妊娠期糖尿病患者孕期甲状腺功能和贫血指标的变化及与母婴结局的相关性

Changes of thyroid function and anemia indicators in patients with gestational diabetes mellitus and the correlations with maternal and fetal outcomes

目的检测妊娠期糖尿病(GDM)患者孕期甲状腺功能和贫血指标的变化,分析与母婴结局的相关性。方法选择2016年1月—2018年1月在杭州市第一人民医院产检并分娩的160例GDM孕妇为GDM组,100例健康孕妇为对照组。检测两组孕妇的血糖、游离三碘甲状腺原氨酸(FT_(3))、游离四碘甲状腺原氨酸(FT_(4))、促甲状腺激素(TSH)、血清铁蛋白(SF)、叶酸(FA)及维生素B_(12)水平,记录所有孕妇及胎儿/新生儿结局。结果 GDM组孕中期FT_(3)水平明显高于对照组,TSH水平明显低于对照组,差异均有统计学意义(均P<0.05);GDM组孕晚期TSH水平明显低于对照组,差异有统计学意义(P<0.05)。GDM组和对照组孕中期SF水平、孕晚期维生素B_(12)水平比较差异均有统计学意义(均P<0.05)。GDM组孕妇空腹血糖水平为(6.27±0.71)mmol/L,与孕妇年龄、体质指数(BMI)、SF、FT_(3)呈正相关(r=0.161,P=0.009;r=0.357,P=0.000;r=0.181,P=0.004;r=0.295,P=0.000),与维生素B_(12)、FT_(4)、TSH呈负相关(r=-0.176,P=0.005;r=-0.130,P=0.036;r=-0.129,P=0.038)。GDM组剖宫产、巨大儿及早产儿发生率均高于对照组,差异均有统计学意义(均P<0.05)。结论应注意GDM患者甲状腺功能和贫血指标水平的变化,定期对GDM孕妇进行SF、维生素B_(12)及FA的监测,有针对性地补充缺乏的维生素,有效控制孕期血糖水平,保障母婴健康。

Objective To detect the changes of thyroid function and anemia indicators in patients with gestational diabetes mellitus(GDM),analyze the correlations with maternal and fetal outcomes.Methods From January 2016 to January 2018,160 pregnant women with GDM giving birth to their babies in Hangzhou First People’s Hospital were selected as GDM group,100 healthy pregnant women were selected as control group.The levels of blood glucose,free triiodothyronine(FT_(3)),free tetraiodothyronine(FT_(4)),thyroid-stimulating hormone(TSH),serum ferritin(SF),folic acid(FA),and vitamin B_(12) in the two groups were detected.The outcomes of pregnant women and fetuses/newborns were recorded.Results The level of FT_(3) during the second trimester of pregnancy in GDM group was statistically significantly higher than that in control group,the level of TSH in GDM group was statistically significantly lower than that in control group(P<0.05).The level of TSH during the third trimester of pregnancy in GDM group was statistically significantly lower than that in control group(P<0.05).There were statistically significant differences in the level of SF during the second trimester of pregnancy and the level of vitamin B_(12) during the third trimester of pregnancy between GDM group and control group(P<0.05).The level of fasting blood glucose in GDM group was(6.27±0.71) mmol/L,which was positively correlated with maternal age,body mass index(BMI),SF,and FT_(3)(r=0.161,P=0.009;r=0.357,P=0.000;r=0.181,P=0.004;r=0.295,P=0.000) and negatively correlated with vitamin B_(12),FT_(4),and TSH(r=-0.176,P=0.005;r=-0.130,P=0.036;r=-0.129,P=0.038).The incidence rates of cesarean section,macrosomia,and premature infant in GDM group were statistically significantly higher than those in control group(P<0.05).Conclusion More attention should be paid to the changes of thyroid function and anemia indicators in GDM patients,monitoring of SF,vitamin B_(12),and FA in GDM patients should be conducted regularly,the vitamins should be supplemented according to the situation,gestational blood glucose level should be controlled effectively to ensure maternal and infantile health.