基于智能手机APP的院内外综合管理对妊娠期糖尿病的效果研究

Effects of comprehensive management based on a smartphone APP in women with gestational diabetes mellitus

目的探讨使用智能手机应用程序(APP)对妊娠期糖尿病(GDM)患者进行孕期院内外综合管理对其孕期血糖水平及妊娠结局的影响。方法为回顾性队列研究,选取2022年1至12月于中国科学技术大学附属第一医院产科分娩并注册我国首个GDM院内外管理互联网服务平台——糖妈妈APP的GDM患者为研究对象,计算其注册APP到完成当次分娩时间段内的APP总体使用活跃度(由血糖监测频率、线上沟通频率、课程学习频率总和组成),并基于此结果将GDM患者分为高活跃度组和低活跃度组。收集研究对象年龄、教育程度、控糖方式、产次,体重和身高并计算孕前体重指数(BMI),糖化血红蛋白(HbA_(1c))并计算HbA_(1c)达标率(HbA_(1c)<6%),孕产妇结局[妊娠期体重增加(GWG)、剖宫产],新生儿结局[大于胎龄儿(LGA)、巨大儿、新生儿高胆红素血症]及新生儿住院费用。采用两独立样本t检验、Mann-WhitneyU检验、卡方检验和Fisher精确检验进行组间比较,采用logistic回归模型分析APP总体使用活跃度对不良妊娠结局的影响。结果共纳入GDM患者616例。其中,高活跃度组308例,低活跃度组308例。与低活跃度组相比,高活跃度组GDM患者孕晚期HbA1c较低[分别为(5.6±0.4)%和(5.5±0.4)%,t=-2.341,P=0.020],孕晚期HbA1c达标率较高[分别为81.1%(154/190)和89.9%(186/207),χ^(2)=6.243,P=0.012],GWG较少[分别为(12.7±5.7)和(11.1±5.7)kg,t=-3.469,P=0.001];高活跃度组剖宫产[分别为53.9%(166/308)和45.1%(139/308),χ^(2)=4.734,P=0.030]、LGA[分别为23.1%(71/308)和11.7%(36/308),χ^(2)=13.855,P<0.001]、巨大儿[分别为14.3%(44/308)和8.8%(27/308),χ^(2)=4.601,P=0.032]及新生儿高胆红素血症[分别为14.9%(46/308)和9.1%(28/308),χ^(2)=4.976,P=0.026]发生率较低,新生儿住院费用较少[分别为5740.0(4465.8,7292.6)元和5304.9(4219.0,5901.2)元,Z=-2.383,P=0.017]。logistic回归分析结果显示,校正孕妇年龄、孕前BMI、教育程度、控糖方式、产次后,GDM患者APP总体使用活跃度高是孕晚期HbA1c达标率增加(OR=2.20,95%CI 1.17~4.12,P=0.014),以及LGA(OR=0.43,95%CI 0.27~0.68,P<0.001)及巨大儿(OR=0.59,95%CI 0.35~0.99,P=0.044)、新生儿高胆红素血症发生率降低(OR=0.56,95%CI 0.34~0.93,P=0.025)的影响因素。结论糖妈妈APP的使用频率增加与GDM患者孕期血糖水平降低和不良妊娠结局风险降低有关。

Objective To evaluate the impact of comprehensive in-hospital and outpatient management using a smartphone application(APP)on glycemic control and pregnancy outcomes in women with gestational diabetes mellitus(GDM).Methods This was a retrospective cohort study.GDM patients who delivered at the Department of Obstetrics,the First Affiliated Hospital of University of Science and Technology of China from January to December 2022,and were registered in the TangMama APP(first internet service platform for GDM management inside and outside hospitals in China)were selected as study subjects.GDM patients were divided into a high-active group and a low-active group based on their overall activity of using the APP(including frequency of blood glucose monitoring,frequency of online communication,and frequency of course learning).Data on age,education level,management of diagnosis,parity,weight,height,pre-pregnancy body mass index(BMI),glycated hemoglobin(HbA_(1c)),HbA_(1c) level in the third trimester<6%,maternal outcomes[gestational weight gain(GWG),cesarean section],neonatal outcomes[large for gestational age(LGA),macrosomia,neonatal hyperbilirubinemia]and neonatal hospitalization costs were collected.Independent sample t-tests,Mann-Whitney U tests,chi-square tests,and Fisher′s exact tests were used for intergroup comparisons.Logistic regression models were used to analyze the association between overall APP usage activity and adverse pregnancy outcomes.Results A total of 616 GDM patients were included,with 308 in the high-activity group and 308 in the low-activity group.Compared with the low-active group,the high-active group demonstrated a lower HbA1c level in the third trimester[(5.6±0.4)%vs.(5.5±0.4)%,t=-2.341,P=0.020],a higher rate of HbA_(1c) level in the third trimester<6%[81.1%(154/190)vs.89.9%(186/207),χ^(2)=6.243,P=0.012],and lower GWG[(12.7±5.7)vs.(11.1±5.7)kg,t=-3.469,P=0.001].The rates of cesarean section[53.9%(166/308)vs.45.1%(139/308),χ^(2)=4.734,P=0.030],LGA[23.1%(71/308)vs.11.7%(36/308),χ^(2)=13.855,P<0.001],macrosomia[14.3%(44/308)vs 8.8%(27/308),χ^(2)=4.601,P=0.032],and neonatal hyperbilirubinemia[14.9%(46/308)vs.9.1%(28/308),χ^(2)=4.976,P=0.026]were lower in the high-active group.The cost of pediatric hospitalization was lower[RMB 5740.0(4465.8,7292.6)Yuan vs.RMB 5304.9(4219.0,5901.2)Yuan,Z=-2.383,P=0.017]in the high-active group.After adjustment for maternal age,pre-pregnancy BMI,educational level,management of diagnosis and parity,higher overall activity was associated with an increased rates of HbA1c level in the third trimester<6%(OR=2.20,95%CI 1.17-4.12,P=0.014),and decreased rates of LGA(OR=0.43,95%CI 0.27-0.68,P<0.001),macrosomia(OR=0.59,95%CI 0.35-0.99,P=0.044),and neonatal hyperbilirubinemia(OR=0.56,95%CI 0.34-0.93,P=0.025)in the logistic regression.Conclusion Higher frequency of TangMama APP use was associated with better maternal glycemic control and a reduced risk of adverse pregnancy outcomes in women with GDM.