基于倾向性得分匹配法分析胎膜早破对妊娠期糖尿病孕妇新生儿结局的影响  

Effect of premature rupture of membranes in pregnant women with gestational diabetes mellitus on neonatal outcomes based on propensity score matching

作　　者：黄蒨 徐竟琪 徐荣 田瑞雪 邹智杰[1] 陈晓莉[1] 陈真[2] 刘文惠[3] HUANG Qian;XU Jingqi;XU Rong;TIAN Ruixue;ZOU Zhijie;CHEN Xiaoli;CHEN Zhen;LIU Wenhui(School of Nursing,Wuhan University,Wuhan 430071,Hubei,China;Chongqing Health Center for Women and Children,Chongqing 401174,China;Dept.of Obstetrics and Gynecology,Zhongnan Hospital of Wuhan University,Wuhan 430071,Hubei,China)

机构地区：[1]武汉大学护理学院,湖北武汉430071 [2]重庆市妇幼保健院,重庆401174 [3]武汉大学中南医院妇产科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2024年第11期1349-1357,共9页Medical Journal of Wuhan University

基　　金：国家社会科学基金项目(编号:21BSH073)。

摘　　要：目的:通过倾向性匹配(PSM)的方法探讨胎膜早破(PROM)对妊娠期糖尿病(GDM)孕妇新生儿结局的影响。方法:选取2017年7月至2020年6月在重庆市某妇幼医院分娩且有活产结局的5 656例单胎妊娠期糖尿病孕妇,将妊娠期糖尿病孕妇分为胎膜早破组和对照组。通过倾向性匹配对基线特征进行1∶1匹配,比较两组妊娠期糖尿病孕妇新生儿不良结局发生率的差异。匹配前后数据采用Logistic回归分析胎膜早破与新生儿不良结局之间的关联。结果:倾向性匹配后,胎膜早破组和对照组各纳入妊娠期糖尿病孕妇1 531例,匹配后两组间协变量均衡(P>0.05);Logistic回归分析结果显示,胎膜早破会增加妊娠期糖尿病孕妇的早产[调整后的比值比(AOR)(95%CI):4.855(3.563~6.741),P<0.001]、低出生体质量儿[AOR(95%CI):2.648(1.862~3.831),P<0.001]和新生儿高胆红素血症[AOR(95%CI):2.073(1.576~2.745),P<0.001]的发生风险,但降低了巨大儿[AOR(95%CI):0.568(0.393~0.813),P<0.05]的发生风险。结论:发生胎膜早破的妊娠期糖尿病孕妇新生儿出现并发症的风险较高,如早产、低出生体质量、高胆红素血症等。Objective:To explore the effect of premature rupture of membranes(PROM)on neonatal outcomes in pregnant women with gestational diabetes mellitus(GDM)by propensity score matching (PSM). Methods: A total of 5 656 singleton GDM pregnant women who delivered at a maternal andchild hospital in Chongqing from July 2017 to June 2020 with live birth outcomes were selected, andthe GDM pregnant women were divided into the PROM group and control group. Baselinecharacteristics of women with GDM and neonates were matched 1∶1 by PSM, and the difference inthe incidence of adverse neonatal outcomes between the two groups of GDM pregnant women wascompared. Logistic regression was used to analyze pre - matching and post - matching data to explorethe association between PROM and adverse neonatal outcomes. Results: After PSM, 1 531 pregnantwomen with GDM were enrolled in PROM groups and control group, and the covariates werebalanced between the two groups after matching (P>0. 05);the results of logistic regression analysesindicated that PROM increased the risk of preterm birth (AOR(95%CI): 4. 855(3. 563 - 6. 741), P<0. 001), low birth weight infants (AOR(95%CI): 2. 648(1. 862-3. 831), P<0. 001) and neonatal hyperbilirubinemia(AOR(95%CI): 2. 073(1. 576 - 2. 745), P<0. 001) in pregnant women with GDM,but the risk of macrosomia (AOR(95%CI): 0. 568(0. 393 -0. 813), P<0. 05) was reduced. Conclusion:Pregnant women with GDM who develop PROM have a higher risk of neonatal complicationssuch as preterm birth, low birth weight, and neonatal hyperbilirubinemia in newborns.

关 键 词：妊娠期糖尿病 胎膜早破 倾向性匹配 新生儿结局 孕妇 

分 类 号：R714.433[医药卫生—妇产科学]