围孕期空腹血糖对妊娠期糖尿病发生的预测作用及其与不良妊娠结局的关系

Predictive Effect of Fasting Blood Glucose during Pregnancy on the Occurrence of Gestational Diabetes Mellitus and its Relationship with Adverse Pregnancy Outcomes

目的:通过队列研究前瞻性分析围孕期空腹血糖(FPG)对妊娠期糖尿病(GDM)发生的预测作用及其与不良妊娠结局的关系,探讨从孕前、孕早期开始防控GDM的相对安全的孕前及孕早期FPG值。方法:选取2020年1月至2021年1月在重庆市妇幼保健院妇产科进行孕前体检并于检查后半年内妊娠的565例女性为研究对象,进行规范孕前检查,常规检测孕前FPG,分为孕前FPG低水平组(3.9 mmol/L≤FPG<5.0 mmol/L)和孕前FPG高水平组(5.0 mmol/L≤FPG<6.1 mmol/L)。孕10~12周检测孕早期FPG值,分为孕早期FPG低水平组(3.9 mmol/L≤FPG≤4.5 mmol/L)和孕早期FPG高水平组(4.5 mmol/L<FPG<5.1 mmol/L)。孕24~28周进行75 g口服葡萄糖耐量试验(OGTT)检测,并分为GDM组和妊娠期血糖正常组。分析比较妊娠期血糖正常组和GDM组的孕前FPG情况,探讨预测诊断GDM的孕前FPG界值,并分析不同孕前FPG水平与孕早期FPG的关系,比较不同孕前FPG、孕早期FPG的妇女不良妊娠结局的差异性。结果:孕前FPG高水平组的孕早期FPG高于孕前FPG低水平组(P<0.05)。当孕前FPG≥4.95 mmol/L时,妊娠后发生GDM的几率明显增加。且孕前FPG≥5.0 mmol/L或孕早期FPG>4.5 mmol/L时,妇女妊娠发生自然流产、死胎、早产、巨大儿、低出生体质量儿不良妊娠结局的风险增加,差异有统计学意义(P<0.05)。结论:当孕前FPG≥4.95 mmol/L或孕早期FPG>4.5 mmol/L时应引起足够的重视,必要时可给予干预,以防治GDM的发生,减小GDM对孕产妇及围产儿健康的影响。

Objective:To prospectively analyze the predictive effect of fasting blood glucose during pregnancy(FPG)on the occurrence of gestational diabetes mellitus(GDM)and its relationship with adverse pregnancy outcomes in a cohort study,and to explore the relatively safe value of preconception and early pregnancy FPG for the prevention and control of GDM in pre-pregnancy and early pregnancy.Methods:A total of 565 women who underwent a pre-pregnancy physical examination and were pregnant within six months of the examination in the Women Health Care Department of Chongqing Maternal and Child Health-Care Hospital between January 2020 and January 2021 were enrolled in our study.Standard pre-pregnancy examinations were conducted for participants and they were routinely tested for preconception FPG.According to the preconception FPG value,they were divided into low level of pre-pregnancy FPG group(3.9 mmol/L≤FPG<5.0 mmol/L)and high level of pre-pregnancy FPG group(5.0 mmol/L≤FPG<6.1 mmol/L).FPG values of early pregnancy were measured at 10-12 weeks of gestation and divided into low FPG level in early pregnancy group(3.9 mmol/L≤FPG≤4.5 mmol/L)and high FPG level in early pregnancy group(4.5 mmol/L4.5 mmol/L during early pregnancy,the incidence of adverse pregnancy outcomes during pregnancy was increased,including spontaneous abortion,stillbirth,premature delivery,macrosomia,and low birth weight infants,and the difference was statistically significant.Conclusions:Enough attention should be paid when FPG≥4.95 mmol/L before pregnancy or FPG>4.5 mmol/L during early pregnancy.The intervention should be given if necessary to prevent and control the occurrence of GDM and to reduce the influence of GDM on maternal and perinatal health.