GDM患者妊娠中期血糖异常项数及妊娠晚期血糖指标与妊娠结局的关系

The association between abnormal blood glucose items,blood glucose levels and pregnancy outcome in women with gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)患者孕24~28周的75 g口服葡萄糖耐量试验(OGTT)血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组(92例),2项异常为GDMⅡ组(48例),3项异常为GDMⅢ组(27例),比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果75 g OGTT血糖异常项数与孕前不同的体质指数(BMI)及妊娠晚期的糖化血红蛋白(HbA1c)间比较差异均有统计学意义(P<0.05)。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义(P<0.05);75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义(P<0.05);③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义(P<0.05)。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义(P<0.05)。结论孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA1c水平。

Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test(OGTT)at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus(GDM)patients.Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children’s Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects.The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠgroup(92 cases),with 2 abnormal items were GDMⅡgroup(48 cases),and with 3 abnormal items were GDMⅢgroup(27 cases).The demographic characteristics of the three groups of GDM patients were compared.The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed.Results①With different BMI and HbA1c,there were significant differences in 75 g OGTT blood glucose items(P<0.05).BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester(P<0.05).②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose(P<0.05).③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups(P<0.05).There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose(P<0.05).Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester.The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome.Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA1c level in the third trimester.