专项健康管理对GDM孕妇孕期和产后代谢指标的影响

Effects of special health management on maternal and postpartum metabolic indicators of GDM pregnant women

[目的]观察专项健康管理对妊娠期糖尿病(GDM)孕妇孕期和产后代谢指标的影响,并探讨和分析专项健康管理在阻断和防范妊娠期糖尿病孕妇孕期和产后发生代谢性疾病风险的作用效果。[方法]选取在本院产检并在孕中期(24周～28周)确诊为妊娠期糖尿病的孕妇220例,按摸球法分为两组,研究组110例,对照组110例。两组孕妇均进行糖尿病家族史、孕周、孕次、年龄等调查,自入组直至产后1年,研究组孕妇给予专项健康管理,对照组孕妇给予常规健康管理,两组孕妇分别在孕中期(24周～28周)、孕晚期(32周～36周)、产后42d、产后6个月、产后1年检测血压、体重指数(BMI)、超敏C反应蛋白(hs-CRP)、空腹血糖(FPG)、口服葡萄糖耐量试验1h血糖(OGTT 1hPG)、口服葡萄糖耐量试验2h血糖(OGTT 2hPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)指标。[结果]①孕中期两组孕妇收缩压、舒张压、BMI、hs-CRP、FPG、OGTT 1hPG、OGTT 2hPG、TG、TC、HDL-C、LDL-C差异均无统计学意义(P>0.05)。②孕晚期研究组孕妇的收缩压、舒张压、BMI、hs-CRP、FPG、OGTT 2hPG、TG比较明显低于对照组,差异有统计学意义(P<0.05)。③研究组孕妇在产后42d的收缩压、舒张压、BMI、hs-CRP、FPG、OGTT 2hPG、TG明显低于对照组,差异有统计学意义(P<0.05)。④研究组孕妇在产后6个月和1年的收缩压、舒张压、BMI、hs-CRP、FPG、OGTT 1hPG、OGTT 2hPG、TG、TC、LDL-C均明显低于对照组,差异有统计学意义(P<0.05)。⑤研究组孕妇产后血压、BMI、hs-CRP、糖代谢、脂代谢的异常率和代谢综合征发生率分别为6.73%、9.62%、11.54%、6.73%、2.88%和11.54%,均明显低于对照组,差异有统计学意义(P<0.05)。⑥多因素Logistic回归分析显示,妊娠期糖尿病孕妇产后代谢综合征的发生与糖尿病家族史、孕晚期收缩压、孕晚期体重指数、孕晚期超敏C反应蛋白、孕晚期FPG、孕晚期OGTT 2hPG和孕晚期三酰甘油呈显著正相关。[结论]影响妊娠期糖尿病孕妇孕期及产后代谢指标的因素较多,本研究结果表明对妊娠期糖尿病孕妇进行专项健康管理能有效阻断和防范妊娠期糖尿病孕妇在孕期和产后发生代谢性疾病的风险。

To observe the effects of special health management on maternal pregnancy and postpartum metabolic indicators of gestational diabetes mellitus（GDM）,and to explore and analyze the effects of special health management on blocking and preven- ting the risk of metabolic diseases in pregnant women with gestational diabetes mellitus and postpartum. Methods： Selected 220 preg- nant women who were diagnosed with gestational diabetes during the second trimester（ 24 weeks to 28 weeks of gestation） and were examined in our hospital. Ball touching was divided into two groups, including 110 cases in the observation group and 110 cases in the control group. Family history of diabetes, gestational age, gestational age and age were investigated in both groups. The pregnant women in the observation group were given special health management, and the pregnant women in the control group were given rou- tine health management. Two groups of pregnant women in midgestation（24 weeks to 28 weeks of pregnancy）, late pregnancy（32 weeks to 36 weeks of pregnancy）, postpartum 42 days,6 months postpartum,postpartum year testing blood pressure,body mass in- dex（BMI）, hypersensitive c- reactive protein（hs- CRP）, fasting plasma glucose（FPG） ,oral glucose tolerance test（OGTT 1 HPG）, o- ral glucose tolerance test （ OGTT 2 HPG）, total cholesterol （ TC）, triglyceride （ TG ）, high - density lipoprotein （ HDL - C ）, lowdensity lipoprotein（LDL- C）. To observe the changes of postpartum and postpartum metabolic indicators of pregnant women in the two groups and analyze the influencing factors of postpartum metabolic abnormality of pregnant women in the two groups. Results：In the middle stage of pregnancy（24 weeks to 28 weeks of pregnancy）, there were no statistically significant differences in systolic blood pressure,diastolic blood pressure,BMI,hs- crp,FPG,OGTT 1 h PG,OGTT 2 h PG,TG,TC,hdl- c,ldl-c between the two groups （P〉0.05）. In the observation group, systolic blood pressure, diastolic blood pressure,BMI, hs- crp, FPG, OGTT 2 hPG and TG were significantly lower than those in the control group（P〈0. 05 ）. The systolic blood pressure,diastolic blood pressure,BMI, hs- crp, FPG, OGTT 2 hPG and TG of pregnant women in the Solomon observation group were significantly lower than those in the control group at 42 d postpartum（P〈0.05）. The systolic blood pressure,diastolic blood pressure,BMI,hs- crp,FPG,OGTT 1 h PG,OGTT 2 h PG, TG, TC, and ldl- c of pregnant women in the disciplinary group were significantly lower than those in the control group at 6 months and 1 year after delivery（ P〈0. 05 ）. The abnormal rates of postpartum blood pressure,BMI, hs -crp,glucose metabolism, and lipid metabolism and the incidence of metabolic syndrome were 6.73% ,9.62% ,11.54% ,6.73% ,2.88%and 11.54% ,respectively, which were significantly lower than the control group, the difference was statistically significant（P〈0. 05）. Multivariate Logistic re- gression analysis showed that the occurrence of postpartum metabolic syndrome in pregnant women with gestational diabetes was sig- nificantly positively correlated with family history of diabetes, systolic blood pressure in late pregnancy, body mass index in late preg- nancy, hypersensitive c- reactive protein in late pregnancy, FPG in late pregnancy, oGTT 2 hPG in late pregnancy and triglyceride in late pregnancy. Conclusions：There are many factors affecting pregnancy and postpartum metabolic indicators of pregnant women with gestational diabetes. The results of this study indicate that special health management for pregnant women with gestational diabetes can effectively prevent and prevent the risk of metabolic diseases in pregnant women with gestational diabetes and postpartum, which is worthy of promotion and application.