益生菌不同用药时机对妊娠合并糖尿病患者胰岛素抵抗及妊娠结局的影响

目的:探讨益生菌不同用药时机对妊娠合并糖尿病患者胰岛素抵抗及妊娠结局的影响。方法:选择2019年5月至2021年5月在衡水市妇幼保健院就建档分娩的妊娠合并糖尿病患者，分为对照组、孕早期组、孕中期组和孕晚期组，每组200例。对照组仅采用常规干预措施(未予以益生菌制剂)，孕早期组、孕中期组和孕晚期组均予以双歧杆菌三联活菌肠溶胶囊420 mg，每日2次口服，疗程均为12周。比较4组患者分娩时血糖水平、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、血脂水平、产妇及新生儿不良妊娠结局等情况。结果:共纳入783例患者。孕早期组、孕中期组和孕晚期组患者分娩时血糖水平、HbA1c、HOMA-IR和血脂水平均优于对照组，孕中期组和孕晚期组优于孕早期组(P<0.05)，而孕中期组和孕晚期组比较差异无统计学意义(P>0.05)。孕早期组、孕中期组和孕晚期组产妇及新生儿妊娠结局不良发生率均小于对照组，孕中期组和孕晚期组产妇及新生儿妊娠结局不良发生率均小于孕早期组，孕中期组早产和产后感染小于孕晚期组(P<0.05)。结论:益生菌不同用药时机对妊娠合并糖尿病患者胰岛素抵抗及妊娠结局存在一定差异，其中孕中期(孕14~16周)开始用药为最佳用药时机。

Study the effect of insulin resistance and pregnancy outcome of probiotics with different medication timing in pregnancy diabetes patients

OBJECTIVE To investigate the effect of insulin resistance and pregnancy outcome of probiotics with different medication timing in pregnancy diabetes patients.METHODS Pregnancy diabetes patients who were selected for treatment and filed delivery in our hospital from May 2019 to My 2021 were divided into the control group,the first trimester group,the second trimester group and the third trimester group,200 patients in each group. The control group were only given conventional interventions (no given probiotics),and other patients were given Bifidobacterium triple live bacteria enteric-coated capsules 420 mg,orally twice a day,the course of treatment were 12 weeks. The 4 groups of patients at delivery in blood sugar level,glycosylated hemoglobin (HbA1c),insulin resistance index (HOMA-IR),blood lipid level,maternal and neonatal adverse pregnancy outcomes were compared.RESULTS A total of 783 patients were included. The results showed that blood glucose level,HbA1c,HOMA-IR and blood lipid level of during delivery in the first trimester group,the second trimester group and the third trimester group were better than those in the control group,the second trimester group and the third trimester group were better than those in the first trimester group (P<0.05),and no significant difference between the second trimester group and the third trimester group (P>0.05).The incidence of poor maternal and neonatal pregnancy outcomes in the first trimester group,the second trimester group and the third trimester group was lower than those of the control group,and the second trimester group and the third trimester group was lower than those of the first trimester group,premature delivery and postpartum infections in the second trimester group were less than those in the third trimester group(P<0.05).CONCLUSION There are certain differences in the timing of probiotics for insulin resistance and pregnancy outcomes in pregnancy diabetes patients,and the best timing of medication is the second trimester (14-16 weeks gestation).