产次对孕妇血脂及妊娠并发症的影响

Influence of Different Parity on Serum Lipid during Pregnancy and Pregnant Outcome

目的:探讨不同产次对孕妇血脂及妊娠并发症的影响。方法:收集2016年9月—2017年12月在河北省人民医院产检并分娩的孕妇共1 669例,按孕周及年龄分为4组:妊娠中期适龄组527例、妊娠中期高龄组261例、妊娠晚期适龄组636例、妊娠晚期高龄组245例,其中每组根据产次分为初产妇和经产妇,比较各组血脂水平、高密度脂蛋白胆固醇(HDL-C)/总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)/TC、LDL-C/HDL-C比值以及妊娠结局。结果:(1)妊娠中期适龄组经产妇(与初产妇比较)三酰甘油(TG)、TC和极低密度脂蛋白胆固醇(VLDL-C)水平明显升高(P<0.05);妊娠中期高龄组经产妇(与初产妇比较)TG、TC、HDL-C、LDL-C、VLDL-C和HDL-C/TC水平呈升高趋势,但仅HDL-C水平差异有统计学意义(P<0.05)。(2)妊娠晚期适龄组经产妇(与初产妇比较)LDL-C、VLDL-C、LDL-C/TC和LDL-C/HDL-C水平显著降低,而HDL-C/TC升高(均P<0.05);妊娠晚期高龄组经产妇(与初产妇比较)TG、TC、HDL-C、LDL-C、HDL-C/TC和LDL-C/HDL-C水平呈下降趋势,VLDL-C水平升高,但差异均无统计学意义(P>0.05)。(3)与初产妇相比,适龄组经产妇胎膜早破及胎儿窘迫的发病率下降,高龄组妊娠期高血压疾病(HDCP)和妊娠期糖尿病(GDM)、胎儿窘迫发生率下降(P<0.05);而适龄组经产妇早产儿和巨大儿发生率升高(P<0.05)。(4)高龄组GDM和HDCP发生率高于适龄组(P<0.05)。结论:产次对血脂有一定程度的影响,可导致妊娠并发症的发生。

Objective：To investigate the influence of parity on serum lipid during pregnancy and pregnant outcome. Methods：Totally, 1 669 women who delivered in Hebei General Hospital from September 2016 to December 2017 were recruited. Those women were divided into four groups based on the age and gestational age：the right-age and mid-pregnancy group（527 cases）, the advanced-age and mid-pregnancy group（261 cases）, the right-age and late-pregnancy group（in the late of pregnancy, 636 cases）, the advanced-age and late-pregnancy group（in the late of pregnancy, 245 cases）. Each group was divided into two subgroups： the primipara subgroup and the multipara subgroup according to the number of births. The levels of serum lipid, HDL-C/TC, LDL-C/TC and the LDL-C/HDL-C ratio were compared. Results：（1）The levels of TG, TC, VLDL-C in multipara women of the right-age and mid-pregnancy group were significantly increased（all P〈0.05）, while the levels of TG, TC,HDL-C, LDL-C, VLDL-C and HDL-C/TC in multipara women of the advanced-age and mid-pregnancy group were mildly increased, only the significant difference in HDL-C level（P〈0.05）, when compared with those primipara women.（2）The levels of LDL-C, VLDL-C, LDL-C/TC and LDL-C/HDL-C in multipara women of the right-age and late-pregnancy group were significantly decreased, and the level of HDL-C/TC increased（all P〈0.05）, while the levels of TG, TC, HDL-C, LDL-C, HDL-C/TC and LDL-C/HDL-C in multipara women of the advanced-age and late-pregnancy group were mildly decreased（but P〉0.05） and the level of VLDL-C mildly increased（but P〈0.05）, when compared with those primipara women.（3）Compared with those primipara women,the multipara women of the right-age groups had lower incidences of premature rupture of membranes and fetal distress, while the multipara women of the advanced-age groups had lower incidences of hypertensive disorder complicating pregnancy（HDCP）, gestational diabetes mellitus（GDM） and fetal distress（all P〈0.05）. However, the incidences of premature and giant babies in those multipara women of the right-age groups were higher than those in the primipara women（both P〈0.05）.（4）The incidences of HDCP and GDM in both advanced-age groups were significantly higher than those in both right-age groups（all P〈0.05）. Conclusions：Parity has a certain degree of effect on serum lipids, which could be related to pregnancy complications.