妊娠期糖尿病患者血脂变化及对妊娠结局的影响

Changes of blood lipid level of pregnant women with gestational diabetes mellitus and its influence on pregnancy outcomes

目的:了解妊娠期糖尿病患者孕期血脂水平变化规律,并分析血脂水平对妊娠结局的影响。方法:回顾性收集本院接诊的150例糖尿病孕妇(观察组)和150例健康孕妇(对照组),在孕早、中、晚期分别对两组行血脂指标检测,记录两组妊娠结局并分析观察组孕中期及孕晚期血脂水平对妊娠结局影响。结果:孕早期各项血脂指标两组比较无差异(P>0.05)。在孕中期和孕晚期,观察组TC、TG、ApoB水平均高于对照组,HDL-C水平均低于对照组(P<0.05),两组ApoA1水平比较无差异(P>0.05)。孕中期及孕晚期观察组LDL-C水平均较孕早期降低,且低于对照组(P<0.05)。观察组发生早产、剖宫产、胎膜早破、巨大儿、新生儿低血糖比例高于对照组(P<0.05),新生儿窒息发生率两组无差异(P>0.05)。孕早期血脂异常检出率两组无差异(P>0.05),孕妇孕中期及孕晚期血脂异常检出率观察组(70.7%、80.7%)均高于对照组(53.3%、58.0%),观察组血脂异常孕妇发生早产、剖宫产、胎膜早破、巨大儿、新生儿低血糖均高于血脂正常孕妇(均P<0.05)。结论:妊娠期糖尿病患者孕期血脂有明显上升趋势,孕晚期发生高脂血症风险较高,而发生高脂血症会增加不良妊娠结局风险。

Objective:To understand the changes of blood lipid level of pregnant women with gestational diabetes mellitus(GDM)during pregnancy,and to analyze its influence on their pregnancy outcomes.Methods:The clinical data of 150 pregnant women with GDM(in observation group)and 150 healthy pregnant women(in control group)were analyzed retrospectively.The blood lipid index of women in the two groups was detected during the first trimester,the second trimester,and the third trimester of pregnancy.The pregnancy outcomes of women were compared between the two groups.The influence of serum lipid levels of women during the second trimester and third trimester of pregnancy on their pregnancy outcomes was analyzed.Results:There were no significant different in the blood lipids levels of women during the first trimester of pregnancy between the two groups(P>0.05).During the second trimester and the third trimester of pregnancy,the levels of TC,TG and ApoB of women in the observation group were significant higher than those of women in the control group,but the HDL-C level of women in the observation group was significant lower(P<0.05).There was no significant different in the ApoA1 level of women between the two groups(P>0.05).The levels of LDL-C of women in the observation group during the second and third trimester of pregnancy were significant lower than those of women in the control group(P<0.05).The incidences of premature delivery,cesarean section,premature rupture of membranes,macrosomia and neonatal hypoglycemia of women in the observation group were significant higher than those of women in the control group(P<0.05),while the incidence of neonatal asphyxia in the two groups had no significant difference(P>0.05).The detection rate of dyslipidemia of women during the first trimester of pregnancy had no significant difference between the two groups(P>0.05).The detection rate of dyslipidemia of women in the observation group during the second trimester and the third trimester of pregnancy was 70.7%and 80.7%,which were significant higher than those(53.3%and 58.0%)of women in the control group(P<0.05).In the observation group,the incidence of premature delivery,cesarean section,premature rupture of membranes,macrosomia and neonatal hypoglycemia of women with abnormal blood lipids level during the second and third trimester of pregnancy were significant higher than those of women with normal blood lipids level(P<0.05).Conclusion:The serum lipid level of pregnant women with GDM has a significant upward trend during pregnancy.The risk of hyperlipidemia increases during the third trimester of pregnancy,which will improve the risk of adverse pregnancy outcomes.