妊娠期糖尿病孕妇血糖控制情况及对胎儿畸形发生率的影响和相关性研究

Study on the effect of blood glucose control and the incidence of fetal malformation in pregnant women with gestational diabetes mellitus

目的探究妊娠期糖尿病(GDM)孕妇血糖控制情况及对胎儿畸形发生率的影响和相关性。方法收集2015年1月至2017年9月我院产科行产前检查为GDM的328例孕妇作为研究对象,根据血糖控制情况分为2组,对照组(142例)为血糖控制良好者,观察组(186例)为血糖控制不佳者;收集2组孕妇临床资料,比较孕妇临床结局、围生儿临床结局、胎儿畸形情况,并采用Pearson相关系数对血糖控制情况与胎儿畸形行关联性分析。结果孕妇妊娠结局上,观察组孕妇在妊娠期高血压、羊水过多、胎膜早破、剖宫产上发生率分别为12.64%、25.82%、8.24%、16.48%,显著高于对照组的1.37%、8.22%、2.74%、4.11%(χ~2=14.607、17.02、4.494、12.695,P<0.05)。围生儿临床结局比较中,观察组早产、窒息、窘迫、低血糖、巨大儿、高胆红素血症发生率分别为14.84%、23.08%、16.48%、20.33%、18.68%、10.44%,显著高于对照组的2.74%、4.11%、2.74%、3.42%、4.11%、4.11%(χ~2=13.849、23.33、16.47、20.735、16.065、4.61,P<0.05)。在胎儿畸形上,观察组心血管畸形发生率4.40%,显著高于对照组的0.68%(χ~2=4.18,P<0.05);且在畸形总发生率上,观察组显著高于对照组(χ~2=6.619,P<0.05)。结论 GDM孕妇血糖控制良好将有利于减少胎儿畸形的发生,因此建议临床需重视血糖异常孕妇,并及早对GDM孕妇行有效的血糖控制干预。

Objective:To investigate the effects of glycemic control and the incidence of fetal malformation in pregnant women with gestational diabetes mellitus(GDM).Methods:From January 2015 to September 2017,328 pregnant women who underwent prenatal examination for GDM in our hospital were enrolled.The patients were divided into two groups according to the glycemic control.The control group(142 patients)had good glycemic control.The observation group(186 cases)was poorly controlled by blood glucose;the clinical data of 2 groups of pregnant women were collected,the clinical outcomes of pregnant women,clinical outcomes of perinatal children,fetal malformations were compared,and Pearson correlation coefficient was used to correlate blood glucose control with fetal malformation.analysis.Results:In the pregnancy outcome of pregnant women,the incidence of gestational hypertension,amniotic fluid,premature rupture of membranes,and cesarean section in pregnant women was 12.64%,25.82%,8.24%,and 16.48%,respectively,which was significantly higher than that of the control group.1.37%,8.22%,2.74%,4.11%(χ^2=14.607,17.02,4.494,12.695,P<0.05).In the perinatal clinical outcome comparison,the incidence of premature delivery,asphyxia,distress,hypoglycemia,macrosomia,and hyperbilirubinemia in the observation group were 14.84%,23.08%,16.48%,20.33%,18.68%,and 10.44%,respectively.Significantly higher than 2.74%,4.11%,2.74%,3.42%,4.11%,4.11%of the control group(χ^2=13.849,23.33,16.47,20.735,16.065,4.61,P<0.05).In the fetal malformation,the incidence of cardiovascular malformation in the observation group was 4.40%,which was significantly higher than 0.68%in the control group(χ^2=4.18,P<0.05).In the total incidence of malformation,the observation group was significantly higher than the control group(χ^2=6.619,P<0.05).Conclusion:GDM pregnant women with good glycemic control will help reduce the occurrence of fetal malformations.Therefore,it is recommended that patients with abnormal blood glucose should be paid attention to in clinical practice,and effective glycemic control intervention for GDM pregnant women should be implemented early.