单纯空腹血糖增加的GDM孕妇母婴结局的相关因素研究

Study on the related factors of maternal and fetal outcomes in GDM women with simple fasting blood glucose increase

目的探讨影响单纯空腹血糖增加的妊娠期糖尿病(GDM)妇女母婴结局的相关因素。方法回顾性分析2015年1月至2018年1月期间湖州市妇幼保健院收治的668例单纯空腹血糖增加的GDM妇女的临床资料,依据是否出现不良母婴结局将其分为对照组(n=296)和不良结局组(n=372)。单因素和多因素Logistic回归分析单纯空腹血糖增加GDM妇女不良母婴结局的相关因素。结果剖宫产、胎膜早破、早产、妊娠期高血压、妊娠期肝内胆汁淤积症为单纯空腹血糖增加的GDM孕妇的主要不良妊娠结局,围产儿不良结局主要有巨大儿、高胆红素血症和胎儿宫内窘迫。单因素分析结果显示,不良结局组在年龄、孕前体质量指数(BMI)、口服葡萄糖耐量试验(OGTT)时间-血糖曲线的曲线下面积(AUC)、75gOGTT1h及2h血糖水平、糖化血红蛋白、低密度脂蛋白胆固醇(LDL-C)、甘油三酯、总胆固醇、超敏C反应蛋白(sCRP)、尿酸(UA)方面与对照组比较差异均有统计学意义(χ^2/t值分别为7.037、4.739、6.389、2.489、2.561、4.385、2.793、2.186、2.549、2.396、2.557,均P<0.05)。Logistic多因素分析结果显示,孕前BMI≥25kg/m2、AUC≥13mmol·L^-1·h^-1、甘油三酯高、总胆固醇高、sCRP高为单纯空腹血糖增加的GDM妇女不良母婴结局的危险因素(OR值分别为1.74、3.52、3.67、2.30、1.99,均P<0.05)。结论应对孕前BMI≥25kg/m2、AUC≥13mmol·L^-1·h^-1、甘油三酯高、总胆固醇高、sCRP高的单纯空腹血糖增加GDM妇女加强监控,降低不良母婴结局的发生率。

Objective To explore the related factors of maternal and fetal outcomes of women with gestational diabetes mellitus(GDM) presenting increase of simple fasting blood glucose.Methods We retrospectively analyzed the clinical data of 668 women with GDM and simple fasting blood glucose during the period from January 2015 to January 2018 in Huzhou Maternal and Child Health Care Hospital.The cases were divided into control group(n=296) and adverse outcomes group(n=372) according to whether there were adverse maternal and fetal outcomes.Univariate and multivariate Logistic regression analysis was conducted regarding related factors of adverse maternal and fetal outcomes.Results Cesarean section,premature rupture of membranes,premature delivery,gestational hypertension,and intrahepatic cholestasis during pregnancy were the main adverse pregnancy outcomes,and adverse perinatal outcomes mainly included macrosomia,hyperbilirubinemia and fetal distress.Univariate analysis showed that age,pre-pregnancy BMI,area under the curve(AUC) of OGTT,1 h and 2 h glucose level in 75 g OGTT,glycated hemoglobin,low-density lipoprotein cholesterol(LDL-C),triglycerides,total cholesterol,hypersensitive C-reactive protein(hsCRP),and uric acid(UA) were statistically different between two groups(χ^2/t value was 7.037,4.739,6.389,2.489,2.561,4.385,2.793,2.186,2.549,2.396 and 2.557,respectively,all P<0.05).Multivariate Logistic analysis showed that pre-pregnancy BMI ≥25 kg/m^2,AUC≥13 mmol/L/h,high triglyceride,high total cholesterol,and hsCRP were risk factors for adverse maternal and fetal outcomes in women with GDM(OR value was 1.74,3.52,3.67,2.30 and 1.99,respectively,all P<0.05).Conclusion With the symptoms of pre-pregnancy BMI ≥25 kg/m^2,AUC≥13 mmol/L/h,high triglyceride,high total cholesterol,and hsCRP,GDM women with simple increase of fasting blood glucose should be monitored to reduce the incidence of adverse maternal and fetal outcomes.