Gui Juan, Li Aizhen, Su Xiaoling, Feng Ling
Department of Obstetrics and Gynecology, Tongji Hospital, Tongji medical college, Huazhong University of Science and Technology, Wuhan, Hubei, China.
BMC Pregnancy Childbirth. 2014 Jan 20;14:34. doi: 10.1186/1471-2393-14-34.
The purposes of this study were to explore whether the maternal-fetal outcomes differed among various types of hyperglycemia during pregnancy and whether the values of glycemic screening in the middle phase of pregnancy could predict maternal-fetal outcomes.
A retrospective study was conducted to study the incidence of maternal-fetal outcomes in 383 singleton pregnant women with diabetes or gestational diabetes admitted to our hospital from November 2007 to March 2013. Patients were divided into three groups: DM (Type 1 and Type 2 diabetes mellitus) group, mGDM (mild gestational diabetes mellitus) group and sGDM (severe gestational diabetes mellitus) group. Maternal basic characteristics, results of oral glucose tolerance test (OGTT), antenatal random glycemia and maternal-fetal outcomes were collected. Binary logistic regression was used to estimate the association of blood glucose with the maternal-fetal outcomes. Predictive accuracy was assessed by calculating the areas under the receiver operating characteristic curves.
The maternal basic characteristics, maternal complications and neonatal complications did not differ significantly between DM group and sGDM group, except neonatal intensive care units admission (NICU). Incidences of preterm, NICU and preeclampsia were significantly lower in the mGDM group than in the DM and sGDM groups (P < 0.05). After adjusted by confounding factors, the value of OGTT 0 h could predict pregnancy induced hypertension (PIH) (OR = 1.24, 95% CI [1.04 to 1.46], P = 0.015), preterm birth (OR = 1.23, 95% CI [1.03 to 1.47], P = 0.025) and stillbirth (OR = 1.55, 95% CI [1.14 to 2.10], P = 0.005); antenatal random glycemia could predict preterm birth (OR = 1.19, 95% CI [1.08 to 1.31], P < 0.001) and stillbirth (OR = 1.41, 95% CI [1.17 to 1.71], P < 0.001).
Pregnant women in the mGDM group have better outcomes than those in the DM and sGDM groups. The values of OGTT in the middle phase of pregnancy and antenatal random glycemia could predict PIH, preterm birth or stillbirth to some extent.
本研究的目的是探讨孕期不同类型高血糖的母婴结局是否存在差异，以及孕中期血糖筛查值能否预测母婴结局。
进行一项回顾性研究，以研究2007年11月至2013年3月期间我院收治的383例单胎糖尿病或妊娠期糖尿病孕妇的母婴结局发生率。患者分为三组：糖尿病（1型和2型糖尿病）组、轻度妊娠期糖尿病（mGDM）组和重度妊娠期糖尿病（sGDM）组。收集产妇基本特征、口服葡萄糖耐量试验（OGTT）结果、产前随机血糖及母婴结局。采用二元逻辑回归估计血糖与母婴结局的关联。通过计算受试者工作特征曲线下面积评估预测准确性。
糖尿病组和重度妊娠期糖尿病组之间产妇基本特征、产妇并发症和新生儿并发症无显著差异，但新生儿重症监护病房入院率（NICU）除外。轻度妊娠期糖尿病组早产、新生儿重症监护病房入院率和子痫前期的发生率显著低于糖尿病组和重度妊娠期糖尿病组（P<0.05）。经混杂因素校正后，OGTT 0小时值可预测妊娠高血压（PIH）（OR = 1.24，95%CI[1.04至1.46]，P = 0.015）、早产（OR = 1.23，95%CI[1.03至1.47]，P = 0.025）和死产（OR = 1.55，95%CI[1.14至2.10]，P = 0.005）；产前随机血糖可预测早产（OR = 1.19，95%CI[1.08至1.31]，P<0.001）和死产（OR = 1.41，95%CI[1.17至1.71]，P<0.001）。
轻度妊娠期糖尿病组孕妇的结局优于糖尿病组和重度妊娠期糖尿病组。孕中期OGTT值和产前随机血糖在一定程度上可预测妊娠高血压、早产或死产。
