1型糖尿病孕妇孕期高血糖与妊娠结局的相关性研究

Correlation between pregnancy hyperglycemia and pregnancy outcome in pregnant women with type 1 diabetes mellitus

目的探讨1型糖尿病(T1DM)孕妇孕期高血糖与妊娠结局的相关性及可能的影响因素。方法选取2015年1月至2020年12月在郑州大学第一附属医院住院的T1DM合并妊娠患者37例作为T1DM组,按照相同年龄1∶2匹配原则,选取同期74例健康孕妇作为对照组。记录两组孕妇的基线资料[孕妇终止妊娠方式、妊娠合并症、新生儿结局、孕期糖尿病酮症酸中毒(DKA)史等],并检测糖化血红蛋白(HbA_(1c))等生化指标。采用条件logistic回归模型分析两组妊娠结局的差异,并采用二元logistic回归模型进一步探讨孕期HbA_(1c)水平及罹患DKA对T1DM孕妇母婴结局的影响。结果与对照组相比,T1DM组出现孕母不良结局(引产、早产、妊娠期高血压疾病、子痫前期)及新生儿不良结局(新生儿入重症监护室、5 min Apgar评分<10分、围产期死亡)的比例更高,差异均具有统计学意义(P<0.05)。条件logistic回归分析结果显示,与对照组相比,在调整了年龄、胎次后,T1DM孕妇引产的风险显著增加(OR=5.561,95%CI 1.455~21.258),早产(OR=10.219,95%CI 2.245~46.515)和妊娠期高血压疾病(OR=11.195,95%CI 1.194~104.962)的发生风险更高,但两组孕妇患子痫前期的结局差异无统计学意义(P>0.05)。T1DM孕妇所产新生儿发生呼吸窘迫(OR=10.082,95%CI 1.173~86.628)、围产期死亡(OR=14.773,95% CI 1.822~119.781)及新生儿入重症监护室(OR=6.907,95%CI 2.284~20.892)的风险也增加。二元logistic回归分析结果显示,在调整年龄后,T1DM组孕妇HbA1c水平与新生儿病理性黄疸(OR=1.630,95%CI 1.013~2.741)的发生风险增加有关。T1DM组孕期发生DKA的产妇共4例。在调整年龄、胎次和孕周后,孕期发生DKA的孕妇所产的新生儿更易发生围产期死亡(OR=27.620,95%CI 1.007~757.507)。结论T1DM孕妇比健康孕妇更容易发生不良母婴结局,并且不良的血糖控制可能与新生儿围产期死亡及病理性黄疸有关。

Objective To explore the correlation between pregnancy hyperglycemia and pregnancy outcome in pregnant women with type 1 diabetes mellitus(T1DM)and the possible influencing factors.Methods A total of 37 patients with T1DM combined with pregnancy hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2015 to December 2020 were selected as T1DM group.According to the 1∶2 matching principle of the same age,74 healthy pregnant women in the same period were selected as the control group.Baseline data[methods of pregnancy termination,pregnancy complications,neonatal outcomes,history of diabetic ketoacidosis(DKA)during pregnancy etc.]were recorded and biochemical indicators such as glycated hemoglobin A1c(HbA_(1c))were detected.Conditional logistic regression model was used to analyze the difference in pregnancy outcome between the two groups,and binary logistic regression model was used to further investigate the effects of HbA_(1c) level during pregnancy and DKA on maternal and infant outcomes of pregnant women with T1DM.Results Compared with the control group,there were higher proportion of adverse maternal outcomes(induced labor,premature delivery,hypertensive disorder in pregnancy,preeclampsia)and adverse neonatal outcomes(neonatal admission to intensive care unit,Apgar score<10 points in 5 min,perinatal death)in T1DM group,and the differences were statistically significant(P<0.05).The logistic regression analysis showed that compared with the control group,after adjusting for age and parity,the risk of induced labor[odd ration(OR)=5.561,95%confidence interval(CI)1.455-21.258]increased significantly in pregnant women with T1DM,furthermore,there was also a higher risk of premature birth(OR=10.219,95%CI 2.245-46.515)and hypertensive diseases during pregnancy(OR=11.195,95%CI 1.194-104.962),but there was no statistically significant difference in the outcome of preeclampsia between the two groups(P>0.05).The risk of neonatal respiratory distress(OR=10.082,95%CI 1.173-86.628),perinatal death(OR=14.773,95%CI 1.822-119.781)and neonatal admission to intensive care unit(OR=6.907,95%CI 2.284-20.892)increased in neonates of pregnant women with T1DM.Binary logistic regression analysis showed that after adjusting for age,HbA1c level in T1DM group was associated with an increased risk of neonatal pathological jaundice(OR=1.630,95%CI 1.013-2.741).There were four parturients with DKA during pregnancy in the T1DM group.After adjusting for age,parity and gestational weeks,the women with DKA during pregnancy were more likely to have newborns with perinatal death(OR=27.620,95%CI 1.007-757.507).Conclusion Pregnant women with T1DM are more likely to have adverse maternal and infant outcomes than healthy pregnant women,and poor glycemic control may be associated with perinatal death and pathological jaundice.