双胎妊娠期糖尿病孕妇胰岛素抵抗、血脂代谢变化及围产结局

Analysis the insulin resistance, blood glucose and lipid metabolism changes, and perinatal outcomes of pregnant women with twin and gestational diabetes mellitus

目的:探究双胎妊娠期糖尿病(GDM)孕妇胰岛素抵抗、血糖及脂质代谢水平变化及与围产结局关系。方法:回顾性分析2016年8月—2019年8月在本院建档并分娩的双胎GDM孕妇47例作为GDM组,同期无糖代谢异常双胎妊娠孕妇82例为对照组,检测两组孕中期胰岛素抵抗指数(HOMA-IR)、空腹胰岛素(FINs)、β细胞功能指数(HOMA-β)、血糖(空腹、服糖1h后、服糖2h后OGTT血糖,产前HbA1c)、脂代谢水平,记录产妇妊娠结局并对比分析。结果:GDM组75g OGTT的空腹、服糖后1h及服糖后2h血糖水平均高于对照组(P<0.05),产前HBA1c两组比较无差异(P>0.05);HOMA-IR高于对照组,FINs、HOMA-β低于对照组,TC、TG、LDL-C、FFA水平高于对照组(均P<0.05);发生胎膜早破(27.7%)及新生儿高胆红素血症(9.6%)、巨大儿(10.6%)比例高于对照组(P<0.05),发生孕妇贫血、产后出血、羊水过多、妊娠期高血压、胎膜早剥及新生儿低血糖、早产、双胎不同一性、围产期死亡等比例两组无差异(P>0.05)。结论:GDM可增加双胎GDM孕妇胎膜早破及新生儿高胆红素血症、巨大儿几率,这可能与GDM能加重孕妇胰岛素抵抗和糖脂代谢异常有关。

Objective: To investigate the changes of the insulin resistance, and blood glucose and lipid metabolism of pregnant women with gemellary pregnancy and gestational diabetes mellitus(GDM), and to study the correlation between them and the perinatal outcomes of the women. Methods: A retrospective analysis was performed. 47 pregnant women with twin and GDM from August 2016 to August 2019 were selected in study group, and 82 normal pregnant normal women with gemellary pregnancy during the same period were selected in control group. The levels of HOMA-IR, FINs, HOMA-β,blood glucose(fasting, 1 h after OGTT, 2 h after OGTT), prenatal HbA1 c, and lipid metabolism(TC, TG, LDL-C, FFA) of the women in the two groups were measured. The maternal pregnancy outcomes were recorded and compared between the two groups. Results: The blood glucose levels of fasting, 1 h and 2 h after 75 g OGTT of the women in the study group were all significant higher than those of the women in the control group(P<0.05), and there was no significant difference in prenatal HbA1 c level of the women between the two groups(P>0.05). HOMA-IR value, and the levels of TC, TG, LDL-C, and FFA of the women in the study group were significant higher than those of the women in the control group, but the levels of FINS and HOMA-β of the women in the study group were significant lower(all P<0.05). The proportion of premature rupture of membranes(27.7%), high neonatal bilirubin concentration(9.6%), and macrosomia proportion(10.6%) of the women in the study group were significant higher than those of the women in the control group(P<0.05), but there were no significant differences in the rates of anemia, postpartum hemorrhage, hydramnios, gestational hypertension, and abruptions of membranes of the women,and the rates of neonatal hypoglycemia,premature birth,unidentity oftwins,and perinatal death between the two groups(P>0.05).Conclusion:The pregnant women with twin and GDM can increase the incidences of their premature rupture of membranes,neonatal hyperbilirubinemia,and macrosomia,which may be related to the aggravation of their insulin resistance and abnormal glucolipid metabolism because of GDM.