75g OGTT不同时间点血糖指标与妊娠期糖尿病产妇妊娠结局的关系分析

摘要

目的:研究75 g口服葡萄糖耐量试验 (OGTT) 不同时间点血糖指标与妊娠期糖尿病 (GDM) 产妇妊娠结局的关系.方法:403例GDM产妇, 其75 g OGTT结果中仅1项血糖升高为A组 (空腹血糖升高为A1组, 1小时血糖升高为A2组, 2小时血糖升高为A3组), 2项血糖升高为B组 (空腹及1小时血糖升高为B1组, 空腹及2小时血糖升高为B2组, 1小时及2小时血糖升高为B3组), 3项血糖升高为C组.回顾性分析孕妇一般资料和妊娠结局.结果:A、B、C 3组孕妇甲状腺功能减退、妊娠期高血压疾病、剖宫产发生率及新生儿体质量指数 (BMI) 、胸围、巨大儿、早产、转入新生儿科发生率比较差异有统计学意义 (P＜0.05), C组母儿不良结局发生率高于A、B组;A2组新生儿BMI、胸围、胎儿窘迫及剖宫产发生率高于A1和A3组 (P＜0.05);B3组巨大儿及剖宫产发生率低于B1与B2组.结论:75 g OGTT 3项时间点血糖均升高的GDM产妇母儿不良结局增加;空腹及任何1项服糖后血糖升高时, 产妇剖宫产及新生儿巨大儿发生率增加;1小时血糖升高和新生儿BMI可能有关.%Objective:To study the relationship between pregnancy outcomes and blood glucose index at different time points in 75 g oral glucose tolerance test (OGTT).Methods:A total of 403 pregnant women who receiveda 75 g OGTT were enrolled.Pregnant women were divided into three groups:group A with one abnormal blood glucose level (group A1:abnormal fasting glucose level;group A2:abnomal 1 hour glucose level;group A3:abnormal 2 hour glucose level), group B with two abnormal blood glucose level (group B1:abnormal fasting and 1 hour glucose level;group B2:abnormal fasting and 2 hours glucose level;group B3:abnormal 1 hour and 2 hours glucose level), and group C with abnormal blood glucose level in all three time points.Retrospective analysis of general information and pregnancy outcomes of pregnant women.Results:There were significant differences in A, B and C groups when comparing the incidence of hypothyroidism, hypertensive disorders of pregnancy, cesarean section rate, neonatal body mass index (BMI), chest circumference, macrosomia preterm birth and transfer to Neonatal Intensive Care Unit (P＜0.05), and the incidence of adverse outcomes in group C was higher than that in group A and B.The neonatal body mass index, chest circumference and fetal distress rate and cesarean section rate in the A2 group were significantly higher than those in the A1 and A3 groups (P＜0.05).The incidence of macrosomia and cesarean section in group B3 was lower than that in group B1 and B2 (P＜0.05).Conclusions:The maternal and neonatal adverse outcomes would increase if the abnormal glucose level was detected in all three time points in 75 g OGTT.When the fasting and 1 or 2 hour blood glucose level were abnormal, the incidence of neonatal macrosomia would increase.There could be a correlation between 1 hour blood glucose level and neonatal body mass index.