心血管健康与妊娠糖尿病产妇不良妊娠结局的关系

Association between cardiovascular health and poor maternal adverse pregnancy outcomes in gestational diabetes mellitus

目的分析心血管健康与空腹血糖异常的妊娠糖尿病产妇不良妊娠结局的关系。方法选取2019年1月至2020年12月在温岭市妇幼保健院院产检的空腹血糖异常妊娠糖尿病产妇604例,根据母婴不良结局发生情况,分为子痫前期组(n=27)与非子痫前期组(n=577),计划性剖宫产组(n=535)与非计划性剖宫产组(n=69),巨大儿组(n=61)与非巨大儿组(n=543),以及新生儿低血糖组(n=58)和新生儿低血糖组(n=546),比较各组临床资料和妊娠期心血管健康评分的差异,并采用二元Logistic回归分析心血管健康评分与多项母婴不良结局的关系。结果非子痫前期组的血压、总胆固醇情况以及心血管健康评分均优于子痫前期组,差异有统计学意义(P<0.05);计划行剖宫产组的空腹血糖(fasting plasma glucose,FPG)、体质量指数(body mass index,BMI)、分娩时孕周以及心血管健康评分均优于非计划性剖宫产组,差异有统计学意义(P<0.05);非巨大儿组的FPG、总胆固醇、BMI、体力活动情况以及心血管健康评分均优于巨大儿组,差异有统计学意义(P<0.05);新生儿非低血糖组的FPG、膳食情况以及心血管健康评分均优于新生儿低血糖组,差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示,血压、总胆固醇及心血管健康评分是子痫前期的独立影响因素(P<0.05);FPG、心血管健康评分是非计划性剖宫产的独立影响因素(P<0.05);FPG、总胆固醇、BMI及心血管健康评分是巨大儿的独立影响因素(P<0.05);FPG、心血管健康评分是新生儿低血糖的独立影响因素(P<0.05)。结论空腹血糖异常的妊娠糖尿病产妇心血管健康程度越好,不良妊娠结局的风险就越低,为今后临床干预奠定了基础。

Objective To Analyze the relationship between cardiovascular health and adverse pregnancy outcomes in women with abnormal fasting glucose and gestational diabetes mellitus.Methods A total of 604 women with abnormal fasting glucose with gestational diabetes mellitus who delivered at Wenling Maternal and Child Health Hospital from January 2019 to December 2020 were selected and grouped according to the occurrence of adverse maternal and infant outcomes into pre-eclampsia group(n=27)and non-pre-eclampsia group(n=577),planned cesarean section group(n=535)and non-planned cesarean section group(n=69),and giant baby group(n=61)and non-giant group(n=543),and the neonatal hypoglycaemia group(n=58)and the neonatal hypoglycaemia group(n=546),to compare the differences in clinical information and cardiovascular health during pregnancy between the groups and to analyse the relationship between cardiovascular health and several adverse maternal and infant outcomes using binary Logistic regression.Results The non-pre-eclampsia group had better blood pressure,total cholesterol and cardiovascular health scores than the pre-eclampsia group,with a statistically significant difference(P<0.05);the planned caesarean section group had better fasting plasma glucose FPG,body mass index(BMI),week of pregnancy at delivery and cardiovascular health scores than the unplanned caesarean section group,with a statistically significant difference(P<0.05);the non-hypertrophic group had better FPG,total cholesterol,BMI,physical activity and cardiovascular health scores than the hypertrophic group(P<0.05);the non-neonatal hypoglycaemia group had better FPG,diet and cardiovascular health scores than the neonatal hypoglycaemia group(P<0.05).Binary Logistic regression analysis showed that blood pressure,total cholesterol and cardiovascular health score are independent influencing factors of preeclampsia(P<0.05);FPG and cardiovascular health score are independent influencing factors of unplanned cesarean section(P<0.05);FPG,total cholesterol,BMI and cardiovascular health score are independent influencing factors of macrosomia Influencing factors(P<0.05);FPG and cardiovascular health score are independent influencing factors of neonatal hypoglycemia(P<0.05).Conclusion The better the cardiovascular health of pregnant women with gestational diabetes mellitus with abnormal fasting glucose,the lower the risk of adverse pregnancy outcomes,which lays the foundation for future clinical interventions.