高龄孕妇糖代谢异常特点与妊娠结局关系研究

Study on the relationship between abnormal glucose metabolism and pregnancy outcomes in elderly pregnant women

目的探讨高龄妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇的糖代谢异常特点对妊娠结局的影响。方法选择2017年1-12月在成都市妇女儿童中心医院进行孕期保健并确诊GDM且信息完整、年龄≥35岁的孕妇851名作为研究对象。通过问卷调查及病历回顾等方式收集其年龄、孕期增重等一般情况信息,家族史、既往病史、孕产史信息,以及口服葡萄糖耐量筛查(oral glucose tolerance test,OGTT)信息。为分析OGTT血糖异常项目与妊娠结局的关系,依据OGTT检查结果,将仅空腹血糖异常、仅服糖后血糖异常以及空腹及服糖后血糖均异常分别定义为GDMa、GDMb和GDMc组。为分析不同血糖异常项数与妊娠结局之间的关系,将OGTT检查血糖值1项、2项、3项异常分别定义为GDM1、GDM2和GDM3组。收集孕妇早产、大于胎龄儿(large for gestational age,LGA)和巨大儿分娩信息,分析不同糖代谢异常特点与以上妊娠结局的关系。结果GDMa、b、c三组孕妇年龄、孕期增重及新生儿出生体重差异无统计学意义(P>0.05)。GDM1、2、3三组孕妇同样在年龄、孕期增重及新生儿出生体重方面差异无统计学意义(P>0.05)。GDMa组和GDMc组LGA的发生率高于GDMb组(P<0.001)。GDM3组LGA的发生率高于GDM1组和GDM2组(P<0.001)。结论OGTT筛查结果影响高龄GDM孕妇LGA的发生,空腹血糖异常及三项血糖异常组LGA发生率更高。建议针对OGTT筛查结果,对高龄GDM孕妇进行分层管理,以减少不良妊娠结局,促进母婴健康。

Objective To explore the effect ofabnormal glucose metabolism on pregnancy outcomes in elderly GDM women.Methods 851 pregnant women over 35 years old with GDM who had their antenatal care in our hospital from January 2017 to December 2017 participated in this research.With acknowledgement of general information on age,weight gain during pregnancy,family history,past medical history,history of gestation,and results of OGTT based on questionnaire and medical history reviewing.Participants were divided into 3 groups based on the results of OGTT,GDMa with only fasting plasma glucose abnormal,GDMb with 1 hOGTT and/or 2 h-OGTT abnormal,and GDMc with fasting plasma glucose and 1 h-OGTT and/or 2 h-OGTT abnormal.To analyze the effect of the number of abnormal result of OGTT on pregnancy outcomes,participants were divided into 3 groups.GDM1 with only 1 result abnormal,GDM2 with 2 results abnormal,and GDM3 with all of the 3 results abnormal.Collected the information of premature deliver,LGA,and macrosomia after delivery.And analysis the effect of abnormal glucose metabolism on pregnant outcomes.Results There were no difference among GDMa,b,c on age,weight gain during pregnant and birth weight of new born(P>0.05).There were no difference among GDM1,2,3 on the three indexes too(P>0.05).The rate of LGA were higher in GDMa and GDMc than in GDMb(P<0.001).The rate of LGA was higher in GDM3 than in GDM1 and GDM2(P<0.001).Conclusion The result of OGTT had effect on the rate of LGA in elderly GDM women.LGA rate in abnormal fasting plasma glucose group(GDMa)was higher.So was in GDM3 with three abnormal results.Medical advice should be given based on the result of OGTT to reduce adverse pregnantr outcomes,and promote health in both mothers and infants.