妊娠期糖尿病孕妇血糖指标对妊娠结局的影响

Effects of blood glucose indexes on pregnancy outcome in pregnant women with gestational diabetes mellitus

目的分析妊娠期糖尿病(GDM)孕妇血糖指标对妊娠结局的影响。方法选取2017年3月—2019年3月中国人民解放军联勤保障部队第987医院收治的120例GDM孕妇作为研究对象,随机分为研究组(60例)和对照组(60例)。研究组给予动态血糖监测治疗,对照组给予常规血糖监测治疗。比较两组患者的空腹血糖、糖化血红蛋白(HbA1c)、口服葡萄糖耐量试验(OGTT)餐后1 h血糖和餐后2 h血糖,分析产妇和新生儿不良结局的危险因素。结果治疗后,研究组患者HbA1c≥6.5%的比例(21.67%)明显低于对照组(43.33%),差异有统计学意义(χ^(2)=6.240,P<0.05)。研究组HbA1c、空腹血糖、餐后1 h血糖及餐后2 h血糖水平分别为(5.74±1.32)%、(4.32±1.87)mmol/L、(8.57±1.12)mmol/L及(6.57±2.37)mmol/L;对照组HbA1c、空腹血糖、餐后1 h血糖及餐后2 h血糖水平分别为(6.43±1.68)%、(5.13±2.34)mmol/L、(9.35±1.73)mmol/L及(7.73±2.51)mmol/L。研究组HbA1c、空腹血糖、餐后1 h血糖及餐后2 h血糖水平均明显低于对照组(t=-2.502,P<0.05;t=-2.095,P<0.05;t=-2.932,P<0.05;t=-2.603,P<0.05)。研究组产妇异常总发生率、胎儿和新生儿异常总发生率分别为25.00%和18.33%,均明显低于对照组的73.33%和60.00%,差异均有统计学意义(χ^(2)=28.041,21.860,均P<0.05)。logistic回归分析显示:HbA1c、空腹血糖及餐后1 h血糖升高是新生儿不良结局的危险因素(均P<0.05),HbA1c和空腹血糖升高是产妇不良结局的危险因素(均P<0.05)。结论动态血糖监测可有效控制血糖指标的变化,良好的血糖控制可以改善孕妇和胎儿的预后。

Objective To analyze the effects of blood glucose indexes on pregnancy outcome in pregnant women with gestational diabetes mellitus(GDM).Methods From March 2017 to March 2019,120 pregnant women with GDM treated in the 987th Hospital of the Chinese People's Liberation Army Joint logistic Support Force were selected and randomly divided into study group and control group,60 cases in each group.The patients in study group were treated with dynamic blood glucose monitoring,and the patients in control group were treated with routine blood glucose monitoring.The differences of fasting blood glucose,glycosylated hemoglobin(HbA1c),postprandial 1-hour blood glucose and postprandial 2-hour blood glucose of oral glucose tolerance test(OGTT)were compared between the two groups,the risk factors of maternal and neonatal adverse outcomes were analyzed.Results After treatment,the proportion of patients with HbA1c≥6.5%in study group(21.67%)was statistically significantly lower than that in control group(43.33%)(χ^(2)=6.240,P<0.05).The levels of HbA1c,fasting blood glucose,postprandial 1-hour blood glucose and postprandial 2-hour blood glucose of OGTT in study group were(5.74±1.32)%,(4.32±1.87)mmol/L,(8.57±1.12)mmol/L,and(6.57±2.37)mmol/L,respectively;the levels of HbA1c,fasting blood glucose,postprandial 1-hour blood glucose and postprandial 2-hour blood glucose of OGTT in control group were(6.43±1.68)%,(5.13±2.34)mmol/L,(9.35±1.73)mmol/L,and(7.73±2.51)mmol/L,respectively.The levels of HbA1c,fasting blood glucose,postprandial 1-hour blood glucose and postprandial 2-hour blood glucose of OGTT in study group were statistically significantly lower than those in control group(t=-2.502,P<0.05;t=-2.095,P<0.05;t=-2.932,P<0.05;t=-2.603,P<0.05).The total incidence rates of maternal abnormalities,fetal and neonatal abnormalities in study group were 25.00%and 18.33%,respectively,which were statistically significantly lower than those in control group(73.33%and 60.00%)(χ^(2)=28.041,21.860,P<0.05).logistic regression analysis showed that increases of HbA1c,fasting blood glucose,postprandial 1-hour blood glucose of OGTT were risk factors of neonatal adverse outcomes(P<0.05),increases of HbA1c and fasting blood glucose were risk factors of maternal adverse outcomes(P<0.05).Conclusion Dynamic blood glucose monitoring can effectively control the changes of blood glucose indexes.High blood glucose control level can significantly improve outcomes of pregnant women and fetuses.