妊娠糖尿病孕妇贫血发生的危险因素分析及营养支持策略

Analysis of risk factors and nutritional support strategies for anemia in pregnant women with gestational diabetes mellitus

目的探究妊娠糖尿病(GDM)孕妇贫血发生的危险因素,分析营养支持策略对贫血发生及妊娠结局的影响。方法选择2020年7月至2021年10月于成都医学院第二附属医院核工业四一六医院进行产检的121例GDM孕妇作为研究对象,根据贫血发生情况分为贫血组(49例)和非贫血组(72例)。比较两组孕妇的临床资料,多因素Logistic回归分析影响GDM孕妇贫血发生的因素;构建列线图预测模型,并评价其预测效能。根据孕期营养支持情况将GDM合并贫血孕妇分为营养支持组(23例)和非营养支持组(26例),比较两组孕妇的妊娠结局相关指标。结果多因素Logistic回归分析结果显示,年龄≥35岁、流产次数≥3次、孕期素食为主、糖化血红蛋白A1c(HbA1c)<6.18%、孕期未坚持使用叶酸是影响GDM孕妇贫血发生的危险因素,预防性口服铁剂和营养支持是保护因素(P<0.05)。列线图预测模型的区分度较好,准确性和有效性较高。非营养支持组的胎膜早破、剖宫产、巨大儿比例明显高于营养支持组(P<0.05)。结论年龄、流产、饮食、HbA1c、孕期使用叶酸、预防性口服铁剂和营养支持均与GDM孕妇贫血发生相关,营养支持还能够降低不良妊娠结局的发生率。

Objective To explore the risk factors of anemia in pregnant women with gestational diabetes mellitus(GDM),and to analyze the effects of nutritional support strategies on the occurrence of anemia and pregnancy outcome.Methods A total of 121 pregnant women with GDM who underwent antenatal examination in the 2nd Affiliated Hospital of Chengdu Medical College from July 2020 to October 2021 were divided into anemia group(n=49)and non-anemia group(n=72)according to the occurrence of anemia.The clinical data of pregnant women in the two groups were compared,and the factors affecting anemia in pregnant women with GDM were analyzed by multivariate Logistic regression analysis,and the predictive model was constructed and evaluated.According to the status of nutritional support during pregnancy,pregnant women with anemia in GDM were divided into nutritional support group(n=23)and non-nutritional support group(n=26).The pregnancy outcome indexes of the two groups were compared.Results The results of multivariate Logistic regression analysis showed that age≥35 years old,times of miscarriage≥3 times,vegetarian diet during pregnancy,glycosylated hemoglobin A1c(HbA1c)<6.18%,non-use of folic acid during pregnancy were risk factors for anemia in GDM pregnant women,and preventive oral iron and nutritional support were protective factors(P<0.05).The nomogram prediction model has good differentiation,high accuracy and effectiveness.The proportion of premature rupture of membranes,cesarean section and macrosomia in the non-nutritional support group was significantly higher than that in the nutritional support group(P<0.05).Conclusion Age,miscarriage,diet,HbA1c,use of folic acid during pregnancy,preventive oral iron and nutritional support were all associated with anemia in pregnant women with GDM,and nutritional support could reduce the incidence of adverse pregnancy outcomes.