摘要
目的探讨妊娠期糖尿病(GDM)对双胎妊娠母婴围产结局的影响。方法对2013年1月至2019年10月在北京市海淀区妇幼保健院住院分娩的772例双绒毛膜性双胎妊娠孕妇进行回顾性研究,收集孕妇基本信息和母婴围产结局数据(包括年龄、孕产次、孕周、受孕方式、分娩方式)及孕产妇及新生儿并发症等。所有研究对象于孕24~28周行口服葡萄糖耐量试验(OGTT),根据OGTT结果将研究对象分为GDM组(157例)和糖耐量正常(NGT)组(615例)。137例GDM孕妇检测了糖化血红蛋白(HbA1c)。按照HbA1c是否达标,将GDM孕妇分为血糖控制未达标的GDM组(HbA1c≥5.5%,25例)和血糖控制达标的GDM组(HbA1c<5.5%,112例)。组间各指标的比较采用t检验、秩和检验、χ²检验或Fisher确切概率法。结果GDM组双胎妊娠孕妇年龄明显大于NGT组孕妇,差异有统计学意义(P<0.001)。GDM组≥35岁的高龄孕妇比例高于NGT组[分别为28.0%(44/157)和17.1%(105/615),P=0.002]。GDM组孕前肥胖患病率较NGT组高,差异具有统计学意义(P=0.002)。GDM组与NGT组双胎妊娠孕妇在分娩孕周、剖宫产率、早产率,胎儿生长受限、妊娠期高血压疾病、胎膜早破、胎盘早剥、产后出血发生率以及新生儿低出生体重、呼吸窘迫、畸形/发育异常、双胎一胎死亡及转入新生儿重症监护室发生率等方面差异均无统计学意义(P>0.05)。血糖控制达标的GDM组、血糖控制未达标的GDM组和NGT组孕妇比较,分娩孕周、剖宫产率、早产率以及胎儿生长受限、妊娠期高血压疾病、胎膜早破、胎盘早剥、产后出血发生率差异均无统计学意义(P>0.05)。然而,血糖控制未达标的GDM组可见早产、胎儿生长受限、胎膜早破发生率呈增加趋势,但差异均无统计学意义(P>0.05),三组子代结局差异也无统计学意义(P>0.05)。结论双胎妊娠女性中,GDM未增加母婴不良围产结局。
Objective To analyze the effect of gestational diabetes mellitus(GDM)on maternal and neonatal outcomes in twin pregnancies.Methods A retrospective cohort study was conducted on 772 cases of dichorionic twin pregnancies delivered in Beijing Haidian Maternal and Child Health Hospital from January 2013 to October 2019.The general clinical characteristics and the maternal and neonatal outcomes were collected,including age,parity,gestational weeks,mode of conception,delivery mode and the maternal and neonatal complications.According to the results of 75 g oral glucose tolerance test(OGTT)on gestational age 24-28 weeks,the subjects were divided into GDM group(157 cases)and normal glucose tolerance(NGT)group(615 cases).The glycated hemoglobin A1c(HbA1c)was tested among 137 GDM women.The GDM women were classified into two groups:the uncontrolled GDM group with HbA1c≥5.5%(25 cases)and well-controlled GDM group with HbA1c<5.5%(112 cases).The t test,rank sum test,χ2 test and Fisher exact probability method were used for comparison between groups.Results The age of GDM group was statistically significant older than that of NGT group(P<0.001).There were more women aged over 35 years in GDM group than in NGT group[28.0%(44/157)vs.17.1%(105/615),P=0.002].Women with GDM were significantly more obese before pregnancy than the NGT women(P=0.002).Whereas there was no significant difference in gestational weeks,cesarean section rate,premature birth rate between the two groups.There was no difference between GDM and NGT groups in the incidence of fetal growth restriction,hypertensive disorders of pregnancy,premature rupture of membranes,placental abruption,postpartum hemorrhage,neonatal low birthweight,neonatal respiratory distress,neonatal malformation or dysplasia neonatal death or admission to neonatal ward(P>0.05).Compared with the NGT group,the well-controlled GDM group and the uncontrolled GDM group,there was no significant difference in gestational weeks,cesarean section rate,premature birth rate,and incidence of fetal grow
作者
陈斯
王海宁
杨进
洪天配
刘晓红
Chen Si;Wang Haining;Yang Jin;Hong Tianpei;Liu Xiaohong(Department of Endocrinology,Peking University Third Hospital,Beijing 100191,China;Department of Prenatal Diagnosis Center,Haidian Maternal and Child Health Hospital,Beijing 100080,China)
出处
《中华糖尿病杂志》
CAS
CSCD
北大核心
2022年第1期32-37,共6页
CHINESE JOURNAL OF DIABETES MELLITUS
基金
国家重点研发计划(2018YFC1313900,2018YFC1313905)
国家自然科学基金(81670701)。
关键词
糖尿病
妊娠
妊娠
多胎
妊娠结局
Diabetes,gestational
Pregnancy,multiple
Pregnancy outcome
