GDM患者妊娠中期血糖异常项数及妊娠晚期血糖指标与妊娠结局的关系

doi:10.3969/j.issn.1000-8535.2024.03.017

摘要/Abstract

摘要： 目的探讨妊娠期糖尿病（GDM）患者孕24~28周的75 g 口服葡萄糖耐量试验（OGTT）血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组（92例）,2项异常为GDMⅡ组（48例）,3项异常为GDMⅢ组（27例）,比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果 75 g OGTT血糖异常项数与孕前不同的体质指数（BMI）及妊娠晚期的糖化血红蛋白（HbA_1c）间比较差异均有统计学意义（P<0.05）。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义（P<0.05）;75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义（P<0.05）;③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义（P<0.05）。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义（P<0.05）。结论孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA_1c水平。

关键词: 妊娠期糖尿病, 糖化血红蛋白, 血糖异常, 妊娠结局

Abstract: Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test（OGTT）at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus（GDM）patients. Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children's Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects．The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠ group（92 cases）,with 2 abnormal items were GDMⅡ group（48 cases）,and with 3 abnormal items were GDM Ⅲ group（27 cases）．The demographic characteristics of the three groups of GDM patients were compared．The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed．Results ①With different BMI and HbA_1c,there were significant differences in 75 g OGTT blood glucose items（P<0.05）．BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester（P<0.05）．②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose（P<0.05）．③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups（P<0.05）．There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose（P<0.05）. Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester．The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome．Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA_1c level in the third trimester．

Key words: gestational diabetes, glycated hemoglobin, abnormal blood glucose, pregnant outcome

唐国一, 杨红梅, 杨恺欣, 曾慧倩, 曹晓旭. GDM患者妊娠中期血糖异常项数及妊娠晚期血糖指标与妊娠结局的关系[J]. 广州医药, 2024, 55(3): 316-323.

TANG Guoyi, YANG Hongmei, YANG Kaixin, ZENG Huiqian, CAO Xiaoxu. The association between abnormal blood glucose items,blood glucose levels and pregnancy outcome in women with gestational diabetes mellitus[J]. Guangzhou Medical Journal, 2024, 55(3): 316-323.

参考文献

[1] PREDA A,PĂDUREANU V,MOȚA M,et al.Analysis of maternal and neonatal complications in a group of patients with gestational diabetes mellitus[J].Medicina,2021,57(11):1170.
[2] 高云鹤,郑海清,殷彩欣,等.妊娠期糖尿病患者糖化血红蛋白及血糖指标异常与妊娠结局的相关性[J].实用妇产科杂志,2019,35(3):228-233.
[3] XODO S,LONDERO A P,D AGOSTIN M,et al.Is glycated hemoglobin A1c level associated with adverse pregnancy outcomes of women affected by pre-gestational diabetes?[J].Medicina,2021,57(5):461.
[4] 管小念,尹霭琦,童嘉宁,等.妊娠期糖尿病患者孕中期糖代谢指标与妊娠结局的关系[J].中国实用妇科与产科杂志,2022,38(5):553-557.
[5] KAYMAK O,ISKENDER D,DANISMAN N.Comparison of one hour versus 90 minute postprandial glucose measurement in women with gestational diabetes;which one is more effective?[J].J Obstet Gynaecol,2022,42(3):447-451.
[6] OZGU-ERDINC A S,ISKENDER C,UYGUR D,et al.One-hour versus two-hour postprandial blood glucose measurement in women with gestational diabetes mellitus:which is more predictive?[J].Endocrine,2016,52(3):561-570.
[7] GAO C,SUN X,LU L,et al.Prevalence of gestational diabetes mellitus in mainland China:A systematic review and meta analysis[J].J Diabetes Investing,2019,10(1):154-162.
[8] 隽娟. 美国糖尿病学会“2020年妊娠合并糖尿病诊治指南”介绍[J].中华围产医学杂志,2020,23(2):139-141.
[9] 徐恒,周梦林,钱婷婷,等.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[J].现代妇产科进展,2021,30(4):273-276.
[10] 陈劲松,梁绮华.妊娠期糖尿病与母婴分娩结局的相关性研究[J].广州医药,2020,51(2):110-116.
[11] 中华医学会妇产科学分会产科学组,中华医学会围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病诊治指南(2014)[J].中国实用乡村医生杂志,2017,24(8):45-52.
[12] American Clollege of Obstetricians Gynecologists.Physical activity and exercise during pregnancy and the postpartum period:ACOG Committee Opinion No.804)[J].Obstet Gynecol,2020,135(4):e178-e188.
[13] 崔斐. 首诊-复诊-住院-产后管理的模块化护理干预在妊娠期糖尿病患者围产期中的应用[J].广州医药,2022,53(4):56-59.
[14] 杨红梅,邓永芳,高玲玲.孕妇运动水平与运动自我效能、运动知识的相关性研究[J].中国实用护理杂志,2017,33(23):1785-1788.
[15] HUIFEN Z,YAPING X,MEIJING Z,et al.Effects of moderate-intensity resistance exercise on blood glucose and pregnancy outcome in patients with gestational diabetes mellitus:A randomized controlled trial[J].J Diabetes Complications,2022,36(5):108186.
[16] 中华医学会儿科分会新生儿学组.新生儿低血糖临床规范管理专家共识(2021)[J].中国当代儿科杂志,2022,24(1):1-13.
[17] 李任远,刘美兰,张莹.妊娠期糖尿病高危人群早期筛查、诊断与干预的研究进展[J].中华产科急救电子杂志,2021,10(2):122-125.
[18] 孙雪,于静,余瑶瑶,等.妊娠期糖尿病发病的危险因素的调查分析[J].中国卫生统计,2021,38(5):710-712.
[19] 丁冰杰,余焕玲,王佳,等.孕前超重/肥胖孕妇妊娠期糖尿病发病的危险因素研究[J].中国妇幼健康研究,2018,29(1):66-69.
[20] PLOWS J,STANLEY J,BAKER P,et al.The pathophysiology of gestational diabetes mellitus[J].Int J Mol Sci,2018,19(11):3342.
[21] 王成书,魏玉梅,杨慧霞.妊娠期糖尿病孕妇不同血糖指标异常与妊娠结局的关系[J].中华妇产科杂志,2013,48(12):899-902.
[22] GUI J,LI A,SU X,et al.Association between hyperglycemia in middle and late pregnancy and maternal-fetal outcomes:a retrospective study[J].BMC Pregnancy Childbirth,2014(14):34.
[23] 梁启峰. 妊娠期高血糖患者母体胰岛β细胞自身抗体对新生儿的影响[J].广州医药,2017,48(1):81-84.
[24] ZHANG X,WEI Y,FAN L,et al.A multicenter all-inclusive prospective study on the relationship between glycemic control markers and maternal and neonatal outcomes in pregnant women[J].J Matern Fetal Neonatal Med,2021,34(19):3154-3161.
[25] WEI Y,XU Q,YANG H,et al.Preconception diabetes mellitus and adverse pregnancy outcomes in over 6.4 million women:A population-based cohort study in China[J].PLoS Med,2019,16(10):e1002926.
[26] BUHARY B M,ALMOHAREB O,ALJOHANI N,et al.Glycemic control and pregnancy outcomes in patients with diabetes in pregnancy:A retrospective study[J].Indian J Endocrinol Metab,2016,20(4):481.
[27] MURPHY H R,HOWGATE C,O'KEEFE J,et al.Characteristics and outcomes of pregnant women with type 1 or type 2 diabetes:a 5-year national population-based cohort study[J].lancet Diabetes Endocrinol,2021,9(3):153-164.
[28] 韩炜,唐成和.母亲妊娠期糖尿病对胎儿结局影响的研究进展[J].中华实用儿科临床杂志,2022,37(14):1117-1120.
[29] NALLY L M,BONDY N,DOIEV J,et al.A feasibility study to detect neonatal hypoglycemia in infants of diabetic mothers using real-time continuous glucose monitoring[J].Diabetes Technol Ther,2019,21(4):170-176.
[30] ANTONIOU M C,GILBERT L,GROSS J,et al.Potentially modifiable predictors of adverse neonatal and maternal outcomes in pregnancies with gestational diabetes mellitus:can they help for future risk stratification and risk-adapted patient care?[J].BMC Pregnancy Childbirth,2019,19(1):469.
[31] 陈浩. 妊娠期糖尿病患者HbA1c水平与新生儿血糖的关系研究[J].实用糖尿病杂志,2021,17(1):72-73.
[32] 张晶晶,顾平,马婉贞,等.妊娠期糖尿病孕期餐后血糖监测与妊娠结局相关性的研究进展[J].护士进修杂志,2019,34(12):1103-1106.
[33] SIVAN E,WEISZ B,HOMKO C J,et al.One or two hours postprandial glucose measurements:Are they the same?[J].Am J Obstet Gynecol,2001,185(3):604-607.
[34] WEISZ B,SHRIM A,HOMKO C J,et al.One hour versus two hours postprandial glucose measurement in gestational diabetes:A prospective study[J].J Perinatol,2005,25(4):241-244.