75 g 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
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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.
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.
引文
[1] Logakodie S,Azahadi O,Fuziah P,et al.Gestational diabetes mellitus:the prevalence,associated factors and foeto-maternal outcome of women attending antenatal care[J].Malaysian Family Physician the Official Journal of the Academy of Family Physicians of Malaysia,2017,12(2):9.
[2] Zyl HV,Levitt NS.Pregnancy outcome in patients with pregestational and gestational diabetes attending Groote Schuur Hospital,Cape Town,South Africa[J].S Afr Med J,2018,108(9):772-776.
[3] 余慧敏.不同时点糖代谢异常孕妇胰岛素抵抗与β细胞功能探讨[J].当代医学,2016,22(14):54-55.
[4] Miyakoshi K,Tanaka M,Saisho Y,et al.Pancreatic β-cell function and fetal growth in gestational impaired glucose tolerance[J].Acta Obstet Gynecol Scand,2011,89(6):769-775.
[5] Zar?ba-Szczudlik J,Pyka?o-Gawińska D,St?pień A,et al.Gestational diabetes mellitus(GDM)-do the number of fulfilled diagnostic criteria predict the perinatal outcome[J].Ginekol Pol,2018,89(7):381-387.
[6] 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):112-115.
[7] Yang S,Shi FT,Leung PC,et al.Low thyroid hormone in early pregnancy is associated with an increased risk of gestational diabetes mellitus[J].Journal of Clinical Endocrinology & Metabolism,2016,101(11):jc20161506.
[8] 苏艺.OGTT血糖异常的妊娠期糖尿病孕妇的临床特点及妊娠结局分析[J].中国计划生育学杂志,2016,24(10):677-681.
[9] Stomnaroska-Damcevski O,Petkovska E,Jancevska S,et al.Neonatal hypoglycemia:a continuing debate in definition and management[J].Prilozi,2015,36(3):91-97.
[10] 王丽萍,黄金,杨卉.口服葡萄糖耐量试验不同时间点血糖水平对妊娠期糖尿病诊断结果的差异及妊娠结局的影响研究[J].中国全科医学,2016,19(32):3918-3922.
[11] Davidson S,Natan D,Novikov I,et al.Body mass index and weight-for-length ratio references for infants born at 33-42 weeks gestation:a new tool for anthropometric assessment[J].Clinical Nutrition,2011,30(5):634-639.
[12] 宋培歌,潘迎,武明辉,等.胎龄别新生儿体质指数分析[J].中国儿童保健杂志,2014,22(4):347-349.
[13] 于彦丽.巨大儿相关因素探讨[J].中外医疗,2011,30(35):41-42.
[14] Mello G,Parretti E,Cioni R,et al.The 75-gram glucose load in pregnancy:relation between glucose levels and anthropometric characteristics of infants born to women with normal glucose metabolism[J].Diabetes Care,2003,26(4):1206-1210.
[15] Shi P,Yang W,Yu Q,et al.Overweight,gestational weight gain and elevated fasting plasma glucose and their association with macrosomia in chinese pregnant women[J].Maternal & Child Health Journal,2014,18(1):10-15.
[16] 刘乐.OGTT各时间点血糖值在诊断糖代谢异常中的意义及1 h高血糖者糖代谢特征的研究[D].天津:天津医科大学,2010.
[17] Rayanagoudar G,Hashi AA,Zamora J,et al.Quantification of the type 2 diabetes risk in women with gestational diabetes:a systematic review and meta-analysis of 95,750 women[J].Diabetologia,2016,59(7):1403-1411.
[18] Abdul-Ghani MA,Stern MP,lyssenko V,et al.Mininal contribution of fasting Hyperglycemia to the incidence of type 2 diabetes in subjects with normal 2-h Plasma glucose[J].Dia Getes care,2010,33(3):557-561.
[19] 陈小丽.妊娠期糖尿病孕妇各项血糖指标异常对妊娠结局的影响[J].深圳中西医结合杂志,2015,25(10):24-26.
[2] Zyl HV,Levitt NS.Pregnancy outcome in patients with pregestational and gestational diabetes attending Groote Schuur Hospital,Cape Town,South Africa[J].S Afr Med J,2018,108(9):772-776.
[3] 余慧敏.不同时点糖代谢异常孕妇胰岛素抵抗与β细胞功能探讨[J].当代医学,2016,22(14):54-55.
[4] Miyakoshi K,Tanaka M,Saisho Y,et al.Pancreatic β-cell function and fetal growth in gestational impaired glucose tolerance[J].Acta Obstet Gynecol Scand,2011,89(6):769-775.
[5] Zar?ba-Szczudlik J,Pyka?o-Gawińska D,St?pień A,et al.Gestational diabetes mellitus(GDM)-do the number of fulfilled diagnostic criteria predict the perinatal outcome[J].Ginekol Pol,2018,89(7):381-387.
[6] 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):112-115.
[7] Yang S,Shi FT,Leung PC,et al.Low thyroid hormone in early pregnancy is associated with an increased risk of gestational diabetes mellitus[J].Journal of Clinical Endocrinology & Metabolism,2016,101(11):jc20161506.
[8] 苏艺.OGTT血糖异常的妊娠期糖尿病孕妇的临床特点及妊娠结局分析[J].中国计划生育学杂志,2016,24(10):677-681.
[9] Stomnaroska-Damcevski O,Petkovska E,Jancevska S,et al.Neonatal hypoglycemia:a continuing debate in definition and management[J].Prilozi,2015,36(3):91-97.
[10] 王丽萍,黄金,杨卉.口服葡萄糖耐量试验不同时间点血糖水平对妊娠期糖尿病诊断结果的差异及妊娠结局的影响研究[J].中国全科医学,2016,19(32):3918-3922.
[11] Davidson S,Natan D,Novikov I,et al.Body mass index and weight-for-length ratio references for infants born at 33-42 weeks gestation:a new tool for anthropometric assessment[J].Clinical Nutrition,2011,30(5):634-639.
[12] 宋培歌,潘迎,武明辉,等.胎龄别新生儿体质指数分析[J].中国儿童保健杂志,2014,22(4):347-349.
[13] 于彦丽.巨大儿相关因素探讨[J].中外医疗,2011,30(35):41-42.
[14] Mello G,Parretti E,Cioni R,et al.The 75-gram glucose load in pregnancy:relation between glucose levels and anthropometric characteristics of infants born to women with normal glucose metabolism[J].Diabetes Care,2003,26(4):1206-1210.
[15] Shi P,Yang W,Yu Q,et al.Overweight,gestational weight gain and elevated fasting plasma glucose and their association with macrosomia in chinese pregnant women[J].Maternal & Child Health Journal,2014,18(1):10-15.
[16] 刘乐.OGTT各时间点血糖值在诊断糖代谢异常中的意义及1 h高血糖者糖代谢特征的研究[D].天津:天津医科大学,2010.
[17] Rayanagoudar G,Hashi AA,Zamora J,et al.Quantification of the type 2 diabetes risk in women with gestational diabetes:a systematic review and meta-analysis of 95,750 women[J].Diabetologia,2016,59(7):1403-1411.
[18] Abdul-Ghani MA,Stern MP,lyssenko V,et al.Mininal contribution of fasting Hyperglycemia to the incidence of type 2 diabetes in subjects with normal 2-h Plasma glucose[J].Dia Getes care,2010,33(3):557-561.
[19] 陈小丽.妊娠期糖尿病孕妇各项血糖指标异常对妊娠结局的影响[J].深圳中西医结合杂志,2015,25(10):24-26.