妊娠期糖尿病孕妇分娩前糖化血红蛋白与新生儿血糖及出生体重的相关性分析

Association between maternal glycated hemoglobin A1c before delivery in gestational diabetes mellitus pregnancies and neonatal blood glucose and birth weight

目的探讨妊娠期糖尿病(GDM)孕妇分娩前糖化血红蛋白(HbA1c)与新生儿血糖及出生体重的相关性。方法选取2018年9月至2020年12月于西南医科大学附属医院分娩的178例GDM孕妇及其新生儿作为研究对象。以分娩前1周内的HbA1c反映GDM孕妇分娩前2~3个月的血糖控制水平,将GDM孕妇分为HbA1c≥6%组(45例)和HbA1c<6%组(133例)。收集新生儿出生体重及出生后早期血糖值作为结局指标。采用Pearson相关分析和Spearman偏相关分析法分析孕妇分娩前HbA1c与新生儿初始血糖的线性相关性,采用多元线性回归模型分析分娩前HbA1c水平与新生儿出生体重的相关性。采用多元logistic回归分析法分析新生儿低血糖和大于胎龄儿(LGA)的发生风险。结果与分娩前HbA1c≥6%组相比,HbA1c<6%组GDM孕妇的新生儿初始血糖更高[分别为(3.5±1.4)和(2.8±1.3)mmol/L,t=2.85,P<0.01]。Pearson相关分析显示,分娩前HbA1c与新生儿初始血糖呈负相关(r=-0.25,P<0.001);采用Spearman偏相关分析控制混杂因素,该负相关关系仍然存在(r=-0.27,P<0.001)。多元线性回归分析结果显示,在排除胎龄等因素的影响后,分娩前HbA1c每降低0.1%,新生儿的出生体重减少24 g(β=24,95%CI 16~33,P<0.001)。将HbA1c以连续变量进入logistic回归模型,调整相关混杂因素后,GDM孕妇分娩前HbA1c每降低0.1%,其新生儿的低血糖发生风险降低12%(OR=0.88,95%CI 0.82~0.95,P<0.001),LGA的发生风险降低8%(OR=0.92,95%CI 0.87~0.97,P<0.01)。将HbA1c以二分类变量进入多元logistic回归模型并调整相关混杂因素,与分娩前HbA1c≥6%组的GDM孕妇相比较,分娩前HbA1c<6%组的GDM孕妇,其子代新生儿低血糖(OR=0.23,95%CI 0.09~0.59)及LGA(OR=0.30,95%CI 0.12~0.71)的发生风险均降低,差异具有统计学意义(均P<0.01)。结论GDM孕妇分娩前HbA1c与新生儿血糖及出生体重相关,良好的血糖控制能显著降低新生儿低血糖及LGA的发生率。

Objective To explore the association between maternal glycated hemoglobin A1c(HbA1c)before delivery in gestational diabetes mellitus(GDM)pregnancies,and neonatal blood glucose and birth weight.Methods A total of 178 pregnant women with GDM and their newborns who were born in Affiliated Hospital of Southwest Medical University from September 2018 to December 2020 were included in this study.The maternal HbA1c within 7 days before delivery was used to reflect the accumulated blood glucose level in the past 2-3 months.Pregnant women with GDM were divided into two groups:HbA1c≥6%group(45 cases)and HbA1c<6%group(133 cases).Neonatal birth weight and neonatal blood glucose were selected as the outcomes.Pearson and Spearman partial correlation analysis were used to verify the linear relationships between maternal HbA1c before delivery and the initial neonatal blood glucose levels.A multivariable linear regression model was used to analyze the association between maternal HbA1c before delivery and neonatal birthweight.A multivariate logistical regression model was used to analyze the risk of neonatal hypoglycemia and large for gestational age(LGA).Results Compared to the newborns of the GDM pregnant women with HbA1c≥6%before delivery,the newborns in the maternal HbA1c<6%group had higher initial neonatal blood glucose levels[(3.5±1.4)vs.(2.8±1.3)mmol/L,t=2.85,P<0.01).The result of Pearson correlation analysis showed a negative correlation between the maternal HbA1c before delivery and the initial neonatal blood glucose(r=-0.25,P<0.001),and the similar conclusion was observed using the Spearman partial correlation analysis to adjust for potential confounding factors(r=-0.27,P<0.001).The result of multivariable linear regression model showed that,after adjusting for potential confounding factors such as gestational age,for every 0.1%reduction in maternal HbA1c before delivery,the birth weight of the newborn was reduced by 24 g(β=24,95%CI 16-33,P<0.001).When HbA1c was entered in the multivariate logistical regression model as a continuous variable,the results showed that,after adjusting for potential confounding factors,for every 0.1%reduction in maternal HbA1c before delivery,the risks of hypoglycemia and LGA decreased by 12%(OR=0.88,95%CI 0.82-0.95,P<0.001)and 8%(OR=0.92,95%CI 0.87-0.97,P<0.01)in their offspring.When HbA1c was entered in the multivariate logistical regression model as a dichotomous variable,the results showed that,after adjusting for potential confounding factors,compared with the newborns of the GDM pregnant women with HbA1c≥6%before delivery,the risks of hypoglycemia(OR=0.23,95%CI 0.09-0.59,P<0.01)and LGA(OR=0.30,95%CI 0.12-0.71,P<0.01)in the maternal HbA1c<6%group were significantly decreased.Conclusions The maternal HbA1c in GDM pregnant women before delivery is associated with the neonatal blood glucose and neonatal birthweight.The good glycemic control before delivery in GDM pregnant women significantly reduces the incidence of neonatal hypoglycemia and LGA.