浙江省舟山群岛地区妊娠期糖尿病孕妇血糖水平和新生儿出生体质量的相关性

Correlation between blood glucose level of pregnant women with gestational diabetes mellitus and neonatal birth weight in Zhoushan islands area,Zhejiang

目的分析浙江省舟山群岛地区妊娠期糖尿病(GDM)孕妇血糖水平和新生儿出生体质量的相关性,为预防GDM相关新生儿体格发育异常提供理论依据。方法选取2018年1月-2019年12月舟山市妇幼保健院的1443例孕妇,分为GDM组(304例)和非GDM组(1139例)。在孕24~28周进行75 g口服葡萄糖耐量试验(OGTT)。采用多元线性回归分析不同时期孕妇血糖水平和新生儿出生体质量的相关性。结果GDM组孕妇的孕早期空腹血糖,孕中期OGTT前空腹血糖、OGTT葡萄糖负荷后1 h血糖及OGTT葡萄糖负荷后2 h血糖水平分别为(5.0±0.4)mmol/L、(5.2±0.6)mmol/L、(8.7±1.9)mmol/L及(7.3±1.6)mmol/L,均高于非GDM组孕妇的(4.8±0.4)mmol/L、(4.5±0.3)mmol/L、(7.0±1.3)mmol/L及(6.1±1.0)mmol/L,两组比较差异均有统计学意义(均P<0.05)。GDM组新生儿出生体质量、大于胎龄儿及巨大儿的比例分别为(3483.7±500.0)g、14.8%及12.8%,均明显高于非GDM组的(3363.8±387.41)g、8.3%及4.9%,两组比较差异均有统计学意义(均P<0.05)。调整了母亲年龄、孕前体质指数、孕期增重、母亲受教育程度、家庭年人均收入及分娩孕周后,多因素线性回归模型分析显示:孕中期OGTT前空腹血糖、OGTT葡萄糖负荷后1 h血糖及OGTT葡萄糖负荷后2 h血糖水平与新生儿出生体质量均呈正相关(均P<0.05)。OGTT葡萄糖负荷后血糖异常者与新生儿出体质量呈正相关(P<0.05)。结论医疗机构应重视孕妇血糖水平筛查,降低GDM和糖耐量异常漏诊率,将孕妇血糖水平控制在合理范围。

Objective To analyze the correlation between blood glucose level of pregnant women with gestational diabetes mellitus(GDM)and neonatal birth weight in Zhoushan islands area,Zhejiang,provide a theoretical basis for GDM-related abnormal physical development of neonates.Methods From January 2018 to December 2019,1443 pregnant women were selected from Zhoushan Municipal Maternal and Child Health Care Hospital,then they were divided into GDM group(304 cases)and non-GDM group(1139 cases),75 g oral glucose tolerance test(OGTT)was performed during 24-28 gestational weeks,multiple linear regression analysis was used to analyze the correlations between blood glucose levels of pregnant women in different periods and neonatal birth weight.Results The fasting blood glucose in early pregnancy,fasting blood glucose before OGTT,one-hour glucose-challenge blood glucose,and two-hour glucose-challenge blood glucose after OGTT in middle pregnancy in GDM group were(5.0±0.4)mmol/L,(5.2±0.6)mmol/L,(8.7±1.9)mmol/L,and(7.3±1.6)mmol/L,respectively,which were statistically significantly higher than those in non-GDM group[(4.8±0.4)mmol/L,(4.5±0.3)mmol/L,(7.0±1.3)mmol/L,and(6.1±1.0)mmol/L,respectively](P<0.05).Neonatal birth weight,the proportions of large for gestational age infant and macrosomia in GDM group were(3483.7±500.0)g,14.8%,and 12.8%,respectively,which were statistically significantly higher than those in non-GDM group[(3363.8±387.41)g,8.3%,and 4.9%,respectively](P<0.05).After adjusting maternal age,progestational body mass index,body weight gain during pregnancy,maternal educational level,per-capita annual income,and delivery gestational week,multivariate linear regression model analysis showed that fasting blood glucose before OGTT,one-hour glucose-challenge blood glucose,and two-hour glucose-challenge blood glucose after OGTT were positively correlated with neonatal birth weight(P<0.05),abnormal blood glucose after OGTT glucose-challenge was positively correlated with neonatal birth weight(P<0.05).Conclusion The medical institutions should pay more attention to blood glucose screening of pregnant women,reduce the missed diagnostic rates of GDM and abnormal glucose tolerance,and control blood glucose of pregnant women within reasonable range.