妊娠期糖尿病孕妇血糖异常的临床特点及对妊娠结局的影响

Clinical Characteristics of Abnormal Blood Sugar in Pregnant Women with Gestational Diabetes Mellitus and its Influence on Pregnancy Outcome

目的探究妊娠期糖尿病孕妇不同血糖水平下临床指标差异特点及对妊娠结局的影响。方法选取武威市凉州医院2016年2月-2018年3月期间收治的113例妊娠期糖尿病(GDM)孕妇为研究对象,对所有孕妇进行口服葡萄糖耐量试验,并测定患者空腹血糖(FPG)水平,依据FPG水平分为三组,甲组(FPG<5.1mmol/L)36例,乙组(FPG 5.1-6.0mmol/L)38例,丙组(FPG≥6.1mmol/L) 39例,观察三组患者血压、血脂、基础胰岛素分泌水平(HOMA-β)、胰岛素抵抗指数(HOMA-IR)、体重指数(BMI)等指标差异规律,并分析其对患者妊娠结局的影响。结果丙组患者舒张压、收缩压、HOMA-β、BMI、三酰甘油水平(TG)最高,丙组>乙组>甲组,各组对比差异有统计学意义(P<0.05)。乙组HOMA-IR最高,乙组>甲组>丙组,各组对比差异有统计学意义(P<0.05)。甲组高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇水平最高,甲组>乙组>丙组,组间对比差异有统计学意义(P<0.05);三组剖宫产率对比,甲组最低,丙组最高,差异有统计学意义(P<0.05)。胎膜早破、胎盘早剥、早产儿等发生率三组对比,差异无统计学意义(P>0.05),新生儿低血糖、巨大儿等发生率甲组最低,丙组最高,三组比较差异有统计学意义(P<0.05)。结论妊娠期糖尿病孕妇会表现出血压、血脂、HOMA-β、HOMA-IR等随着血糖升高而升高的临床特点,对妊娠结局具有明显影响,会导致剖宫产率增加,不良妊娠结局发生风险增加,针对GDM孕妇需要做好血糖控制。

Objective To explore the differences of clinical indicators and their effects on pregnancy outcomes in pregnant women with gestational diabetes mellitus(GDM)under different blood sugar levels. Methods 113 pregnant women with gestational diabetes mellitus(GDM)admitted to Liangzhou Hospital of Wuwei City from February, 2016 to March, 2018 were selected as the study subjects. All pregnant women were given oral glucose tolerance test,and their fasting blood glucose(FPG)levels were measured. They were divided into three groups according to FPG levels. There were 36 cases in Group A(FPG<5.1 mmol/L), 38 cases in Group B(FPG 5.1-6.0 mmol/L), 39 cases in group C(FPG ≥ 6.1 mmol/L). The differences of blood pressure, blood lipids,basic insulin secretion level(HOMA-beta), insulin resistance index(HOMA-IR), body mass index(BMI)and other indicators were observed and their effects on pregnancy outcome were analyzed. Results The diastolic blood pressure, systolic blood pressure,HOMA-beta, BMI and triglyceride levels(TG)were the highest in group C(Group C>Group B>Group A). There was significant differences among the groups(P<0.05). Group B had the highest HOMA-IR, Group B>Group A>Group C. There were significant difference among the groups(P<0.05). Group A had the highest levels of high density lipoprotein cholesterol, low density lipoprotein cholesterol and total cholesterol, Group A>Group B>Group C. The difference among groups was significant(P<0.05).The rate of cesarean section was the lowest in group A and the highest in group C(P<0.05). There was no significant difference in the incidence of premature rupture of membranes, placental abruption and premature infants among the three groups(P>0.05).The incidence of neonatal hypoglycemia and macrosomia was the lowest in group A and the highest in group C, with significant difference among the three groups(P<0.05). Conclusion Pregnant women with gestational diabetes mellitus will show the clinical characteristics of blood pressure, blood lipids, HOMA-beta, HOMA-IR rising with the increase of blood sugar, which has a significant impact on pregnancy outcomes. It will lead to an increase in cesarean section rate and the risk of adverse pregnancy outcomes. For GDM pregnant women, blood sugar control needs to be done well.