妊娠期糖尿病孕妇不同孕周阴道菌群变化及对妊娠结局的影响:前瞻性队列研究  

Title Vaginal Microbiota Changes of Gestational Diabetes Mellitus Pregnant Women at Different Gestational Weeks and the Impact on Pregnancy Outcome:a Prospective Cohort Study

作　　者：杨昕晖 彭笑笑 马丽丽 赵国玉 马秀华 郭晶[1] YANG Xinhui;PENG Xiaoxiao;MA Lili;ZHAO Guoyu;MA Xiuhua;GUO Jing(Department of General Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of General Medicine,Daxing Teaching Hospital of Capital Medical University,Beijing 102600,China;Department of Gynecology and Obstetrics,Daxing Teaching Hospital of Capital Medical University,Beijing 102600,China)

机构地区：[1]首都医科大学附属北京友谊医院全科医学科,北京市100050 [2]首都医科大学大兴教学医院全科医学科,北京市102600 [3]首都医科大学大兴教学医院妇产科,北京市102600

出　　处：《中国全科医学》2024年第29期3587-3594,共8页Chinese General Practice

摘　　要：背景妊娠期糖尿病(GDM)是妊娠期常见并发症,既往研究表明,GDM孕妇生殖道感染性疾病的患病风险较高,但相关队列研究少见。目的了解GDM孕妇不同孕周阴道菌群变化特点,对比GDM孕妇与非GDM孕妇阴道菌群差异,观察阴道菌群异常对妊娠结局的不良影响。方法本研究采用连续抽样法,选取2022年3月—2023年3月在首都医科大学大兴教学医院建立档案并规范保健的孕妇,在妊娠24~28周行75 g口服糖耐量试验(OGTT)检查,诊断是否为GDM。采用倾向得分匹配法(PSM)进行GDM组与非GDM组1∶1匹配,于妊娠24~28周(A阶段)、妊娠32~35周(B阶段)和妊娠37~40周(C阶段)分别采集阴道分泌物,进行3次阴道微生态检测,并进一步分为GDM阴道菌群正常组、GDM阴道菌群异常组、非GDM阴道菌群正常组及非GDM阴道菌群异常组,随访至分娩后7 d以评估妊娠结局。结果本研究最初纳入426名参与者,141例发生GDM。经过PSM匹配,GDM组和非GDM组成功匹配122对,作为研究队列。本研究中有9例GDM孕妇和5例非GDM孕妇发生早产(妊娠<37周),故最终有113例GDM孕妇和117例非GDM孕妇进入C阶段。A阶段阴道菌群优势菌为乳杆菌所占比例高于C阶段,阴道pH值、阴道菌群异常发生率、细菌性阴道病(BV)及外阴阴道假丝酵母菌病(VVC)发生率均低于C阶段(P<0.05)。A阶段GDM组优势菌为乳杆菌所占比例高于非GDM组,阴道菌群异常和VVC发生率均低于非GDM组(P<0.05)。C阶段GDM组优势菌乳杆菌比例低于非GDM组,阴道菌群异常发生率高于非GDM组(P<0.05)。GDM阴道菌群异常组(n=65)不良妊娠结局发生率高于GDM阴道菌群正常组(n=57)(P<0.05);GDM阴道菌群异常组不良妊娠结局的发生风险是GDM阴道菌群正常组的1.830倍(RR=1.830,95%CI=1.293~2.590,P<0.001)。结论GDM孕妇在妊娠37~40周时,阴道菌群异常发生率高于妊娠24~28周。相比于非GDM孕妇,GDM孕妇在妊娠24~28周时阴道菌群异常发生率低,而在Background Gestational diabetes mellitus(GDM)is a common complication of pregnancy,and previous studies have shown that pregnant women with GDM have a higher risk of developing infectious diseases of the reproductive tract than healthy pregnant women,but relevant cohort studies are rare.Objective To investigate the variation characteristics of vaginal microbiota in pregnant women with GDM at different gestational weeks,to compare the differences of vaginal microbiota between GDM and non-GDM women,and to observe the effects of vaginal microbiota changes on pregnancy outcomes.Methods In this study,we used a consecutive sampling method to recruit pregnant women who established their records and regulated health care at Daxing Teaching Hospital of Capital Medical University from March 2022 to March 2023.They underwent 75 g oral glucose tolerance test(OGTT)at 24-28 weeks of gestation to diagnose GDM.The GDM group was matched 1∶1 with the non-GDM group using propensity score matching method(PSM).Sample of vaginal secretions were collected at 24-28 weeks(stage A),32-35 weeks(stage B)and 37-40 weeks(stage C)for three vaginal microecological examination,respectively.Based on the results,participants were further divided into the GDM normal vaginal flora subgroup,GDM abnormal vaginal flora subgroup,non-GDM normal vaginal flora subgroup and non-GDM abnormal vaginal flora subgroup,and were followed up until 7 d after delivery to assess pregnancy outcome.Results A total of 426 participants were initially enrolled in this study,and GDM occurred in 141 cases.After PSM mathing,the GDM and non-GDM groups were successfully matched in 122 pairs.In this study,because 9 women with GDM and 5 women without GDM had preterm birth(<37 weeks of gestation),113 women with GDM and 117 women without GDM ended up in stage C.The proportion of the dominant vaginal flora of Lactobacillus was higher in stage A than in stage C.Moreover,the vaginal pH,the incidence of vaginal flora abnormalities,and the incidence of BV and VVC were lower than those

关 键 词：妊娠期糖尿病 妊娠中期 妊娠晚期 阴道菌群 妊娠结局 队列研究 

分 类 号：R714.256[医药卫生—妇产科学]