单纯空腹血糖升高妊娠期糖尿病孕妇不良妊娠结局及其影响因素研究

Adverse Pregnancy Outcomes and Its Associated Factors in Gestational Diabetes Mellitus with Isolated Fasting Hyperglycemia

背景单纯空腹血糖升高的妊娠期糖尿病(GDM)孕妇可能对仅空腹血糖升高未重视,导致妊娠期血糖管理不佳,而这种情况是否会造成不良妊娠结局,及其相关影响因素有待研究。目的探究单纯空腹血糖升高的GDM孕妇不良妊娠结局发生情况,并分析其影响因素。方法选取2020年6月至2021年3月在西北妇女儿童医院行产前检查的单纯空腹血糖升高的411例GDM孕妇为研究对象。所有孕妇随访至分娩,并根据最终分娩结局分为不良妊娠结局组和无不良妊娠结局组。收集孕妇的临床资料和不良妊娠结局发生情况,采用多因素Logistic回归分析探究单纯空腹血糖升高的GDM孕妇发生不良妊娠结局的影响因素。结果411例单纯空腹血糖升高的GDM孕妇中157例(38.2%)接受妊娠期规范化血糖管理并达标,88例(21.4%)接受妊娠期规范化血糖管理但未控制达标,166例(40.4%)未接受血糖管理;323例(78.6%)发生不良妊娠结局(不良妊娠结局组),88例(21.4%)妊娠结局良好(无不良妊娠结局组)。两组孕妇年龄、妊娠前超重肥胖所占比例、妊娠期血糖管理情况、空腹血糖、口服葡萄糖耐量试验(OGTT)1 h血糖、OGTT 2 h血糖、糖化血红蛋白(HbA_(1c))≥5.5%、血清总蛋白(TP)、血清白蛋白(ALB)、低蛋白血症发生率、时间-血糖曲线的曲线下面积(AUC)比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,妊娠前超重肥胖〔OR=2.89,95%CI(1.45,5.78),P=0.003〕、妊娠期血糖管理〔管理未达标:OR=3.64,95%CI(1.64,8.06),P=0.001;未管理:OR=3.46,95%CI(1.91,6.25),P<0.001〕、HbA_(1c)〔OR=2.38,95%CI(1.06,5.34),P=0.035〕、低蛋白血症〔OR=2.25,95%CI(1.15,4.41),P=0.018〕、时间-血糖曲线的AUC〔OR=1.23,95%CI(1.03,1.47),P=0.024〕是单纯空腹血糖升高GDM孕妇发生不良妊娠结局的影响因素。结论妊娠前超重肥胖、妊娠期血糖管理未达标或未管理、高HbA_(1c)、低蛋白血症、时间-血糖曲线的AUC是单纯空腹血糖升高GDM孕妇发生不良妊娠结局的高危因素,临床上应指导孕妇妊娠前保持正常体质量、规范化管理血糖等,以促进母婴健康。

Background Due to possible neglect of elevated fasting glucose,poor intra-pregnancy glycemic control may occur in gestational diabetes mellitus(GDM)women with isolated fasting hyperglycemia,but whether it is related to adverse pregnancy outcomes,and associated factors need to be evaluated further.Objective To explore the prevalence of adverse pregnancy outcomes in GDM with simple isolated fasting hyperglycemia and its influencing factors.Methods A total of 411 GDM patients with isolated fasting hyperglycemia who had prenatal examination in Northwest Women and Children's Hospital between June 2020 and March 2021 were selected,and followed up until delivery.Clinical data and pregnancy outcomes(normal and adverse)were collected.Multivariate Logistic regression was used to examine the factors associated with adverse pregnancy outcomes.Results Among the 411 cases,245 received standardized glycemic management,157(38.2%)of whom achieved adequate glycemic control,but other 88 cases(21.4%)still had poor glycemic control;the other 166 cases(40.4%)did not receive standardized blood glucose management.Three hundred and twenty-three(78.6%)patients had adverse pregnancy outcomes,and other 88(21.4%)had normal pregnancy outcomes.Patients with normal and adverse pregnancy outcomes had statistically significant differences in mean maternal age,prevalence of pre-pregnancy maternal obesity,intra-pregnancy glycemic management,mean fasting glucose,one-and two-hour plasma glucose level during the OGTT,prevalence of HbA_(1c)≥5.5%,serum total protein,serum albumin,prevalence of hypoproteinemia and the AUC of the time-blood glucose curve of the OGTT(P<0.05).Multivariate Logistic regression analysis showed that pre-pregnancy maternal overweight or obesity〔OR=2.89,95%CI(1.45,5.78),P=0.003〕,intra-pregnancy glycemic management〔poor glycemic control:OR=3.64,95%CI(1.64,8.06),P=0.001;non-management:OR=3.46,95%CI(1.91,6.25),P<0.001〕,prenatal HbA_(1c)〔OR=2.38,95%CI(1.06,5.34),P=0.035〕,hypoproteinemia〔OR=2.25,95%CI(1.15,4.41),P=0.018〕,and elevated AUC of the time-blood glucose curve of the OGTT〔OR=1.23,95%CI(1.03,1.47),P=0.024〕were associated with increased risk of adverse pregnancy outcomes.Conclusion Pre-pregnancy maternal overweight or obesity,uncontrolled or non-management of blood glucose during pregnancy,high prenatal HbA_(1c) values,hypoproteinemia,and high AUC of the time-blood glucose curve of the OGTT may be high risk factors for adverse outcomes in GDM with isolated fasting hyperglycemia.To improve the rate of normal maternal and neonatal outcomes,clinical guidance should be given to pregnant women to maintain a normal pre-pregnancy weight and to standardizedly manage the blood glucose.