妊娠期糖尿病孕妇血脂特点及对分娩结局的影响

The blood lipid characteristics in pregnant women with gestational diabetes mellitus and their effects on delivery outcomes

目的探讨妊娠期糖尿病孕妇孕中晚期脂代谢特点及对分娩结局的影响。方法2018年1月至2019年1月分娩的孕妇中随机抽取无合并症健康孕妇300例为对照组(A组),孕24~28周确诊为妊娠期糖尿病(GDM),且通过控制饮食,血糖控制良好的孕妇280例为试验组,其中试验组又分为糖耐量结果一项异常组180例(B组)、糖耐量结果两项以上异常组100例(C组)。测定3组孕妇孕中晚期血清血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、载脂蛋白A1(APOA1)、载脂蛋白B(APOB)及糖化血红蛋白(HbA1c)水平;比较3组新生儿出生体重、巨大儿率、新生儿低血糖率、新生儿出生时窒息率以及分娩时侧切率;将试验组孕妇TG、TC、LDL、APOB、HbA1c、体重指数(BMI)及孕期增重做为自变量,新生儿出生体重做为因变量,进行多元线性回归分析,研究新生儿体重的影响因素。结果B组、C组孕妇孕中、晚期TG、LDL、APOB均明显高于A组(P<0.05);B组、C组孕妇的巨大儿率、新生儿低血糖率、剖宫产率、侧切率均明显高于A组(P<0.05);B组、C组孕妇的TG、HbA1c、LDL、BMI、孕期增重对新生儿体重影响大,且影响顺序从大到小依次为TG、HbA1c、BMI、LDL、孕期增重。结论妊娠期糖尿病孕妇积极控制血糖的同时,应注意孕期血脂的控制,可降低围产期并发症,改善分娩结局。

Objective To investigate the blood lipid characteristics in pregnant women with gestational diabetes mellitus(GDM)during mid and late trimester of pregnancy and their effects on delivery outcomes.Methods A total of 300 healthy pregnant women who delivered in our hospital from January,2018 to January,2019 were enrolled as control group(group A),and 280 pregnant women with GDM who were diagnosed during 24w-28w pregnancy and were treated by blood glucose control and diet control were enrolled as experimental group,moreover,the experimental group was redivided into one-item blood glucose abnormality group(group B,n=180),and more than two-item blood glucose abnormality group(group C,n=100).The levels of total cholesterol(TC),triglyceride(TG),high-density ipoprotein(HDL),low-density lipoprotein,apolipoproteinA1(APOA1),apolipoproteinB(APOB)and glycosylated hemoglobin(HbA1c)were analyzed among mid and late trimester of pregnancy were observed and compared among the three groups.Moreover the delivery outcomes(neonatal weight,macrosomia rate,neonatal hypoglycemia,neonatal asphyxia rate and lateral cutting rate)were analyzed,and the correlation between neonatal weight and the levels of TG,TC,LDL,APOB,HbA1c,BMI,weight gain was analyzed by multiple linear regression analysis.Results The levels of TG,LDL,APOB in group B and group C during mid and late trimester of pregnancy were significantly higher than those in group A(P<0.05),however,the the incidence rates of macrosomia,neonatal hypoglycemia,cesarean section and lateral cutting in group B and group C were significantly lower than those in group A(P<0.05).In addition the levels of TG,HbA1c,LDL,body mass index(BMI)and weight gain had obvious effects on birth weight in B and C group,the influence order was TG,HbA1c,BMI,LDL,weight gain(from great to little).Conclusion It is necessary to control blood glucose and blood lipid in pregnant women with GDM,which can reduce perinatal complications and improve delivery outcomes.