孕期血糖监测频率对饮食控制的妊娠期糖尿病围产结局的影响

目的:探讨血糖监测频率对饮食控制的妊娠期糖尿病(GDM)孕妇围产结局的影响。方法:选取2015年11月至2018年4月在浙江大学医学院附属妇产科医院产检并分娩单胎、孕前无糖尿病高血压疾病的5453例饮食控制的GDM孕妇。根据OGTT试验时的血糖水平将孕妇分为高危组2699例(49.5%)和低危组2754例(50.5%)。分别在高危和低危组中比较不同血糖监测频率组间临床资料及围产结局差异。采用单因素方差分析、χ2检验及二元logistic回归分析对数据进行统计分析。结果:高危组孕妇的平均年龄(33.21±4.50)岁vs(32.30±4.34)岁、孕前BMI(21.77±3.38)kg/m2 vs(21.26±3.20)kg/m2、经产妇比例(51.0%vs 47.9%)、糖尿病家族史(4.4%vs 3.3%)及巨大儿生产史比例(5.2%vs 4.1%)均显著高于低危组孕妇(P均<0.05),两组间血糖监测频率无显著差异。在围产结局方面,高危组孕妇的早产(10.8%vs 8.8%)及初次剖宫产比例(35.9%vs 31.3%)均显著高于低危组孕妇(P均<0.05)。高危组孕妇中,大于胎龄儿的发生率与血糖监测频率呈负相关(P<0.05);与从不监测血糖相比,偶尔监测和定期监测血糖均为大于胎龄儿的负相关独立影响因素(P<0.05,OR=0.708、0.644)。低危组孕妇中,不同血糖监测频率组间大于胎龄儿发生率差异无统计学意义。无论在低危还是高危孕妇中,其围产结局发生率在各血糖监测频率组间差异无统计学意义。结论:对于饮食控制的GDM孕妇,应在评估其高危程度后拟定个体化血糖监测方案。对于低危孕妇,单纯增加血糖监测频率对围产结局无明显助益;对于高危孕妇,增加血糖监测频率可显著减少大于胎龄儿的发生。

Effect of blood glucose monitoring frequency on perinatal outcome of GDM pregnant women with diet control

Objective:To investigate the effect of blood glucose monitoring frequency on the perinatal outcome of pregnant women with gestational diabetes mellitus(GDM)controlled by diet.Methods:5453 GDM pregnant women controlled by diet who underwent maternal examination and delivered singletons without diabetes and hypertension before pregnancy were collected in the Women's Hospital School of Medicine Zhejiang University from November 2015 to April 2018.The pregnant women were divided into high-risk group(2699 pregnant women)and low-risk group(2754 pregnant women)according to the blood glucose level at the time of OGTT test.The differences in clinical data and perinatal outcomes between groups with different blood glucose monitoring frequencies were compared between high-risk and low-risk groups.The datas were analyzed by one-way ANOVA,2 test and binary logistic regression analysis.Result:The average age of pregnant women in the high-risk group(33.21±4.50 vs 32.30±4.34),pre-pregnancy BMI(21.77±3.38)kg/m2 vs(21.26±3.20)kg/m2],proportion of multiparous women(51.0%vs 47.9%),family history of diabetes(4.4%vs 3.3%)and proportion of macrosomia(5.2%vs 4.1%)were significantly higher than those in the low-risk group(P<0.05),and the frequency of blood glucose monitoring between the two groups was not significantly different.In terms of perinatal outcomes,the proportion of premature delivery(10.8%vs 8.8%)and first cesarean section(35.9%vs 31.3%)of pregnant women in the high-risk group were significantly higher than those in the low-risk group(all P<0.05).Among high-risk pregnant women,the incidence of large-for-gestational-age was negatively correlated with the frequency of blood glucose monitoring(P<0.05).Compared with never monitoring blood glucose,occasional monitoring and regular monitoring of blood glucose were negatively correlated independent influencing factors for large-for-gestational-age(P<0.05,OR=0.708,0.644).However,in low-risk pregnant women,there was no significant difference in the incidence of large-for-gestational-age infants between groups with different blood glucose monitoring frequencies.The incidence of other perinatal outcomes did not differ significantly among the groups with different blood glucose monitoring frequencies.Conclusion:For GDM pregnant women with diet control,the individualized scheme should be formulated after assessing the high-risk degree.For low-risk pregnant women,increasing the frequency of blood glucose monitoring has no significant effect on perinatal outcomes;for high-risk pregnant women,increasing the frequency of blood glucose monitoring can significantly reduce the incidence of larger than gestational age infants.