OGTT两项升高初产妇的临床特点及围产结局分析

Analysis of clinical characteristics and perinatal outcomes of nulliparae with two abnormal values in oral glucose tolerance test

目的探讨口服葡萄糖耐量试验(OGTT)两项血糖值升高初产妇的临床特点及围产结局。方法收集2015年11月1日至2018年4月30日在浙江大学医学院附属妇产科医院产前检查和妊娠中期OGTT升高的单胎头位初产妇679例为病例组,根据OGTT空腹、服糖后1h和2h血糖异常时点分为:妊娠期糖尿病(GDM)Ⅰ组(空腹及服糖后1h或2h血糖升高)142例和GDMⅡ组(空腹血糖正常,服糖后1h和2h血糖均升高)537例,同期随机选取753例孕中期OGTT正常的初产妇为对照组[正常糖耐量(NGT)组],对其临床特点及围产结局进行分析。结果三组产妇的年龄、孕前身体质量指数(BMI)、妊娠中期糖化血红蛋白和孕晚期糖化白蛋白差异均有统计学意义(F值分别为40.92、38.21、31.77、118.95,P<0.01)。三组的妊娠期高血压疾病、早产及剖宫产发生率差异均有统计学意义(χ^(2)值分别为17.74、13.87、9.89,P<0.05);调整母亲的年龄、孕前BMI因素后,妊娠期高血压疾病发生风险GDMⅠ组是NGT组的1.93倍(95%CI:1.093.39),P<0.05,早产发生风险GDMⅠ组、GDMⅡ组分别是NGT组的2.23倍(95%CI:1.054.72)、2.19倍(95%CI:1.253.84),P<0.05。三组的新生儿出生体质量(F=7.18)及巨大儿(χ^(2)=13.37)、新生儿出生1min Apgar评分≤7分(χ^(2)=12.12)、新生儿低血糖(χ^(2)=14.17)、入住新生儿重症监护病房(NICU)(χ^(2)=24.19)的发生率差异均有统计学意义(P<0.05);调整母亲年龄、孕前BMI、妊娠期高血压疾病和早产因素后,新生儿出生1min Apgar评分≤7分发生风险GDMⅠ组是NGT组的5.25倍(95%CI:1.7615.73),P<0.05,新生儿低血糖发生风险GDMⅠ组、GDMⅡ组分别是NGT组的3.39倍(95%CI:1.428.09)、2.66倍(95%CI:1.355.23),P<0.05,新生儿入住NICU发生风险GDMⅠ组、GDMⅡ组分别是NGT组的2.95倍(95%CI:1.685.19)、1.68倍(95%CI:1.092.58),P<0.05。结论在OGTT两项异常初产妇中,空腹联合服糖后血糖升高者不良围产结局发生风险增加,应提供个性化血糖监测和及时的干预,以减少不良围产结局的发生。

Objective To investigate clinical characteristics and perinatal outcomes of nulliparae with gestational diabetes mellitus(GDM)who got two abnormal values of oral glucose tolerance test(OGTT).Methods 679 nulliparae singleton head nulliparae with elevated OGTT in the second trimester,who took regular prenatal visits in Women′s Hospital,Zhejiang University School of Medicine from November 1,2015 to April 30,2018,were randomly recruited as case group.According to the OGTT fasting and 1 h and 2 h blood glucose abnormalities after taking sugar,they were divided into GDMⅠgroup with 142 women(with elevated fasting blood glucose and increased 1-hour or 2-hour postprandial glucose blood levels)and GDMⅡgroup with 537 women(with normal fasting blood glucose but increased levels of 1-hour and 2-hour postprandial blood glucose).At the same time,753 nulliparae with normal OGTT in the second trimester were randomly selected as the control group[Normal Glucose Tolerance(NGT)group],and their clinical characteristics and perinatal outcomes were analyzed.Results Statistically significant differences in age,pre-pregnancy body mass index and glycosylated hemoglobin in the second trimester and glycosylated albumin in the third trimester were found among groups of GDMⅠ,GDMⅡand NGT(F=40.92,38.21,31.77 and 118.95,respectively,all P<0.01).There were notable differences in incidence of gestational hypertension,preterm delivery and cesarean section delivery among the groups of GDMⅠ,GDMⅡand NGT(χ^(2)=17.74,13.87 and 9.89,respectively,all P<0.05).After adjusting for maternal age and pre-pregnancy body mass index,the adjusted odds ratio(OR)for the risk of gestational hypertension in GDMⅠgroup was 1.93 compared with NGT group(95%CI:1.09~3.39,P<0.05),the adjusted OR for the risk of preterm delivery of GDMⅠgroup and GDMⅡgroup were 2.23(95%CI:1.05~4.72,P<0.05)and 2.19(95%CI:1.25~3.84,P<0.05)compared with NGT group,respectively.There were significant differences in neonatal birth weight,macrosomia incidence,newborns with an APGAR score≤7 at 1 minute after birth,neonatal hypoglycemia and newborn intensive care unit(NICU)admission among these three groups(F/χ^(2)=7.18,13.37,12.12,14.17 and 24.19,respectively,all P<0.05).After adjusting for maternal age,pre-pregnancy body mass index,gestational hypertension and preterm delivery,the adjusted ORs for newborns with an Apgar score≤7 at 1 minute after birth of GDMⅠgroup was 5.25 compared with NGT group(95%CI:1.76~15.73,P<0.05).Besides,among the nulliparae of GDMⅠand GDMⅡ,adjusted ORs for neonatal hypoglycemia were 3.39(95%CI:1.42~8.09,P<0.05)and 2.66(95%CI:1.35~5.23,P<0.05)compared with NGT group,respectively.Adjusted ORs for NICU admission of GDMⅠand GDMⅡgroups were 2.95(95%CI:1.68~5.19,P<0.05)and 1.68(95%CI:1.09~2.58,P<0.05)compared with NGT group,respectively.Conclusion GDM patients with both abnormal fasting and postprandial blood glucose levels of OGTT were prone to adverse pregnancy outcomes,suggesting that more attention should be paid for GDM population on tailored blood glucose monitoring and early intervention to improve pregnancy outcomes.