妊娠期糖尿病导致大于胎龄儿发生的危险因素及其预测价值分析

Risk Factors and Predictive Value of Large for Gestational Age Infants Caused by Gestational Diabetes Mellitus

目的探讨妊娠期糖尿病导致大于胎龄儿发生的相关危险因素及其预测价值。方法回顾性分析172例妊娠期糖尿病孕妇的临床资料,根据新生儿出生体质量进行分组,研究组(大于胎龄儿组)34例与对照组(非大于胎龄儿组)138例。收集孕妇入院分娩的一般情况及相关因素并进行分析。结果研究组孕前体质量指数(BMI)、妊娠期增重、孕晚期糖化血红蛋白(HbA1c)明显高于对照组,差异有统计学意义(P<0.05);两组孕周、年龄、孕次、产次、孕晚期腹围比较差异无统计学意义(P>0.05)。研究组空腹血糖高于对照组,差异有统计学意义(P<0.05);两组服糖后1 h及2 h血糖比较差异无统计学意义(P>0.05)。采用Logistic回归模型进行分析显示,孕前BMI、妊娠期增重、孕晚期HbA1c、空腹血糖中孕前BMI(OR=1.809)、妊娠期增重(OR=1.328)、孕晚期HbA1c(OR=12.369)均为妊娠期糖尿病导致大于胎龄儿发生的危险因素。孕前BMI、妊娠期增重、孕晚期HbA1c的ROC曲线下面积分别为81.3%、65.0%、76.3%,对大于胎龄儿预测价值均有意义(P<0.05)。结论妊娠期糖尿病孕妇需控制孕前体质量,加强对妊娠期体质量增长的管理,监测糖化血红蛋白水平,可降低大于胎龄儿的发生率。

Objective To investigate the risk factors and predictive value of gestational diabetes mellitus(GDM)in large for gestational age infants.Methods The clinical data of 172 pregnant women with gestational diabetes mellitus were retrospectively analyzed.According to the birth weight of the newborn,34 cases were in the study group(large for gestational age group)and 138 cases were in the control group(non-large for gestational age group).The general conditions and related factors of delivery were collected and the correlation analysis was performed.Results Pre-pregnancy BMI,gestational weight gain,and HbA1c in the third trimester of the study group were significantly higher than those of the control group.The difference was statistically significant(P<0.05).There were no significant differences in gestational age,gestational age,parity,parity and abdominal circumference in the third trimester between the two groups(P>0.05).Fasting blood glucose in the study group was significantly higher than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in blood glucose between the two groups at 1 h and 2 h after administration of glucose(P>0.05).Logistic regression model was used to analyze the glucose levels.Pregestational BMI,gestational weight gain,HbA1c in the third trimester,pregestational BMI(OR=1.809),gestational weight gain(OR=1.328),and HbA1c in the third trimester(OR=12.369)were risk factors for large for gestational age infants caused by gestational diabetes mellitus.The area under the ROC curve of pre-pregnancy BMI,gestational weight gain,and late gestational HbA1c were 81.3%,65.0%,and 76.3%,respectively,which had significant predictive value for large for gestational age infants(P<0.05).Conclusion Pregnant women with gestational diabetes should control their pre-pregnancy weight,strengthen the management of gestational weight gain,and monitor the level of glycosylated hemoglobin,which can reduce the incidence of large for gestational age infants.