孕晚期HbA1c测定对未行OGTT孕妇妊娠结局的价值分析

Analysis of the value of HbA1c measurement in late pregnancy for pregnancy outcome of pregnant women without OGTT

目的探讨孕晚期糖化血红蛋白(HbA1c)测定对未行口服葡萄糖耐量试验(OGTT)孕妇妊娠结局的价值。方法 716例产科门诊行产前检查的妊娠前无糖尿病的孕24～28周孕妇为研究对象,其中孕期不正规产检孕妇设为A组(226例),孕期正规产检孕妇490例根据OGTT检查结果分为妊娠期糖尿病(GDM)组(B组, 69例)和非GDM组(C组, 421例)。A、B、C三组再根据HbA1c检查结果以5.5%为截断值分为A1组(HbA1c<5.5%, 208例)、A2组(HbA1c≥5.5%, 18例), B1组(HbA1c<5.5%, 9例)、B2组(HbA1c≥5.5%, 60例), C1组(HbA1c<5.5%, 411例)、C2组(HbA1c≥5.5%, 10例)。比较各组的妊娠结局[胎膜早破、妊娠高血压综合征(妊高症)、羊水过多、新生儿窒息、高胆红素血症]情况。结果 A1组胎膜早破、妊高症、羊水过多、新生儿窒息、高胆红素血症发生率明显低于A2组,差异均具有统计学意义(X^2=50.843、93.657、44.064、71.572、98.206, P<0.05)。B1组胎膜早破、妊高症、羊水过多、新生儿窒息、高胆红素血症发生率明显低于B2组,差异均具有统计学意义(X^2=4.528、6.994、4.224、4.845、9.488, P<0.05)。C1组胎膜早破、妊高症、羊水过多、新生儿窒息、高胆红素血症发生率明显低于C2组,差异均具有统计学意义(X^2=92.077、120.817、43.388、72.460、127.131, P<0.05)。A1、B1、C1组胎膜早破、妊高症、羊水过多、新生儿窒息、高胆红素血症发生率比较,差异均无统计学意义(P>0.05)。A2、B2、C2组胎膜早破、妊高症、羊水过多、新生儿窒息、高胆红素血症发生率比较,差异均无统计学意义(P>0.05)。结论 HbA1c检测以5.5%为截断值可用于孕期未行OGTT检查孕妇的GDM筛查及妊娠结局的评估,为GDM后续干预方案的制定提供依据。

Objective To discuss the value of glycosylated hemoglobin (HbA1c) measurement in late pregnancy for pregnancy outcome of pregnant women without oral glucose tolerance test (OGTT). Methods A total of 716 pregnant women at 24~28 weeks of gestation without diabetes mellitus before pregnancy who underwent prenatal examination in obstetric clinic were selected as the study objects. Among them, 226 pregnant women with irregular prenatal examination were assigned to group A. 490 pregnant women with regular prenatal examination were divided into gestational diabetes mellitus (GDM) group (group B, 69 cases) and non-GDM group (group C, 421 cases) according to the results of OGTT. Group A, B and C were further divided into A1 group (HbA1c < 5.5%, 208 cases), A2 group (HbA1c ≥ 5.5%, 18 cases), B1 group (HbA1c < 5.5%, 9 cases), B2 group (HbA1c ≥ 5.5%, 60 cases), C1 group (HbA1c < 5.5%, 411 cases), C2 group (HbA1c ≥ 5.5%, 10 cases) according to the HbA1c test results with a cutoff value of 5.5%. Pregnancy outcomes[ premature rupture of membranes, pregnancy-induced hypertension (PIH) syndrome, polyhydramnios, neonatal asphyxia, hyperbilirubinemia] were compared among the groups. Results A1 group had obviously lower incidence of premature rupture of membranes, pregnancy-induced hypertension syndrome, polyhydramnios, neonatal asphyxia, hyperbilirubinemia than A2 group, and their difference was statistically significant (χ^2=50.843, 93.657, 44.064, 71.572, 98.206, P<0.05). B1 group had obviously lower incidence of premature rupture of membranes, pregnancyinduced hypertension syndrome, polyhydramnios, neonatal asphyxia, hyperbilirubinemia than B2 group, and their difference was statistically significant (χ^2=4.528, 6.994, 4.224, 4.845, 9.488, P<0.05). C1 group had obviously lower incidence of premature rupture of membranes, pregnancy-induced hypertension syndrome, polyhydramnios, neonatal asphyxia, hyperbilirubinemia than C2 group, and their difference was statistically significant (χ^2=92.077, 120.817, 43.388, 72.460, 127.131, P<0.05). There was no statistically significant difference in incidence of premature rupture of membranes, pregnancy-induced hypertension syndrome, polyhydramnios, neonatal asphyxia, hyperbilirubinemia in A1, B1 and C1 group (P>0.05). There was no statistically significant difference in incidence of premature rupture of membranes, pregnancy-induced hypertension syndrome, polyhydramnios, neonatal asphyxia, hyperbilirubinemia in A2, B1 and C2 group (P>0.05). Conclusion The HbA1c test with a cut-off value of 5.5% can be used for GDM screening and pregnancy outcome evaluation in pregnant women without OGTT examination during pregnancy, and provide a basis for the development of a follow-up intervention program for GDM.