妊娠期糖尿病患者糖化血红蛋白水平与不良妊娠结局的关系

摘要

Objective To study the relationship between glycated hemoglobin (HbA1c) levels in gestational diabetes mel-litus (GDM) and obstetric adverse pregnancy outcomes. Methods 80 cases who were diagnosed with GDM in Depart-ment of Obstetrics and Gynecology of Dongfeng People's Hospital of Zhongshan City (“our hospital”for short) from Novem-ber 2013 to December 2014 were treated as study group, and another 80 pregnant women without GDM during the same period admitted in our hospital were chosen as control group. Study group was on glycemic control strictly, and then all cases were followed up until the termination of pregnancy. HbA1c of pregnant women in the study group were detected, the incidence of obstetric adverse symptoms (premature birth, polyhydramnios, fetal distress, macrosomia and premature rupture of membrane) of pregnant women with different levels of HbA1c was compared. Results The inci-dence of premature birth, polyhydramnios, fetal distress and macrosomia of the study group was significantly higher than those of the control group (P<0.05), and the incidence of adverse pregnancy outcomes mentioned above increased significantly with increasing levels of HbA1c (≤6.0%, >6.0%-6.5%, >6.5%-7.0%, >7.0% ), and the differences were statistically significant (P< 0.05). The incidence of premature rupture of membrane between study group and control group was not significant different and the occurrence rate of premature rupture of membrane showed no significant in-crease with increasing levels of HbA1c (P> 0.05). Conclusion HbA1c is an important indicator for evaluation of GDM, and the testing of HbA1c in clinic should be strengthened for better predicting of adverse pregnancy outcomes and en-suring maternal and newborn health.%目的：探究确诊妊娠期糖尿病的患者血清糖化血红蛋白(HbA1c)水平与不良妊娠结局的关系。方法以2013年11月~2014年12月中山市东凤人民医院(以下简称“我院”)妇产科收治的80例确诊妊娠期糖尿病的患者为研究组，选取我院同期非妊娠期糖尿病的正常孕妇80例为对照组，对研究组进行严格血糖控制，并对患者进行追踪研究至终止妊娠。检测研究组患者的HbA1c水平，比较不同HbA1c水平患者早产、羊水过多、巨大儿及胎儿宫内窘迫等发生情况。结果研究组早产、羊水过多、巨大儿及胎儿宫内窘迫发生率均高于对照组，差异均有统计学意义(P<0.05)，且以上不良妊娠结局的发生率随HbA1c水平的升高(≤6.0%、>6.0%~6.5%、>6.5%~7.0%、>7.0%)而显著增加，不同HbA1c水平患者其不良妊娠结局的发生率比较，差异均有统计学意义(P<0.05)；但两组胎膜早破发生率比较差异无统计学意义(P>0.05)，且胎膜早破发生率随HbA1c水平升高无明显增加(P>0.05)。结论HbA1c是妊娠期糖尿病的重要临床评价指标，临床应加强HbA1c的检测以便更好地预判妊娠结局，确保母婴平安。