妊娠晚期三酰甘油水平及产前体重指数对单胎妊娠结局的预测价值

The predictive value of late pregnancy triglyceride levels and prenatal body mass index on singleton pregnancy outcomes

目的分析单胎孕妇妊娠晚期血脂水平、产前体重指数与不良妊娠结局的相关性。方法回顾性队列研究2021年5月至2022年5月在东部战区总医院秦淮医疗区建卡分娩的473例单胎孕妇的临床资料。不良妊娠结局为不良结局组(n=181,其中产后出血38例,巨大儿42例,妊娠期糖尿病48例,妊娠期高血压23例,早产30例),正常妊娠者为对照组(n=292)。比较基本临床资料、三酰甘油(TG)和总胆固醇(TC)水平。行多因素Logistic回归分析明确不良妊娠结局发生的独立危险因素。绘制ROC曲线分析三酰甘油及产前体重指数预测不良妊娠结局的价值。结果Logistic回归模型分析结果显示孕妇年龄、分娩孕周、产前BMI、三酰甘油、孕期增重均为不良妊娠结局的影响因素(P<0.05)。利用Logistic回归分析矫正年龄、分娩孕周、孕期增重混杂因素影响后,显示三酰甘油、产前体重指数仍为不良妊娠结局的危险因素(OR>1,P<0.05)。ROC曲线显示TG>2.945 mmol/L、BMI>28.325 kg/m^(2)可作为妊娠晚期预测巨大儿、妊娠糖尿病、妊娠期高血压疾病的血清指标(P<0.05),联合检测的曲线下面积为0.710~0.779,敏感性为65.2%~71.0%,特异性为71.2%~81.8%。结论妊娠晚期高三酰甘油水平、产前体重指数增加与不良妊娠结局有一定的相关性,其联合检测对巨大儿、妊娠期糖尿病、妊娠期高血压疾病有较高的预测价值。

Objective To analyze the correlation between late pregnancy lipid levels,prenatal body mass index and adverse pregnancy outcomes in singleton pregnant women.Methods A retrospective cohort study was conducted on the clinical data of 473 singleton pregnancies who gave birth in Qinhuai Medical Area,General Hospital of Eastern Theater Command from May 2021 to May 2022.The adverse pregnancy outcome group was the observation group(n=181,including 38 cases of postpartum hemorrhage,42 cases of fetal macrosomia,48 cases of gestational diabetes mellitus,23 cases of gestational hypertension,30 cases of premature delivery),and those with normal pregnancies were the control group(n=292).Basic clinical data,triglyceride(TG)and total cholesterol(TC)were compared.Multivariate logistic regression was used to identify the independent risk factors for the adverse pregnancy outcomes.ROC curveswere drawn to analyze the value of TG and prenatal body mass index in predicting adverse pregnancy outcomes.Results Logistic regression model analysis results showed that maternal age,gestational age at delivery,prenatal BMI,triglycerides,and weight gain during pregnancy were all risk factors for adverse pregnancy outcomes(P<0.05).Logistic regression analysis was used to correct for the influence of confounding factors such as age,gestational age at delivery,and weight gain during pregnancy.It was shown that triglycerides and prenatal body mass index were still risk factors for adverse pregnancy outcomes(OR>1,P<0.05).ROC curves show that TG>2.945 mmol/L and BMI>28.325 kg/m^(2)can be used as serum indicators for predicting macrosomia,gestational diabetes mellitus and gestational hypertension in late pregnancy(P<0.05).The area under the curve of joint detection was 0.710-0.779,the sensitivity was 65.2%-71.0%,and the specificity was 71.2%-81.8%.Conclusion High triglyceride levels in late pregnancy and increased prenatal body mass index have a certain correlation with adverse pregnancy outcomes.The joint detection has a high predictive value for macrosomia,gestational diabetes mellitus and gestational hypertension.