妊娠期糖尿病对孕晚期糖脂水平及巨大儿的影响研究

Effects of Gestational Diabetes on Glycolipid Levels and Macrosomia Incidence in Late Pregnancy

背景临床对妊娠期糖尿病(GDM)孕妇进行饮食和运动等生活方式的干预十分重视,近年来有研究发现虽然GDM孕妇血糖控制满意,但巨大儿发生率并未有明显下降。目的探究GDM对孕晚期糖脂水平及巨大儿的影响。方法依托于北京市通州区妇幼保健院电子信息系统,回顾性选取2014—2018年在本院足月分娩的16134例孕妇为研究对象。将孕期诊断为GDM的孕妇作为GDM组,未诊断为GDM的孕妇作为非GDM组。根据GDM与巨大儿的发生情况进一步分亚组:娩出巨大儿的GDM产妇为GM亚组,娩出非巨大儿的GDM产妇为GN亚组;娩出巨大儿的非GDM产妇为NM亚组,娩出非巨大儿的非GDM产妇为NN亚组。比较GDM组、非GDM组,GM亚组、GN亚组、NM亚组、NN亚组孕晚期总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低高度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)。采用多因素Logistic回归分析探究孕妇娩出巨大儿的影响因素。结果GDM组3834例,非GDM组12300例,其中GM亚组411例,GN亚组3423例,NM亚组898例,NN亚组11402例。GDM组孕晚期TG、FBG高于非GDM组,TC、HDL-C、LDL-C低于非GDM组(P<0.05)。GN亚组孕晚期TG、FBG低于GM亚组,HDL-C高于GM亚组(P<0.05);NM亚组孕晚期TC、HDL-C、LDL-C高于GM亚组,TG、FBG低于GM亚组(P<0.05);NN亚组孕晚期TC、HDL-C、LDL-C高于GN亚组,TG、FBG低于GN亚组(P<0.05);NN亚组孕晚期HDL-C高于NM亚组,TG、FBG低于NM亚组(P<0.05)。多因素Logistic回归分析结果显示,GDM〔是:OR=1.338,95%CI(1.158,1.547)〕、孕前体质指数(BMI)分类〔消瘦:OR=0.476,95%CI(0.361,0.626);超重:OR=1.770,95%CI(1.537,2.039);肥胖:OR=2.854,95%CI(2.282,3.568)〕、孕期增重〔OR=1.100,95%CI(1.087,1.113)〕、分娩孕周〔OR=1.728,95%CI(1.622,1.841)〕、孕晚期TC〔OR=0.705,95%CI(0.514,0.966)〕、孕晚期TG〔OR=1.282,95%CI(1.153,1.425)〕、孕晚期LDL-C〔OR=1.487,95%CI(1.094,2.021)〕、孕晚期FBG〔OR=1.692,95%CI(1.482,1.933)〕是孕妇娩出巨大儿的影响因素(P<0.05)。结论GDM孕妇TG、FBG高于非GDM孕妇,TC、HDL-C、LDL-C低于非GDM孕妇,且GDM及孕晚期血脂、血糖是孕妇娩出巨大儿的影响因素。在孕期应加强孕妇血脂、血糖监测,特别是TG和FBG,加强整个妊娠期体质量管理以减少巨大儿的发生。

Background Great attention has been paid to lifestyle intervention such as diet and exercise in pregnant women with gestational diabetes mellitus(GDM)clinically.Recent studies have found that glycemic control in pregnant women with GDM is satisfactory,but the incidence of macrosomia has not decreased significantly.Objective To investigate the effects of GDM on glycolipid levels and macrosomia incidence in the third trimester of pregnancy.Methods Through the hospital information system of Tongzhou Maternal&Child Health Hospital of Beijing,we retrospectively selected 16134 women with full-term delivery in the hospital from 2014 to 2018,and divided them into GDM group〔including those with a delivered baby with macrosomia(GM subgroup)and with a delivered baby with normal birth weight(GN subgroup)〕and non-GDM group〔including those with a delivered baby with macrosomia(NM subgroup)and with a delivered baby with normal birth weight(NN subgroup)〕by GDM prevalence.We compared total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-high lipoprotein cholesterol(LDL-C),and fasting blood glucose(FBG)at the third trimester between GDM and non-GDM groups,GM and GN subgroups,NM and NN subgroups,NM and GM subgroups,and NN and GN subgroups,respectively.Multivariate Logistic regression analysis was used to explore the associated factors of macrosomia.Results There were 3834 cases in GDM group(411 in GM subgroup,and 3423 in GN subgroup),and 12300 in non-GDM group(898 in NM subgroup,and 11402 in NN subgroup).GDM group showed higher mean TG and FBG levels and lower mean TC,HDL-C and LDL-C levels than non-GDM group(P<0.05).GN subgroup had lower mean TG and FBG levels and higher mean HDL-C level than GM subgroup(P<0.05).NM subgroup had higher mean TC,HDL-C and LDL-C levels and lower mean TG and FBG levels than GM subgroup(P<0.05).NN subgroup had higher mean TC,HDL-C and LDL-C levels and lower mean TG and FBG levels than GN subgroup(P<0.05).NN subgroup had higher mean HDL-C level and lower mean TG and FBG levels than NM subgroup(P<0.05).Multivariate Logistic regression analysis found that GDM〔OR=1.338,95%C(I 1.158,1.547)〕,and pre-pregnancy BMI〔emaciated:OR=0.476,95%CI(0.361,0.626);overweight:OR=1.770,95%CI(1.537,2.039);obesity:OR=2.854,95%CI(2.282,3.568)〕,weight gain during pregnancy〔OR=1.100,95%CI(1.087,1.113)〕,gestational age at delivery〔OR=1.728,95%CI(1.622,1.841)〕,TC in late pregnancy〔OR=0.705,95%CI(0.514,0.966)〕,TG in late pregnancy〔OR=1.282,95%CI(1.153,1.425)〕,LDL-C in late pregnancy〔OR=1.487,95%CI(1.094,2.021)〕,and FBG in late pregnancy〔OR=1.692,95%CI(1.482,1.933)〕were associated with the delivery of a baby with macrosomia(P<0.05).Conclusion Elevated TG and FBG and decreased TC,HDL-C and LDL-C were found in pregnant women with GDM.GDM,blood lipid and blood glucose in late pregnancy may be associated factors of delivering a baby with macrosomia.To reduce macrosomia incidence,it is suggested to strengthen the monitoring of blood lipid and blood glucese(especially TG and FBG levels)as well as weight management in pregnancy.