妊娠期糖尿病围手术期血糖水平与产后出血量及新生儿血糖关系

Association of perioperative blood glucose with postpartum hemorrhage and neonatal blood glucose in women with gestational diabetes mellitus

目的:探讨妊娠期糖尿病孕妇围手术期血糖水平与产后出血量及新生儿血糖的关系。方法:前瞻性收集2020年4月⁃2021年4月在广州市妇女儿童医疗中心行剖宫产妊娠期糖尿病孕妇175例,按照孕期血糖控制状况分为控制良好的研究A组和控制不佳的研究B组;将同时期剖宫产的非糖尿病孕妇设为对照C组,分析3组孕妇围手术期血糖与产后出血量及新生儿血糖关系。结果:3组的术后2 h血糖、术后24 h出血量、新生儿血糖均有统计学差异(P<0.05),术后2 h血糖为A组(5.1±1.0)mmol/L,B组(5.7±1.3)mmol/L,C组(5.5±1.0)mmol/L;24 h出血量为A组440(410,500)mL,B组480(404,578)mL,C组420(370,506)mL;新生儿血糖为A组(3.1±0.8)mmol/L,B组(2.8±0.8)mmol/L,C组(3.7±0.9)mmol/L。术后24 h出血量与术后2 h血糖相关(P<0.05)。通过曲线拟合分析得出妊娠期糖尿病术后血糖的理想范围为4.4~6.7 mmol/L。结论:做好妊娠糖尿病孕妇孕期及围手术期血糖的科学管理,可能减少产后出血量及降低新生儿低血糖发生率。

Objective:To investigate the association of perioperative blood glucose level with postpartum hemorrhage and neonatal blood glucose in pregnant women with gestational diabetes mellitus(GDM).Methods:Prospectively included in this study were 175 pregnant women with GDM who underwent cesarean section in Guangzhou Women and Children􀆳s Medical Center between April 2020 and April 2021.According to blood glucose control in pregnancy,those with well⁃controlled blood glucose were assigned to group A,while those with poorly⁃controlled blood glucose were assigned to group B.A contemporary cohort of non⁃GDM pregnant women who underwent cesarean section were included as controls(group C).The association of perioperative blood glucose with postpartum hemorrhage and neonatal blood glucose was analyzed in the three groups.Results:Significant differences were noted in 2h postoperative blood glucose,24h postoperative blood loss,and neonatal blood glucose across the three groups(P<0.05).The level of 2h postoperative blood glucose was(5.1±1.0)mmol/L in group A,(5.7±1.3)mmol/L in group B,and(5.5±1.0)mmol/L in group C.The 24h postoperative blood loss was 440(410,500)mL in group A,480(404,578)mL in group B,and 420(370,506)mL in group C.The level of neonatal blood glucose was(3.1±0.8)mmol/L in group A,(2.8±0.8)mmol/L in group B,and(3.7±0.9)mmol/L in group C.The 24h postoperative blood loss was associated with the 2 h postoperative blood glucose level(P<0.05).Curve fitting analysis suggested that the ideal range of postoperative blood glucose was 4.4-6.7 mmol/L for pregnant women with GDM.Conclusion:Proper management of blood glucose during pregnancy and perioperative period in pregnant women with GDM may reduce postpartum hemorrhage and incidence of neonatal hypoglycemia.