摘要
目的:探讨妊娠期糖尿病(GDM)孕妇新生儿不良结局高危因素并建立logistic风险模型。方法:选取2020年2月-2022年8月本院产科门诊接收的GDM孕妇196例临床资料,依据新生儿结局分为不良组、良好组。采用logistic回归分析明确GDM孕妇发生不良新生儿结局高危因素,建立logistic风险模型,采用Hosmer-Lemeshow检验判定风险模型拟合优度,受试者工作特征(ROC)曲线探讨风险模型的预测效力。结果:最终纳入的168例孕妇中出现不良新生儿结局44例、未出现124例。不良组与良好组妊娠期高血压疾病、抑郁症状、孕前BMI、孕期增重情况、空腹血糖(FPG)、服糖后1 h血糖(1 h PG)、分娩前糖化血红蛋白(HbA1c)有差异;logistic回归分析显示,妊娠期高血压疾病、抑郁症状、孕期增重过度、分娩前HbA1c水平高均为GDM孕妇发生不良新生儿结局独立危险因素(均P<0.05)。基于独立危险因素建立logistic风险模型,Logit(P)=-15.610+1.472×妊娠期高血压疾病(有=1,无=0)+0.884×抑郁症状(有=1,无=0)+1.014×孕期增重情况(孕期增重过度=2,孕期增重不足=1,孕期增重正常=0)+2.053×分娩前HbA1c(%),Hosmer-Lemeshow检验(χ^(2)=9.952,P=0.268)拟合优度良好。ROC曲线显示,logistic风险模型预测GDM孕妇发生不良新生儿结局的曲线下面积为0.792,95%CI 0.707~0.877,最佳预测敏感度77.3%,预测特异度72.6%。结论:GDM孕妇不良新生儿结局高危因素包括妊娠期高血压疾病、抑郁症状、孕期增重过度、分娩前HbA1c水平高,应用其建立的logistic风险模型预测效力较好,为临床干预提供参考。
Objective:To explore the highrrisk factors of the adverse neconatal outcomes of pregnant women with gestational diabetes mellitus(GDM),and to establish a Logistic risk model.Methods:The clinical data of 196 Pregnant women with GDM who were admitted to the obstetrics elinic of the hospital from February 2020 to August 2022 were selected.According to the neonatal outcomes,these women were divided into study group(women with adverse neonatal outcomes)and control group(women without adverse nconatal outcomes).Logistic regression analysis was used to determine the high-risk factors of the adverse neonatal outcomes of the pregnant women with GDM,and Logistic risk model was established.Hosmer Lemeshow test was used to determine the goodness of fit of the risk model.Receiver operating characterstic(ROC)curve was used to explore the predictive efet of this risk model.Results:Among 168 pregnant women,there were 44 cases with adverse neonatal outcomes and 124 cases without adverse neonatal outcomes.There were significant differences in the hypertensive disorders complicating pregnancy occurrence.the depressive symptoms,the pre pregnancy BMI value,the weight gain during pregnancy.and the levels of fasting plasma glucose(FPG),1-hour plasma glucose(1h PG)and glycosylated hemoglobin(HbA1c)before delivery of the women between the two groups.Logistic regression analysis showed that the hypertensive disorders complicating prcegnancy,the depressive symptoms,the excessive weight gain during pregnancy and the high HbAlc level before delivery of the women with GDM were the independent risk factors of their adverse neonatal outcomes(all P<0.05).A logistic risk model was established based on these independent risk factors,which was Logit(P)-15.610+1.472X byperten-sive disorder complicating pregnancy(yes-1,no-0)+0.884 X depressive symptoms(yes-1,no-0)+1.014 X weight gain during pregnancy(excessive weight gain-2,insufficient weight gain=1).Normal weight gain during pregnancy-0+2.053X HbA1c(%)before delivery.Hosmer-Lemeshow test(χ^(2)=9.952,P-0.268)had a good goodness of fit for this model.ROC curve showed that the area under the curve of this logistic risk model for predicting the adwerse neonatal outcomes of the pregnant women with GDM was 0.792,95%CI-0.707-0.877.the best predictive sensitivity and specificity of this logistic risk model for the adverse neonatal outcomes were 77.3%and 72.6%.Conclusion:The high-risk factors of the adverse neonatal outcomes of the pregnant women with GDM include the hypertensive disorders complicating pregnancy,the depressive symptoms,the excessive weight gain during pregnancy and the high HbAI c level before delivery.The Logistie risk model established by these high-risk factors of the adverse neonatal outcomes has a good predictive effect,and which can provide evidences for clinical intervention.
作者
孙延霞
王灵环
王飞
张应丽
SUN Yanxia;WANG Linghuan;WANG Fei;ZHANG Yingli(Jinan Fourth People's Hospital,Jinan,Shandong Province,250031)
出处
《中国计划生育学杂志》
2024年第1期216-221,共6页
Chinese Journal of Family Planning
关键词
妊娠期糖尿病
新生儿不良结局
危险因素
风险模型
预测
Gestational diabetes mellitus
Adverse neonatal outcomes
Risk factor
Risk model
Prediction
