动态血糖监测及葡萄糖目标范围内时间对妊娠期糖尿病患者妊娠结局的影响研究

Impact of Continuous Glucose Monitoring and Time-in-range on Pregnancy Outcome in Patients with Gestational Diabetes Mellitus

背景妊娠期糖尿病(GDM)是一种临床常见疾病,我国GDM的发病率为12.8%~16.7%。因妊娠期血糖控制不佳或者血糖监测不严密,母婴并发症明显增加。动态血糖监测系统(CGMS)通过探头检测细胞间液葡萄糖浓度动态反映血糖的变化,弥补了传统末梢血糖监测的不足,能够更好地监测妊娠期血糖,有效地改善母婴结局。目的探究动态血糖监测及葡萄糖目标范围内时间(TIR)对GDM患者妊娠结局的影响。方法选取2019年9月至2021年3月于郑州大学第二附属医院内分泌科住院的GDM患者120例,根据血糖监测方法的不同分为动态血糖组(n=80)和末梢血糖组(n=40)。根据CGMS记录的72 h平均TIR值将动态血糖组分为TIR≥85%亚组和TIR<85%亚组。比较动态血糖组和末梢血糖组以及TIR≥85%亚组和TIR<85%亚组的妊娠结局。结果动态血糖组和末梢血糖组羊水异常发生率、宫内感染发生率、新生儿身长、高胆红素血症发生率、新生儿窒息发生率比较,差异均无统计学意义(P>0.05);动态血糖组剖宫产发生率、早产发生率、胎盘早剥发生率、胎膜早破发生率、妊娠期高血压综合征发生率、新生儿体质量、低体质量儿发生率、巨大儿发生率低于末梢血糖组,新生儿胎龄高于末梢血糖组(P<0.05)。TIR≥85%亚组和TIR<85%亚组早产、胎盘早剥、胎膜早破、羊水异常、宫内感染、妊娠期高血压综合征、巨大儿、高胆红素血症、新生儿窒息发生率比较,差异均无统计学意义(P>0.05);TIR≥85%亚组剖宫产发生率、新生儿体质量、新生儿身长低于TIR<85%亚组,新生儿胎龄高于TIR<85%亚组(P<0.05)。结论对GDM患者实行动态血糖监测可为临床治疗提供连续血糖数据,有助于改善母婴结局;另外当TIR≥85%时,母婴获益程度更大。

Background Gestational diabetes mellitus (GDM) is a common clinical disease with a morbidity about 12.8%-16.7% in China,which may lead to significantly increased risk of maternal and fetal complications due to poor blood glucose control or imprecise blood glucose monitoring in pregnancy.Continuous glucose monitoring (CGM) system detects the glucose concentration in the intercellular fluid through a probe,reflecting the changes of blood glucose,which makes up for the deficiency of traditional capillary glucose monitoring,and could better monitor in-pregnancy blood glucose,promoting the improvement of maternal and infant outcomes.Objective To explore the impact of CGM and time-in-range(TIR) on pregnancy outcome in patients with GDM.Methods One hundred and twenty GDM inpatients who were hospitalized in Department of Endocrinology of the Second Affiliated Hospital of Zhengzhou University from September 2019 to March 2021,were selected and divided into ambulatory glucose monitoring group (n=80) and capillary glucose monitoring group (n=40) according to the glucose monitoring method.Gestational outcomes were compared between ambulatory glucose monitoring and capillary glucose monitoring groups,and between two subgroups of ambulatory glucose monitoring patients divided by the average value of TIR monitored by the CGM system within 72 hours (TIR≥85%,and TIR<85%).Results Ambulatory glucose monitoring and capillary glucose monitoring groups had no significant differences in the incidence of abnormal amniotic fluid,incidence of intrauterine infection,length of newborns,incidence of neonatal hyperbilirubinemia and incidence of asphyxia(P>0.05).Ambulatory glucose monitoring group had statistically lower incidence of cesarean section,premature delivery,placental abruption,premature rupture of membranes,pregnancy-induced hypertension,low-weight infants,and macrosomia,and lower average weight of newborns,as well as greater average gestational age of newborns(P<0.05).Two TIR subgroups had no significant differences in the incidence of premature delivery,placental abruption,premature rupture of membranes,abnormal amniotic fluid,intrauterine infection,pregnancy-induced hypertension,macrosomia,neonatal hyperbilirubinemia and asphyxia(P>0.05).TIR≥85% subgroup demonstrated statistically lower incidence of cesarean section,lower average weight and length of newborns,as well as greater average gestational age of newborns(P<0.05).Conclusion The data of CGM for GDM patients may support the clinical treatment,benefiting the improvement of maternal and infant outcomes,and the benefit may be greater when TIR≥85%.