计学意义(P<0.05),超标组均显著高于达标组与对照组,差异均具有统计学意义(P<0.05),超标组出现1例死胎。结论 HbAlc水平与妊娠糖尿病患者妊娠结局具有紧密联系,HbAlc水平增加孕妇及围产儿的并发症发生率,可通过HbAlc水平监测防治GDM的不良妊娠。

Objective To investigate the relationship between dynamic glycosylated hemoglobin（ HbAlc） levels and pregnancy outcome in gestational diabetes mellitus（ GDM） patients,and provided a theoretical basis for prevention and treatment of GDM adverse pregnancy outcomes. Methods Selected 60 GDM women of June 2014 to June 2017 underwent antenatal examination and delivery in our hospital were as study objects,32 cases were divided into up to standard group（ 5% ≤HbAlc 〈 6% ） and over standard group（ 6% ≤HbAlc 〈 7% ,28 cases）,30 HbAlc normal pregnant women of the same period were selected as control group. The maternal and perinatal outcomes of the three groups were compared,and the correlation among HbAlc levels and maternal body mass index（ Body,Mass,Index,BMI）,postpartum1 min,Apgar scores,and birth weight was analyzed. Results The pregnancy hypertension during pregnancy,hydramnios,preeclampsia ratio,premature premature rupture of membranes（ PROM） ratio,cesarean section ratio and the difference of BIM of the three groups were statistically significant（ P 〈 0. 05）,in which the over standard group was significantly higher than that of the standard group and the control group,the difference was statistically significant（ P 〈0. 05）,there was no significant difference in gestational age between the three groups（ P 〉 0. 05）; Among the three perinatal outcomes,macrosomia,premature infants,neonatal hypoglycemia,hyperbilirubinemia,and neonatal weight,1 min,Apgar scores were statistically significant（ P 〈 0. 05）,the over standard group was significantly higher than that of the standard group and the control group,the difference was statistically significant（ P 〈 0. 05） with 1 cases of stillbirth in the over standard group. Conclusion The level of HbAlc is closely related to the pregnancy outcome of gestational diabetes mellitus,and the level of HbAlc increases the incidence of complications in pregnant women and perinatal infants. It can monitor the adverse pregnancy of GDM by monitoring the level of HbAlc.