妊娠期糖尿病与出生结局的关联研究:脐动脉血流参数的中介作用

Association between umbilical artery ultrasound parameters and birth outcomes in gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)对出生结局和孕晚期脐动脉(UA)血流参数的影响,并分析UA血流参数在GDM与出生结局中的作用。方法以中国安徽—芜湖出生队列为基础,收集189例GDM孕妇为病例组,在非GDM孕妇中按照年龄、孕前体质量指数进行1∶1配对,选择189名正常孕妇作为对照组。按孕晚期空腹血糖将GDM孕妇分为控制不良组和控制良好组,并收集分析孕晚期UA血流参数和胎儿出生结局信息。结果与对照组相比,控制不良组和控制良好组UA参数升高(F=6.63,P<0.05;F=4.43,P<0.05;F=5.57,P<0.05)。GDM血糖控制不良会导致新生儿出生体质量增高和大于胎龄儿风险上升。多因素线性回归模型显示,控制不良组收缩期峰值流速/舒张末期流速(S/D)Z评分与出生体质量呈负相关(β=-209.78,95%CI:-301.48~-118.07)。S/D指数Z评分在血糖控制不良与出生体质量之间起到中介作用。中介效应值为-58.41(95%CI:-106.40~-19.65),占总效应的25.98%。结论GDM血糖控制不良是胎儿体质量增加的危险因素,UA血管功能以部分中介作用影响新生儿出生体质量。GDM孕妇应严格控制血糖水平以更好地保护母婴健康。

Objective To investigate the effects of gestational diabetes mellitus(GDM)on birth outcome and umbilical artery(UA)blood flow parameters in the third trimester,and to analyze the role of UA blood flow parameters in GDM and birth outcome.Methods Based on the birth cohort from Wuhu,Anhui,China,189 pregnant women with GDM were collected as the case group.The non-GDM pregnant women were matched 1:1 according to age and pre-pregnancy body mass index,and 189 normal pregnant women were selected as the control group.Pregnant women with GDM were divided into poorly controlled group and well controlled group according to fasting blood glucose in the third trimester.The UA blood flow parameters and fetal birth outcomes in the third trimester were tracked.Results Compared with the control group,UA parameters in poorly contrlled and well controlled groups significantly increased(F=6.63,P<0.05;F=4.43,P<0.05;F=5.57,P<0.05).Poor glycemic control of GDM was associated with increased birth weight and risk of larger than gestational age.The multi-factor linear regression model showed that the Z score of the peak systolic velocity/end diastolic velocity(S/D)in the poorly controlled group was negatively correlated with birth weight(β=-209.78,95%Cl:-301.48-118.07).S/D index Z score mediated the relationship between poor blood glucose control and birth weight.The intermediate effect value was-58.41(95%CI:-106.40~-19.65),accounting for 25.98%of the total effect.Conclusion Poor glycemic control in GDM is a risk factor for fetal weight gain,and UA function plays a partial mediating role in influencing neonatal birth weight.GDM pregnant women should strictly control blood glucose level to better protect maternal and infant health.