妊娠期糖尿病产妇妊娠晚期阴道微生态改变与围产结局的相关性分析

Correlation analysis of vaginal microecology changes and perinatal outcome in the third trimester of gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)产妇妊娠晚期阴道微生态的改变与围产结局的关系。方法选择2017年1月至2019年6月期间在我院门诊进行产检并于我院产科分娩的150例GDM孕妇组成GDM组,并选择同期于我院产检及分娩的150例健康孕妇作为对照组(NC组),孕检时所有研究对象进行阴道分泌物标本采集,并行白带常规检查。检查内容包括阴道分泌物的清洁度、pH值等,采用革兰染色法检测唾液酸苷酶(NA)、过氧化氢(H_(2)O_(2))及白细胞酯酶(LE)水平,根据分泌物培养结果判定阴道菌群密集度及多样性,并对围产结局进行随访。比较GDM组与NC组阴道微生态情况及围产结局。结果GDM组孕妇妊娠晚期阴道微生态异常的发生率高于NC组(χ^(2)=14.064,P<0.05)。GDM微生态异常组早产、胎膜早破、绒毛膜羊膜炎、产后出血、新生儿窒息、新生儿感染、新生儿黄疸发生率明显高于GDM微生态正常组(P<0.05),产褥感染及剖宫产、低出生体重率差异无统计学意义(P>0.05)。NC微生态异常组早产、绒毛膜羊膜炎、产后出血、新生儿感染发生率均明显高于NC微生态正常组(P<0.05),胎膜早破、产褥感染及剖宫产、新生儿窒息、新生儿黄疸、低出生体重发生率差异无统计学意义(P>0.05)。结论GDM孕妇妊娠晚期阴道微生态异常发生率高,显著增加不良围产结局的发生率,影响孕产妇及新生儿的健康,临床上应动态监测、合理干预以减少围产期不良结局的发生。

Objective To explore the relationship between the changes of vaginal microecology and perinatal outcome in pregnant women with gestational diabetes mellitus(GDM)in the third trimester.Methods One hundred and fifty pregnant women with GDM in our hospital during January 2017 and June 2019 for prenatal examination and delivery were enrolled as the GDM group,with 150 healthy pregnant women in the same period as the control group(NC group).Vaginal discharge parallel leucorrhea routine inspection was performed during pregnancy test;the contents of examination included the cleanliness and pH of vaginal secretions,and the levels of neuraminidase(NA),hydrogen peroxide(H_(2)O_(2))and leucocyte esterase(LE)were detected using Gram staining.The concentration and diversity of vaginal flora were determined according to the results of secretion culturing,and the perinatal outcomes were followed up.The vaginal microecology and perinatal outcomes were compared between the two groups.Results The incidence of vaginal microecological disorder in GDM group was higher than that in NC group(χ^(2)=14.064,P<0.05).The incidences of preterm labor,premature rupture of fetal membrane,chorionic amnitis,postpartum hemorrhage,neonatal asphyxia,neonatal infection and neonatal jaundice in GDM abnormal microbiota group were significantly higher than those in GDM normal microbiota group(P<0.05).There were no statistical significances in puerperal infection,cesarean section and low birth weight rate(P>0.05).The incidence of premature birth,chorionic amnitis,postpartum hemorrhage and neonatal infection in the NC microecological abnormality group were significantly higher than those in the NC microecological abnormality group(P<0.05).There was no statistical significance in the incidence of premature rupture of fetal membrane,puerperal infection,cesarean section,neonatal asphyxia,neonatal jaundice and low birth weight(all P>0.05).Conclusion The high incidence of vaginal microecologic disorder in the third trimester of pregnancy in pregnant women with GDM significantly increases the incidence of adverse perinatal outcomes and affects the health of pregnant women and newborns.Therefore,dynamic monitoring and reasonable intervention should be conducted clinically to reduce the occurrence of adverse outcome.