妊娠期糖尿病合并亚临床甲状腺功能减退的临床特点及妊娠结局研究

Clinical characteristics and pregnancy outcome of gestational diabetes mellitus combined with subclinical hypothyroidism

目的分析妊娠期糖尿病(GDM)合并亚临床甲状腺功能减退(SCH)的临床特点及妊娠结局。方法选择2017年1月至2019年6月我院收治的单胎妊娠孕妇GDM患者200例(GDM组,其中GDM合并SCH 50例,GDM未合并SCH组150例),以及同期正常健康孕妇150例(NC组),分析各组间的临床资料、血生化、甲状腺素水平、妊娠结局及影响因素。结果与NC组和GDM未合并SCH组比较,GDM合并SCH组孕妇分娩孕周明显下降,即刻血糖、空腹血糖、餐后2 h血糖、糖化血红蛋白(HbA1c)、甘油三酯、促甲状腺激素(TSH)水平明显升高(P<0.05);GDM合并SCH组孕妇胎膜早破、早产、总体不良妊娠结局明显增高(P<0.05);分娩孕周<35周、HbA1c>6.5%和TSH>5.0 mIU/L是GDM合并SCH患者不良妊娠结局的独立危险因素。结论GDM合并SCH孕妇更易发生不良妊娠结局,分娩孕周、HbA1c和TSH水平可对其不良妊娠结局产生影响。

Objective To analyze the clinical characteristics and pregnancy outcome of gestational diabetes mellitus(GDM)combinedwith subclinical hypothyroidism(SCH).Methods A total of 200 single pregnancy pregnant women with GDM from January 2017 to June 2019 were selected as GDM group.Among the patients,50 were GDM combined with SCH and 150 were GDM without SCH.At the same time,150 normal healthy pregnant women were selected as normal control(NC)group.Clinical data,blood biochemical analysis,thyroxine level,pregnancy outcome,and influencing factors were analyzed in each group.Results Compared with the NC group and the GDM without SCH group,the gestational duration of GDM with SCH group was significantly decreased,and the levels of immediate blood glucose,fasting blood glucose,2 h postprandial blood glucose,glycosylated hemoglobin(HbA1c),triglyceride and thyroid-stimulating hormone(TSH)were significantly increased(all P<0.05).Compared with the NC group and the GDM without SCH group,the patients with premature rupture of membranes,premature delivery and overall adverse pregnancy outcome in the GDM with SCH group were significantly increased(P<0.05).Gestationalage<35weeks,HbA1c>6.5%and TSH>5.0 miu/L were independent risk factors for adverse pregnancy outcome in patients with GDM complicated with SCH.Conclusion Pregnant women with GDM combined with SCH are more likely to have adverse pregnancy outcome.Gestational age,HbA1c,and TSH levels canaffect their adverse pregnancy outcome.