脐动脉多普勒与无应激试验在评估妊娠期糖尿病胎儿健康状况中的比较：一项前瞻性队列研究。
Comparison of umbilical artery Doppler and non-stress test in assessment of fetal well-being in gestational diabetes mellitus: A prospective cohort study.
作者信息
Niromanesh Shirin, Shirazi Mahboobeh, Eftekhariyazdi Mitra, Mortazavi Forough
机构信息
Perinatologist, Professor, Maternal, Fetal and Neonatal Research Center, Women Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Perinatologist, Associate Professor, Breast Feeding Research Center, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Electron Physician. 2017 Dec 25;9(12):6087-6093. doi: 10.19082/6087. eCollection 2017 Dec.
BACKGROUND
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is related to poor perinatal outcomes. Reduction of neonatal complications of GDM is feasible by assessment of fetal well-being. Both fetal Doppler and NST are used for the screening of high-risk pregnancies.
OBJECTIVE
We aimed to compare the non-stress test (NST) and umbilical artery (UA) Doppler assessments for evaluation of the adverse perinatal outcomes in GDM.
METHODS
We conducted a prospective cohort study on 50 pregnant women with GDM in Jame Zanan Hospital, Tehran, Iran, from Oct 2014 to Sep 2015. A convenient sampling method was used for patient recruitment. Inclusion criteria were women with GDM, singleton pregnancies, and gestational age>32 weeks who had neither medical conditions nor fetal anomalies. Adverse perinatal outcomes were defined as Apgar scores at 1-min and 5-min <7, hypoglycemia (blood glucose <45 mg/dl), neonatal acidosis (PH<7.2), hypocalcemia (Ca<8 mg/dl), admission to the NICU for more than 24 hours, and perinatal death. Statistical analyses were performed with SPSS version 16 using Chi-square, Fisher's exact test, and independent-samples t-test. The significance level was considered at 0.05.
RESULTS
Totally, 22% and 12% of women had an abnormal UA Doppler and a non-reactive NST respectively. Poor outcomes were detected in 13 women. The most frequent poor outcomes were hypoglycemia (n=9), Apgar 1-min <7 (n=8), neonate admitted in NICU (n=6), and respiratory distress syndrome (n=6). Poor outcome was more prevalent in women with non-reactive NST (p<0.001), abnormal UA Doppler (p=0.033), and those with infant birth weight >4000 gram (p=0.033). Sensitivity and specificity of the NST in predicting different poor outcomes were 76.9% and 97.3% respectively. Sensitivity and specificity of UA Doppler in predicting different poor outcomes were 30.8% and 94.6% respectively.
CONCLUSION
NST is a better predictor of adverse perinatal outcomes in GDM patients.
背景
妊娠期糖尿病（GDM）是妊娠最常见的医学并发症之一，与不良围产期结局相关。通过评估胎儿健康状况来降低GDM的新生儿并发症是可行的。胎儿多普勒检查和无应激试验（NST）均用于高危妊娠的筛查。
目的
我们旨在比较无应激试验（NST）和脐动脉（UA）多普勒检查对评估GDM患者不良围产期结局的作用。
方法
2014年10月至2015年9月，我们在伊朗德黑兰贾梅扎南医院对50例GDM孕妇进行了一项前瞻性队列研究。采用方便抽样法招募患者。纳入标准为患有GDM、单胎妊娠且孕周>32周，无内科疾病及胎儿畸形的女性。不良围产期结局定义为1分钟和5分钟时阿氏评分<7分、低血糖（血糖<45mg/dl）、新生儿酸中毒（PH<7.2）、低钙血症（Ca<8mg/dl）、入住新生儿重症监护病房（NICU）超过24小时以及围产期死亡。使用SPSS 16版软件进行统计分析，采用卡方检验、Fisher精确检验和独立样本t检验。显著性水平设定为0.05。
结果
总体而言，分别有22%和12%的女性UA多普勒检查异常和NST无反应。13名女性出现了不良结局。最常见的不良结局是低血糖（n = 9）、1分钟阿氏评分<7分（n = 8）、新生儿入住NICU（n = 6）和呼吸窘迫综合征（n = 6）。NST无反应的女性（p<0.001）、UA多普勒检查异常的女性（p = 0.033）以及婴儿出生体重>4000克的女性（p = 0.033）中不良结局更为普遍。NST预测不同不良结局的敏感性和特异性分别为76.9%和97.3%。UA多普勒检查预测不同不良结局的敏感性和特异性分别为30.8%和94.6%。
结论
NST是GDM患者不良围产期结局的更好预测指标。
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