孕前甘油三酯葡萄糖指数及孕期增重对妊娠期糖尿病患者分娩巨大儿的预测价值

Predictive value of progestational triglyceride glucose indexes and gestational weight gain on gestational diabetes mellitus petients with delivery of macrosomia

目的 分析孕前甘油三酯葡萄糖(TyG)指数及孕期增重与妊娠期糖尿病(GDM)患者分娩巨大儿的关系。方法 以2020年06月1日-2022年01月31日就诊于河北省人民医院产科住院分娩且确诊为GDM的孕产妇共476例为研究对象,统计患者各项临床资料。根据新生儿体重,分为巨大儿组(124例)和非巨大儿组(352例)。分析GDM患者分娩巨大儿的独立影响因素,绘制受试者工作特征(ROC)曲线以分析孕前TyG指数及孕期增重对GDM患者分娩巨大儿的预测价值。结果 巨大儿组年龄、孕期增重及孕前TyG指数均高于非巨大儿组(P<0.05)。巨大儿组初孕及初产比例均低于非巨大儿组(P<0.05)。多因素Logistic回归分析结果显示,孕期增重、孕前TyG指数是GDM患者分娩巨大儿的独立影响因素(P<0.05)。ROC曲线结果显示:孕期增重(AUC:0.613, 95%CI:0.554~0.672,P<0.01)、孕前TyG指数(AUC:0.720,95%CI:0.672~0.768,P<0.01)对GDM患者分娩巨大儿有一定预测能力,但二者联合预测能力更高(AUC:0.746, 95%CI:0.699~0.794,P<0.01),可更好的预测GDM患者分娩巨大儿。结论 孕期增重、孕前TyG指数是GDM患者分娩巨大儿的独立危险因素,且对于GDM患者分娩巨大儿具有较好的预测价值。

Objective To analyze relationship between progestational triglyceride glucose(TyG) index, gestational weight gain and large for gestational age(LGA) in patients with gestational diabetes mellitus(GDM). Methods A total of 476 cases of pregnant women diagnosed with GDM during June 1, 2020 to January 31, 2022 in Obstetrics Department, Hebei General Hospital for institutional delivery were as the study subjects. All clinical data were collected from the two groups which comprised the macrosomia group(n=124) and non-macrosomia group(n=352), grouped based on the newborn weigh. The independent factors influencing macrosomia in GDM patients were analyzed, and receiver operating characteristic(ROC) curve was drawn to evaluate the predictive value of progestational TyG index and gestational weight gain for macrosomia in GDM patients.Results The age, gestational weight gain, and progestational TyG index in the macrosomia group were higher than those in the non-macrosomia group(P<0.05). The proportions of first pregnancy and first birth in the macrosomia group were lower than those in the non-macrosomia group(P<0.05). Multivariate logistic regression analysis showed that gestational weight gain and progestational TyG index were independent factors influencing LGA delivery of GDM patients(P<0.05). ROC curve results showed that gestational weight gain(AUC:0.613, 95%CI: 0.554-0.672, P<0.01) and progestational TyG index(AUC: 0.720, 95%CI: 0.672-0.768, P<0.01) had certain predictive abilities for macrocosm in GDM patients, and the combined predictor of two indices(AUC: 0.746, 95%CI: 0.699-0.794, P<0.01) had a higher ability, and it could predict LGA delivery of GDM patients in a better manner.Conclusion Gestational weight gain and progestational TyG index are independent risk factors for LGA delivery of GDM patients, and with better predictive value.