HbA1c水平对GDM孕妇临床结局和母婴肠道菌群的影响

Effect of HbA1c on the clinical outcome of pregnant women with GDM and gut microbiota of mother and infant

目的分析糖化血红蛋白(HbA1c)对妊娠期糖尿病(GDM)孕妇临床结局、感染相关并发症及母婴肠道菌群的影响。方法采集2018年1月-2019年6月承德医学院附属医院收治的单胎妊娠无其他内科疾病GDM孕妇124例的临床资料,依据HbA1c控制情况分为HbA1c≤6.5%组(A组,n=87)与HbA1c>6.5%组(B组,n=37),比较不同HbA1c控制水平GDM孕妇妊娠结局及感染相关并发症;并采集所有GDM孕妇粪便标本及新生儿排出粪便第一时间粪便样品,进行孕妇及胎儿肠道菌群监测,比较不同HbA1c控制水平GDM孕妇及胎儿肠道菌群的差异。结果 A组羊水过多(8.05%)、胎膜早破(27.59%)、羊水污染(14.94%)、剖宫产率(49.43%)、巨大儿(10.34%)、胎儿窘迫(2.30%)、新生儿低血糖(5.75%)低于B组(P<0.05);A组感染相关总并发症发生率为6.90%低于B组(P<0.05);A组GDM孕妇肠杆菌、肠球菌、拟杆菌等菌群菌落数为(8.24±0.93)、(7.12±1.56)、(8.93±1.12)logN/g低于B组(P<0.05),双歧杆菌、乳杆菌菌落数为(8.09±0.33)logN/g、(6.79±1.45)logN/g高于B组(P<0.05);A组新生儿肠杆菌、肠球菌菌落数为(7.75±0.43)logN/g、(6.82±0.65)logN/g低于B组(P<0.05),双歧杆菌、乳杆菌菌落数为(7.86±0.34)logN/g、(6.56±1.23)logN/g高于B组(P<0.05)。结论 HbA1c控制不良GDM孕妇不良母婴结局发生率高,感染相关并发症发生风险高,母婴肠道菌群紊乱更明显。

OBJECTIVE To analyze the influence of glycated hemoglobin(HbA1 c) on clinical outcomes and infection-related complications in pregnant women with gestational diabetes mellitus(GDM) as well as gut microbiota of mother and infant. METHODS The clinical data of 124 GDM pregnant women with single pregnancy and without other medical diseases who were admitted to the Affiliated Hospital of Chengde Medical College from Jan. 2018 and Jun. 2019, were collected, and were divided into HbA1 c≤6.5% group(group A, n=87) and HbA1 c>6.5% group(group B, n=37) according to the control of HbA1 c. The pregnancy outcomes and infection-related complications of GDM pregnant women with different HbA1 c control levels were compared, the fecal samples of all GDM pregnant women and the first fecal samples of neonates were collected. The intestinal floras of mothers and infants were monitored, the differences in the intestinal floras of pregnant women and infants with different HbA1 c control level were compared. RESULTS The incidence rates of polyhydramnios(8.05%), premature rupture of membranes(27.59%), amniotic fluid contamination(14.94%), cesarean section(49.43%), macrosomia(10.34%), fetal distress(2.30%) and neonatal hypoglycemia(5.75%) in group A were significantly lower than those in group B(P<0.05). The overall incidence of infection-related complications in group A was 6.90%, significantly lower than that in group B(P<0.05). The colony numbers of Enterobacter, Enterococcus and Bacteroides and other bacterial communities of GDM pregnant women in group A were(8.24±0.93) logN/g,(7.12±1.56) logN/g and(8.93±1.12) logN/g, respectively, lower than those in group B(P<0.05), while the colony numbers of Bifidobacteria and Lactobacillus were(8.09±0.33) logN/g and(6.79±1.45) logN/g, respectively, higher than those in group B(P<0.05). The colony numbers of Enterobacter and Enterococcus in group A were(7.75±0.43) logN/g and(6.82±0.65) logN/g, respectively, significantly lower than those in group B(P<0.05), while the colony of Bifidobacteria and Lactobacillus were(7.86±0.34) logN/g and(6.56±1.23) logN/g, respectively, significantly higher than those in group B(P<0.05). CONCLUSION The incidence of adverse maternal and infant outcomes and the risk of infection-related complications were high, and gut microbiota disorders of mother and infant were more significant in GDM pregnant women with poor HbA1 c control.