妊娠期糖尿病母亲新生儿低骨密度危险因素分析及相关模型构建

目的探究影响妊娠期糖尿病(gestational diabetes mellitus,GDM)母亲新生儿低骨密度的危险因素,并构建预测模型。方法选取2017年1月至2019年12月在广西壮族自治区江滨医院进行产检与分娩的200例GDM孕妇及其所产新生儿作为研究对象,根据新生儿是否出现低骨密度分为低骨密度组(50例)与正常骨密度组(150例),收集两组GDM孕妇的年龄、体质量指数(body mass index,BMI)、孕期增重、胎次、分娩方式、居住环境、孕期日均户外活动时间、孕期规律补钙情况、规律补充维生素D情况、家庭收入、血清钙水平、血清骨钙素(bone gla protein,BGP)、血清碱性磷酸酶(alkaline phosphatase,ALP)、25-羧基维生素D等资料并比较。经多因素Logistic回归分析探究影响GDM母亲新生儿低骨密度的危险因素,并建立预测模型。结果多因素Logistic回归分析得出孕期未规律补钙、未规律补充维生素D、低BGP水平及低ALP水平是GDM母亲新生儿低骨密度的危险因素。模型经ROC曲线分析得出AUC为0.869,灵敏度为79.64%,特异度为88.69%,通过验证得出模型预测灵敏度为81.82%,特异度为86.49%。结论孕期未规律补充钙与维生素D、BGP与ALP较低是GDM母亲新生儿低骨密度危险因素,根据危险因素建立预测模型能有效评估GDM母亲新生儿低骨密度发生风险。

Analysis of risk factors for low bone mineral density in newborns of gestational diabetic mothers and related model construction

Objective To explore the risk factors of low bone mineral density in neonates of gestational diabetes mellitus(GDM)mothers and construct a predictive model.Methods A total of 200 pregnant women with GDM and their newborns who underwent check-ups and delivery in Jiangbin Hospital of Guangxi Zhuang Autonomous Region from January 2017 to December 2019 were selected as the research objects.The newborns were classified as low bone density group(50 cases)and normal bone mineral density group(150 cases)according to whether they had low bone density.The age,body mass index(BMI),weight gain during pregnancy,parity,delivery method,living environment,daily average outdoor activity time,regular calcium supplementation during pregnancy,regular vitamin D supplementation during pregnancy,family income,serum calcium level,serum osteocalcin(bone gla protein,BGP),serum alkaline phosphatase(al-kaline phosphatase,ALP),25-Carboxy Vitamin D and other information were collected and compared during pregnancy of the two groups of GDM pregnant women.Multivariate logistic regression analysis was used to explore the risk factors of low bone mineral density in newborns of GDM mothers,and establish a predictive model.Results Multivariate logistic regression analysis showed that irregular calcium supplementation during pregnancy,irregular vitamin D supplementation during pregnancy,low BGP level and low ALP level were risk factors for low bone mineral density in newborns of GDM mothers.The ROC curve analysis of the model shows that the AUC was 0.869,the sensitivity was 79.64%,and the specificity was 88.69%.After verification,the model predicts that the sensitivity was 81.82%and the specificity was 86.49%.Conclusion Irregular supplementation of calcium and vitamin D,low BGP and ALP during pregnancy are risk factors for low bone mineral density in newborns with GDM.The establishment of a predictive model based on risk factors can effectively assess the risk of low bone mineral density in newborns with GDM mothers.