妊娠期糖尿病孕妇糖化血红蛋白水平与母婴结局的关系

目的:分析妊娠期糖尿病(GDM)患者中不同糖化血红蛋白(HbAlc)水平与母婴妊娠结局的相关性,探讨HbAlc在产前糖尿病病情监测中的意义。方法:选取2014年1月至12月在青海省妇女儿童医院行产前检查并分娩的119例GDM孕产妇,根据产前HbAlc控制水平将119例产妇分为达标组(5%≤HbAlc6%,68例)、未达标组(6%≤Hb Alc7%,51例)。选取同期55例HbAlc正常产妇为对照组。比较3组的母婴结局,分析不同HbAlc水平与母婴结局的相关性。结果:妊娠期间高血压(25.5%vs 10.3%vs5.5%)、羊水过多(17.6%vs 7.4%vs 3.6%)、胎膜早破比例(29.4%vs 5.9%vs 3.6%)、子痫前期比例(15.7%vs 5.9%vs 3.6%)及剖宫产比例(76.5%vs 45.6%vs 47.3%)由高到低依次为未达标组达标组正常组。未达标组的妊娠高血压、胎膜早破、妊娠周期、剖宫产比例与达标组比较,差异有统计学意义(P0.05)。Pearson积矩相关分析显示,HbAlc与妊娠周期呈显著负相关(r=-0.166,P=0.028)。围产儿中早产比例(27.5%vs 11.8%vs 7.3%)、巨大儿比例(29.4%vs 10.3%vs 3.6%)、1min Apgar评分≤7分比例(25.5%vs 11.8%vs 7.3%)、新生儿体重[(3702.7±402.5)g vs(3561.3±380.4)g vs(3252.8±345.7)g]、新生儿低血糖比例(33.3%vs 11.8%vs 10.9%)高到低排序为未达标组达标组正常组。未达标组的早产儿比例、巨大儿比例、1min Apgar评分≤7分比例、新生儿低血糖比例均显著高于达标组(P0.05)。Pearson积矩相关分析显示,Hb Alc与新生儿1min Apgar评分呈显著负相关(r=-0.156,P=0.040)。结论:GDM产妇体内HbAlc水平与母婴结局密切相关,HbAlc水平越高,妊娠与分娩期间发生母婴并发症的几率就越大;可将HbAlc作为孕妇血糖控制的重要监测指标。

Study on relationship between the level of glycosylated hemoglobin and maternal and fe-tal outcomes in pregnant women with gestational diabetes mellitus

Objective:To analyze the relationship between levels of HbAlc and the ma-ternal and fetal outcomes in pregnant women with GDM, and to explore the significance of HbAlc in the monitoring of the disease. Methods:119 GDM women of Jan. to Dec. 2014 under-went antenatal examination and delivery in our hospital were selected as study objects,all cases were given health guidance and actively blood sugar control. 119 cases were divided into up to standard group(5%≤HbAlc<6%,68 cases) and not up to standard group (6%≤HbAlc<7%,51 cases) according to prenatal HbAlc level,and maternal & perinatal fetus outcome were recorded. Besides,55 HbAlc normal pregnant women of the same period were selected as control group,compare three groups of maternal and neonatal outcomes and analysis the relationship be-tween HbAlc levels and maternal and infant outcomes. Results:Sequence order from high to low of pregnancy hypertension during pregnancy ( 25 . 5% vs 10 . 3% vs 25 . 5%) , hydramnios (17. 6% vs 7. 4% vs 3. 6%), premature premature rupture of membranes ( PROM) ratio (29. 4% vs 5. 9% vs 3. 6%),preeclampsia ratio (15. 7% vs 5. 9% vs 3. 6%) and cesarean section ratio ( 76 . 5% vs 45 . 6% vs 47 . 3%) was not up to standard group> up to standard group >normal group. Not up to standard group whose pregnancy hypertension ratio,PROM rati-o,pregnancy period, cesarean section ratio were all significantly different from up to standard group. Pearson product moment correlation analysis showed that HbAlc and pregnancy period was significant negative correlated ( r=-0 . 16 , P=0 . 028 ) . Three groups with sequence order from high to low on perinatal maternal preterm births ratio(27. 5% vs 11. 8% vs 7. 3%),mac-rosomia ratio(29. 4% vs 10. 3% vs 29. 4%),ratio of 1 min apgar score<7 (25. 5% vs 11. 8%vs 7. 3%),neonatal weight[(3702. 7 ±402. 5)g vs (3561. 3±380. 4)g vs (3252. 8±345. 7) g],neonatal hypoglycemia ratio(33. 3% vs 11. 8% vs 10. 9%) was not up to standard group>up to standard group >normal group,either. Not up to standard group whose preterm births rati-o,macrosomia ratio, ratio of 1 min apgar score, neonatal hypoglycemia ratio were significantly higher than the up to standard group. Pearson product moment correlation analysis showed that HbAlc and neonatal 1min Apgar score with significantly negative correlation ( r=-0. 156,P=0 . 040 ) . Conclusion:GDM women whose HbAlc level is closely related to maternal and infant outcomes,the higher level of HbAlc,the higher risk of maternal and infant complications. HbAlc can be viewed as and important monitoring indicator for blood sugar control of GDM women.