妊娠期糖尿病患者糖化血红蛋白及血糖指标异常对妊娠结局的影响

Effect of Abnormal HbA1c and Blood Glucose on Pregnancy Outcome in Patients with Gestational Diabetes Mellitus

目的:探讨妊娠期糖尿病(GDM)患者糖化血红蛋白(HbA1c)及血糖指标异常对妊娠结局的影响。方法:选取2015年6月—2020年2月河南科技大学第一附属医院收治的110例妊娠期糖尿病患者作为研究对象,依据葡萄糖耐量试验(OGTT),将单纯空腹血糖(FPG)值异常设为GDM甲组(n=32例),将FPG异常合并任意其他时间点血糖异常设为GDM乙组(n=29例),将FPG正常合并任意其他时间点血糖异常设为GDM丙组(n=49例)。同时按照HbA1c水平高低将研究对象分为两组,HbA1c超标组(HbA1c>6%)66例和HbA1c标准组(HbA1c≤6%)44例。比较各组间妊娠结局。结果:三组巨大儿、新生儿低血糖发生率相比,差异有统计学意义(P<0.05);GDM乙组巨大儿、新生儿低血糖发生率高于GDM甲组和GDM丙组,差异有统计学意义(P<0.05)。HbA1c超标组剖宫产、巨大儿、新生儿窒息发生率均高于HbA1c标准组,差异有统计学意义(P<0.05)。结论:GDM患者HbA1c>6%及OGTT试验血糖3项时间点血糖均异常时,剖宫产、巨大儿、新生儿窒息、新生儿低血糖发生率显著增加,应加强重视并给予有效干预,以改善母婴结局。

Objective:To investigate the effect of abnormal glycated hemoglobin(HbA1 c)and blood glucose on pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods:110 cases of gestational diabetes mellitus in the hospital from June 2015 to February 2020 were selected as the research objects.According to the glucose tolerance test(OGTT),the abnormal fasting blood glucose(FPG)value was set as GDM group A(n=32),FPG abnormality combined with abnormal blood glucose at any other time point was set as GDM group B(n=29),the normal FPG combined with abnormal blood glucose at any other time point was set as the GDM group C(n=49).At the same time,the study subjects were divided into two groups according to the level of HbA1 c,66 cases of HbA1 c exceeding standard group(HbA1 c>6%)and 44 cases of HbA1 c standard group(HbA1 c≤6%).Pregnancy outcomes were compared among the groups.Results:There were statistically significant differences in the incidence of macrosomia and neonatal hypoglycemia of the three groups(P<0.05).The incidence of hypoglycemia in macrosomia and neonates in GDM group B was higher than that in GDM group A and GDM group C(P<0.05).The incidence of cesarean section,macrosomia and neonatal asphyxia in the HbA1 c exceeding standard group were higher than those in the HbA1 c standard group(P<0.05).Conclusion:The incidence of cesarean section,macrosomia,neonatal asphyxia and neonatal hypoglycemia increases significantly in GDM patients with HbA1 c>6%and OGTT blood glucose at three time points,which should be paid more attention to and given effective intervention to improve maternal and infant outcomes.