IVF-ET术后GDM患者的妊娠风险评估及预测模型构建  

Risk assessment and prediction model construction of pregnant women with IVF-ET and GDM

作　　者：姚俊秀 董旭东 YAO Junxiu;DONG Xudong(Department of Obstetrics,Affiliated Hospital of Kunming University of Science and Technology/the First People’s Hospital of Yunnan Province,Kunming,Yunnan 650500,China;Department of Obstetrics and Gynecology,West China Second University Hospital,Sichuan University,Chengdu,Sichuan 610066,China)

机构地区：[1]昆明理工大学附属医院/云南省第一人民医院产科,昆明650500 [2]四川大学华西第二医院妇产科,成都610066

出　　处：《重庆医学》2024年第15期2269-2276,2283,共9页Chongqing Medical Journal

基　　金：国家自然科学基金项目(42167060);云南省卫生健康委员会高级人才项目(L-2018006);云南省妇产疾病临床医学研究中心开放课题(2022YJZX-FC20)。

摘　　要：目的探讨不同受孕方式的妊娠期糖尿病(GDM)患者不良妊娠结局并构建风险预测模型。方法采用回顾性队列研究分析2018年1月至2022年8月在云南省第一人民医院产科产检且分娩的1453例GDM患者的临床资料,其中接受体外受精胚胎移植(IVF-ET)的436例GDM患者作为观察组,同期自然受孕的1017例GDM患者作为对照组。采用t检验、χ^(2)检验比较两组间基本资料、体重变化、血糖合格率、母婴妊娠结局及相关并发症;采用多因素logistic回归分析导致不良妊娠结局的危险因素;根据各危险因素的回归系数权重构建预测模型,采用受试者工作特征(ROC)曲线及曲线下面积(AUC)评估各独立危险因素及联合预测模型的预测效能。结果IVF-ET是GDM患者发生首次剖宫产(OR=1.809,95%CI:1.339~2.442)、早产(OR=1.622,95%CI:1.090~2.413)、产后出血(OR=2.377,95%CI:1.406~4.018)、胎盘粘连(OR=1.971,95%CI:1.211~3.209)、低出生体重儿(OR=2.232,95%CI:1.354~3.680)的独立危险因素(P<0.05)。应用产次、年龄、胎数、孕期总增重、IVF-ET和瘢痕子宫建立联合预测模型,联合预测概率P=e^(Logit(P))/(1+e^(Logit(P))),Logit(P)=β_(1)X_(1)+β_(2)X_(2)+…+β_(n)X_(n)。该模型对早产、剖宫产、低出生体重儿的联合预测效能较好,AUC约0.8,均大于各独立危险因素的AUC。结论由产次、年龄、胎数、孕期总增重、IVF-ET和瘢痕子宫构成的联合预测模型对GDM患者剖宫产、早产及低出生体重儿发生风险有一定的预测价值。Objective To explore the adverse pregnancy outcomes of gestational diabetes mellitus(GDM)patients with different conception methods,and to construct a risk prediction model.Methods A retrospective cohort study was carried out to analyze the clinical data of 1453 cases of GDM patients who received regular prenatal care and delivery in the obstetrics department of the First People’s Hospital of Yunnan Province from January 2018 to August 2022.A total of 436 patients with GDM who underwent in vitro fertilization-embryo transfer(IVF-ET)were served as the observation group,1017 GDM patients with natural gestation during the same period were selected as the control group.Chi-square test and t-test were used to compare the basic data,weight change,blood glucose reaching standard rate,maternal and infant pregnancy outcomes and related complications between the two group.The risk factors causing adverse pregnant outcomes were analyzed after controlling the confounding variables by adopting multivariate logistic regression.The prediction model was constructed according to the regression coefficient weight of each risk factor.The receiver operating characteristic(ROC)curve and the area under the curve(AUC)were used to evaluate the predictive efficiency of each independent risk factor and combined predictive factors.Results IVF-ET was an independent risk factor for the first cesarean section(OR=1.809,95%CI:1.339-2.442),preterm birth(OR=1.622,95%CI:1.090-2.413),postpartum hemorrhage(OR=2.377,95%CI:1.406-4.018),adherent placenta(OR=1.971,95%CI:1.211-3.209),low birth weight infant(OR=2.232,95%CI:1.354-3.680)in the patients with GDM(P<0.05).A combined prediction model was established by parity,age,fetus number,gestational weight gain,IVF-ET and scar uterus.The combined prediction probability was P=e^(Logit(P))/(1+e^(Logit(P))),Logit(P)=β_(1)X_(1)+β_(2)X_(2)+…+β_(n)X_(n).The combined prediction efficacy of this study model for preterm birth,cesarean section and low birth weight infants was good,AUC was approximately 0.8,wh

关 键 词：体外受精胚胎移植 妊娠期糖尿病 妊娠结局 危险因素 预测 

分 类 号：R714.256[医药卫生—妇产科学]