PCOS合并妊娠期糖尿病患者母婴结局分析

Analysis of Maternal and Infant Outcomes in Patients with PCOS with Gestational Diabetes Mellitus

目的探讨多囊卵巢综合征合并妊娠期糖尿病孕妇的一般情况、糖脂代谢水平以及母婴结局,以期为疾病的个性化治疗及远期并发症预防提供理论依据。方法收集2014年5月～2018年4月黑龙江中医药大学附属第一医院产科门诊诊断为GDM的患者205例,根据PCOS诊断标准将205例GDM患者分为两组,即PCOS+GDM组84例、非PCOS+GDM组121例;选取同期就诊于笔者医院产科门诊进行产检的75g糖耐量实验正常的孕妇158例作为对照组,比较3组孕妇的一般情况、糖脂代谢水平及母婴结局。结果 PCOS组孕妇的产前BMI、T、AND、不良孕史、自然流产、胚胎停育、糖尿病家族史以及胰岛素使用比例显著大于非PCOS组及对照组; GDM孕妇的产次显著低于对照组、孕妇出生体重显著高于对照组;非PCOS+GDM组孕妇的孕前BMI及糖尿病家族史显著高于对照组(P <0. 05)。PCOS组孕妇的FINS、HOMA-IR、TC及LDL值显著大于非PCOS组及对照组,Hb A1c检测孕周小于非PCOS组及对照组; GDM孕妇的FPG及Hb A1c显著高于对照组;非PCOS+GDM组孕妇的FPG、FINS HOMA-IR、Hb A1c、Hb A1c检测孕周及LDL显著高于对照组(P <0. 05)。PCOS组孕妇的子痫前期、早产及羊水过多的发生率显著高于非PCOS组及对照组; GDM孕妇的胎膜早破、羊水过多及产后出血的发生率显著高于对照组(P <0. 05)。PCOS组的新生儿体重及大于胎龄儿发生率显著高于非PCOS组及对照组; GDM组的新生儿黄疸发生率显著高于对照组; PCOS组的新生儿低血糖发生率显著高于对照组(P <0. 05)。结论 PCOS合并GDM孕妇的一般情况较重,且PCOS加重了GDM孕妇不良妊娠结局。PCOS合并GDM孕妇糖脂代谢异常程度较重,PCOS合并GDM新生儿结局不良,并发症发生率较高。

Objective To explore the general situation of pregnant women with polycystic ovary syndrome with gestational diabetes mellitus,glucose lipid metabolism and maternal and infant outcomes,in order to provide a theoretical basis for the individualized treatment of diseases and prevention of long-term complications.Methods From May 2014 to April 2018,205 patients with GDM were diagnosed in the obstetrics department of the first affiliated hospital of heilongjiang university of traditional Chinese medicine,and 205 GDM patients were divided into two groups according to the diagnostic criteria of PCOS.There were 84 cases of PCOS+GDM group and 121 cases of non-pcos+GDM group.We selected 158 cases of pregnant women as control group during the same period in our hospital maternity clinic for prenatal 75g glucose tolerance test with normal results.The comparison of three groups of pregnant women in general,sugar,fat metabolism and outcomes was performed.Results In the PCOS group,pre-pregnancy BMI,T,AND,adverse pregnancy history,spontaneous abortion,embryo abortion,family history of diabetes and insulin use were significantly greater than those of non-pcos group and control group.The production time of GDM was significantly lower than that of the control group,and the birth weight of pregnant women was significantly higher than that of the control group.The family history of pre-pregnancy BMI and diabetes in non-pcos+GDM group was significantly higher than that in the control group(P<0.05).The values of FINS,IR,TC and LDL of pregnant women in PCOS group were significantly higher than those of non-pcos group and control group.And the detection of gestational weeks was smaller than that of non-pcos group and control group.FPG and HbA1c of GDM pregnant women were significantly higher than those in the control group.FPG,FINS-IR,HbA1c and HbA1c of pregnant women in non-pcos+GDM group were significantly higher than those in the control group(P<0.05).The incidence of preeclampsia,premature delivery and excessive amniotic fluid in PCOS group was significantly higher than that in non-pcos group and control group.The incidence of premature rupture of fetal membrane,excessive amniotic fluid and postpartum hemorrhage in GDM pregnant women was significantly higher than that in the control group(P<0.05).The neonatal weight of PCOS group was significantly higher than that of non-pcos group and control group.The incidence of jaundice in GDM group was significantly higher than that in the control group.The incidence of neonatal hypoglycemia in PCOS group was significantly higher than that in the control group(P<0.05).Conclusion PCOS combined with GDM pregnant women were generally heavier,and PCOS increased the adverse pregnancy outcome of GDM pregnant women.PCOS combined with GDM pregnant women had a higher degree of metabolic abnormality.(3)PCOS combined with GDM had a poor outcome and a high incidence of complications.