摘要
目的探讨妊娠中期75 g口服葡萄糖耐量试验(OGTT)异常模式对孕妇分娩大于胎龄儿(LGA)风险的影响。方法收集2016年12月24日至2022年7月26日在广东省妇幼保健院定期产前检查并分娩的66 290例孕妇的一般临床资料包括OGTT结果。根据OGTT结果,将孕妇分为8组,血糖正常组(空腹、服糖后1 h、2 h血糖均正常,共54 518例)、妊娠期糖尿病(GDM)0组(仅空腹血糖异常,共1 430例)、GDM 1组(仅服糖后1 h血糖异常,共2 150例)、GDM 2组(仅服糖后2 h血糖异常,共3 736例)、GDM 0+1组(空腹、服糖后1 h血糖均异常,共371例)、GDM 0+2组(空腹、服糖后2 h血糖均异常,共280例)、GDM 1+2组(服糖后1 h、2 h血糖均异常,共2 981例)、GDM 0+1+2组(空腹、服糖后1 h、2 h血糖均异常,共824例)。采用多因素logistic回归分析不同OGTT异常模式对LGA的影响。此外,将OGTT检测3个时间点的血糖测量指标进行组合,并作为连续性变量应用到受试者工作特征(ROC)曲线中,以评估各血糖测量模式对LGA的预测价值并对曲线下面积(AUC)进行比较。结果 (1)多因素logistic回归分析结果显示,GDM 0组(OR=1.76,95%CI为1.50~2.08)、GDM 0+1组(OR=2.29,95%CI为1.72~3.04)、GDM 0+1+2组(OR=1.98,95%CI为1.61~2.43)孕妇分娩LGA的风险显著升高(P均<0.001)。(2)ROC曲线分析结果显示,空腹血糖、服糖后1 h血糖、服糖后2 h血糖、空腹+服糖后1 h血糖、空腹+服糖后2 h血糖、服糖后1 h+2 h血糖、空腹+服糖后1 h+2 h血糖测量模式对LGA均具有一定的预测价值(P均<0.001)。空腹血糖测量模式较服糖后2 h血糖测量模式预测LGA的AUC高,差异有统计学意义(P<0.05);空腹血糖与其他血糖测量模式预测LGA的AUC分别比较,差异均无统计学意义(P均>0.05)。结论 OGTT异常模式中,空腹血糖异常、空腹+服糖后1 h血糖异常、空腹+服糖后1 h+2 h血糖异常的孕妇分娩LGA的风险增加。空腹血糖检测对LGA的预测具有重要意义,临床上可作为评估LGA风险的优选指标。
Objective To investigate the impact of abnormal patterns of 75 g oral glucose tolerance test(OGTT)in the second trimester on the risk of large for gestational age(LGA)newborn deliveries.Methods General clinical data and OGTT results of 66290 pregnant women who received regular prenatal care and delivered in Guangdong Maternal and Child Health Hospital from December 24,2016 to July 26,2022 were collected.According to the results of OGTT,the pregnant women were divided into 8 groups:normal blood glucose group(normal fasting blood glucose,1-hour and 2-hour after oral glucose,54518 cases),gestational diabetes mellitus(GDM)0 group(only abnormal fasting blood glucose,1430 cases),GDM 1 group(only abnormal blood glucose at 1-hour after oral glucose,2150 cases),GDM 2 group(only abnormal blood glucose at 2-hour after oral glucose,3736 cases),GDM 0+1 group(both fasting blood glucose and 1-hour after oral glucose were abnormal,371 cases),GDM 0+2 group(both fasting blood glucose and 2-hour after oral glucose were abnormal,280 cases),GDM 1+2 group(abnormal blood glucose at 1-hour and 2-hour after oral glucose,2981 cases)and GDM 0+1+2 group(abnormal fasting blood glucose,1-hour and 2-hour after oral glucose,824 cases).Multivariate logistic regression was used to analyze the effects of different abnormal OGTT patterns on LGA.In addition,the blood glucose measurements at the three time points of OGTT were combined and used as continuous variables in the receiver operating characteristic(ROC)curve to evaluate the predictive value of each blood glucose measurement mode for LGA and the area under the curve(AUC)was compared.Results(1)Multivariate logistic regression analysis showed that the risks of LGA were significantly increased in GDM 0 group(OR=1.76,95%CI:1.50-2.08;P<0.001),GDM 0+1 group(OR=2.29,95%CI:1.72-3.04;P<0.001),and GDM 0+1+2 group(OR=1.98,95%CI:1.61-2.43;P<0.001).(2)ROC curve analysis showed that fasting blood glucose,1-hour after oral glucose,2-hour after oral glucose,fasting+1-hour after oral glucose,fasting+2-hour after oral glucose,1-hour+2-hour after oral glucose,and fasting+1-hour+2-hour after oral glucose had certain predictive value for LGA(all P<0.001).The AUC of fasting blood glucose measurement was higher than that of 2-hour blood glucose measurement in predicting LGA,and the difference was statistically significant(P<0.05).There was no significant difference in the AUC between fasting blood glucose and other blood glucose measurement modes for predicting LGA(all P>0.05).Conclusions In the abnormal OGTT patterns,pregnant women with abnormal fasting blood glucose,abnormal fasting+1-hour after oral glucose,and abnormal fasting+1-hour+2-hour after oral glucose have an increased risk of LGA.Fasting blood glucose measurement is of great significance for the prediction of LGA,and could be used as an optimal indicator to evaluate the risk of LGA in clinical practice.
作者
张澳
苏敏仪
郑丽娟
陈丽
刘国成
宋璐璐
王友洁
Zhang Ao;Su Minyi;Zheng Lijuan;Chen Li;Liu Guocheng;Song Lulu;Wang Youjie(Department of Obstetrics and Gynecology,Guangdong Maternal and Child Health Hospital,Guangzhou 511400,China;Department of Maternal and Child Health,School of Public Health,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2024年第3期184-191,共8页
Chinese Journal of Obstetrics and Gynecology
基金
国家自然科学基金(82073660)。
关键词
糖尿病
妊娠
葡糖耐量试验
出生体重
妊娠中期
婴儿
大于胎龄
Diabetes,gestational
Glucose tolerance test
Birth weight
Pregnancy trimester,second
Infant,large for gestational age
