妊娠期糖尿病孕妇血糖波动对妊娠结局的影响  

Effect of blood glucose fluctuation on pregnancy outcomes in pregnant women with gestational diabetes mellitus

作　　者：刘秀丽[1] 谢佳[1] 刘芳[1] 马玥[1] 刘琴[1] 杨雯[1] 巫兴聪 吕婷[1] 陈东[1] LIU Xiu-Li;XIE Jia;LIU Fang(Department of Obstetrics,Panzhihua Central Hospital,Panzhihua,Sichuan 617067,China)

机构地区：[1]攀枝花市中心医院产科,四川攀枝花617067

出　　处：《中国妇幼保健》2018年第20期4585-4588,共4页Maternal and Child Health Care of China

摘　　要：目的探讨妊娠期糖尿病孕妇血糖波动对妊娠结局的影响,为临床诊治提供参考依据。方法选择2015年1月-2016年6月在攀枝花市中心医院围生期保健的妊娠期糖尿病孕妇200例为研究对象。在入组第1周的第1天与入组第5周的第1天采用动态血糖监测系统(CGMS)对孕妇进行血糖波动检测,观察平均血糖水平、血糖平均标准差,平均血糖波动幅度,日间血糖平均绝对差结果。记录患者不良妊娠结局,分析血糖波动对不良妊娠结局的影响。结果非条件多因素Logistics回归分析结果显示,第1周平均血糖水平,初产妇是初产剖宫产的独立危险因素;第1周平均血糖波动幅度、第1周平均血糖水平是大于胎龄儿的独立危险因素;第1周平均血糖波动幅度、第1周平均血糖水平、第5周平均血糖波动幅度是巨大儿的独立危险因素;第1周平均血糖波动幅度是新生儿不良妊娠结局的独立危险因素。多重线性回归分析结果显示,第1周平均血糖水平、第5周平均血糖波动幅度与新生儿出生体重明显相关(P<0.05)。结论妊娠期糖尿病孕妇血糖波动是剖宫产、大于胎龄儿、巨大儿、新生儿不良妊娠结局的独立危险因素。Objective To explore the effect of blood glucose fluctuation on pregnancy outcomes in pregnant women with gestational diabetes mellitus（ GDM）,provide a reference basis for clinical diagnosis and treatment of GDM. Methods A total of 200 pregnant women with GDM receiving perinatal health care in Panzhihua Central Hospital from January 2015 to June 2016 were selected as study object. Continuous glucose monitoring system（ CGMS） was used to detect blood glucose fluctuation on the first day of the first week and the fifth week after admission. The mean blood glucose level,mean standard deviation of blood glucose,mean fluctuation of blood glucose,and mean absolute difference of daytime blood glucose were observed. The adverse pregnancy outcomes were recorded. The effect of blood glucose fluctuation on adverse pregnancy outcomes were analyzed. Results Non-conditional multivariate logistic regression analysis showed that the mean blood glucose level during the first week and primipara were independent risk factors of cesarean section; the mean fluctuation of blood glucose and mean blood glucose level during the first week were independent risk factors of large for gestational age infant; the mean fluctuation of blood glucose and mean blood glucose level during the first week,the mean fluctuation of blood glucose during the fifth week were independent risk factors of macrosomia; the mean fluctuation of blood glucose during the first week was independent risk factor of neonatal adverse pregnancy outcomes. Multiple linear regression analysis showed that the mean fluctuations of blood glucose during the first week and the fifth week were significantly correlated with neonatal birth weight（ P〈0. 05）. Conclusion Blood glucose fluctuation in GDM pregnant women is an independent risk factor of cesarean section,large for gestational age infant,macrosomia,and neonatal adverse pregnancy outcomes.

关 键 词：妊娠期糖尿病 血糖波动 妊娠结局 

分 类 号：R714[医药卫生—妇产科学]