| Background:Gestational diabetes mellitus(GDM)refers to the first occurrence or discovery of abnormal glucose metabolism during pregnancy.It is a common obstetric complication of pregnancy,which seriously threatens the health of the mother,fetus,and neonate.At the same time,pregnant women with GDM and maternal offspring are the high-risk groups of type 2 diabetes mellitus.With the improvement of living conditions,diet refinement,the opening of two child policies,the postponement of child-bearing age and the change of GDM diagnostic criteria,the incidence of GDM is increasing year by year.The pathogenesis of gestational diabetes mellitus is related to insulin deficiency orinsulin resistance.The specific function link is not clear,and it is difficult to prevent from the source.The level of blood glucose control during pregnancy is closely related to the prognosis of mother and fetus.So far,there are few studies on oralglucose tolerance test(OGTT)in the second trimester,blood glucose levels,lipid metabolism,and outcomes of mother and fetus.According to the number of items of abnormal blood glucose at OGTT and blood lipid profile in the second and the third trimester,perinatal outcomes were analyzed to provide guidance for stratified management of GDM maternal blood glucose levels and lipid profile,and for reducing adverse perinatal outcomes.Methods:There were 8564 pregnant women who received prenatal examination and delivered in Women’s Hospital School of Medicine Zhejiang University from January 1,2014 to December 31,2014.All the pregnant women enrolled in the study were performed 75g OGTT in 24～28 weeks of pregnancy.According to each time point blood glucose results of OGTT,they were divided into 4 groups.GDM A:one abnormal blood glucose of OGTT result(1002 cases);GDM B:two abnormal blood glucose(430 cases);GDM B:three abnormal blood glucose(85 cases);the normal group had normal blood glucose.All of the participants in the study were fasting at OGTT and at 34 weeks of pregnancy to determine serumtriglyceride,total cholesterol,high-density lipoprotein and low-density lipoprotein.Records of perinatal outcomes were recorded by special personnel.All included pregnant women met the following criteria:(1)Singleton pregnancy,gestational age over 28 weeks;(2)Without diabetes mellitus andhypertension before pregnancy;(3)No cardiovascular disease,kidney disease,blood disease,thyroid dysfunction,other endocrine and metabolic diseases,and infectious diseases;(4)No mental disorders;(5)No trauma,burns,etc surgical diseases;(6)No assisted reproductive technology;(7)With complete case data.The above studies were discussed and approved by the ethics committee.The criteria of diagnosis and evaluation were referred to the eighth edition of Obstetrics and Gynecology of people’s Medical Publishing House:(1)Pre-pregnancybody mass index(BMI):weight(kg)/height2(m2);Weight gain during pregnancy was the weight at delivery minus pre-pregnancy weight;(2)Hydramnion:Ultrasound showed amniotic fluid volume was greater than or equal to 8.0cm before delivery;Amniotic fluid indexes≥25.0cm or Amniotic fluid volume exceeded 2000ml during pregnancy;(3)Postpartum hemorrhage:The volume of blood loss within 24h after vaginal delivery≥500ml,≥1000ml at cesarean section;(4)Preterm birth:Delivery at 28～37 gestational weeks;(5)Macrosomia:birthweight≥4000g;(6)Asphyxia neonatorum:Apgar at 1 minute or 5 minute≤7 points.According to the pre-pregnancy BMI,they were divided into obesity group(>28kg/m2),overweight group(24～27.9kg/m2),normal weight group(18.5～23.9 kg/m2);underweight group(<18.5 kg/m2).Results:1.Comparison of the general situation of 4 groups:There were statistically significant differences in the average age of the 4 groups of pregnant women,gravidity,parity,pre-gestational BMI(P<0.001).The average age,gravidity,parity,and pre-gestational BMI were the highest in the group GDM C while they were the lowest in the normal group.After pairwise comparisons,there were significant differences(P<0.05);The weight gain during pregnency was the highest in the normal group(14.73±4.33kg)while it was the lowest in the group GDM C(2.36±4.72kg).After pairwise comparisons,there were significant differences(P<0.05).2.Comparison of GDM maternal age and OGTT blood glucose:In pregnent women over the age of 35,one abnormal blood glucose was increased in 16.7%of them;two abnormal blood glucose were increased in 9.7%of them;three abnormal blood glucose were increased in 2%of them,which were all higher than those in pregnent women less than the age of 35,they were 11.3%,4.6%,0.9%,respectively.The differences were statistically significant(P<0.05).3.Comparison of GDM maternal pre-gestational BMI and OGTT blood glucose:19.6%of obese women in the GDM pre-pregnancy obesity group had one abnormal blood glucose,higher than overweight women(16.9%),normal women(11.9%)and underweight women(9.5%);7.8%of them had two abnormal blood glucose,higher than overweight women(6.1%),normal women(5.1%)and underweight women(4.3%);7.8%of them had three abnormal blood glucose,higher than overweight women(3.9%),normal women(0.9%)and underweight women(0.4%);The differences were statistically significant(P<0.001).4.Comparison of OGTT elevated blood glucose levels in GDM groups:The fasting plasma glucosein the group GDM C were higher than that in group A and group B.After pairwise comparisons,the differences were statistically significant(P<0.05).After comparing the 1h postload glucose and 2h postload glucose of 3 groups and HbA1c results,the Group C was the highest,followed by the Group B and A.After pairwise comparisons,the differences were statistically significant(P<0.05).5.The relationship of increased blood glucose levels and lipid profile during pregnancy in normal pregnancy group and GDM group:In the GDM group,the TG in the second and the third trimesterwas higher than that in the normal group,and the highest in the C group.After pairwise comparisons,the differences were statisticallysignificant(P<0.05).In the group GDMC,the HDL-C in the second trimesterwaslower than that in the normal group,group A and group B.HDL-C in the three GDM groups was lower than that in the normal group in the third trimester,and it was the lowest in the group GDMC.The differences were statistically significant(P<0.05).All of the subjects in the third trimester had higher TG,TC,TG,LDL-C levels than those in the second trimester,but HDL-C level was lower that that in the second trimester,the differences were statistically significant(P<0.05).6.Comparison of perinatal outcomes:The rate of cesarean section in the group GDM C(60%)was higher than that of group B(42.1%),group A(39.9%)and normal group(35.8%);The rate of macrosomia in the group GDM C(23.5%)was higher than that of group B(7.9%),group A(7.5%)and normal group(5.7%);The risk of macrosomia in the group GDM C was 4.8 times higher than in the normal group(OR=4.80,95%CI=2.77～8.32).The group GDM B was 1.6 times of the normal group(OR=1.60,95%CI=1.09～2.33)and the group GDM A was 1.34 times of the normalgroup(OR=1.34,95%CI=1.03～1.75).The differences were statistically significant(P<0.01).The incidence of hypertensive disorder complicating pregnancy in the group GDM C(11.8%)was higher than that in group B(4.2%)and group A(5.4%)as well as in normal group(2.9%).The differences were statistically significant(P<0.05).The risk of hypertensive disorder complicating pregnancy in the group GDM C was 3.16 times higher than in the normal group(OR=3.16,95%CI=1.53～6.49).The group GDM A was 1.83 times of the normal group(OR=1.83,95%CI=1.33～2.52).The differences were statistically significant(P<0.01).Conclusion:In addition to the pregnant age,gravidity,parity,pre-gestational BMI,as the number of hyperglycemic values in the OGTT increased,there are related to the high blood lipid levels in the second and the third trimester,associated with an increased risk of adverse perinatal out comes among women with Gestational Diabetes Mellitus.Therefore,according to the abnormal results of OGTT,stratification management should be carried out,active intervention can control blood glucose levels and lipid profile at the same time,so as to reduce the occurrence of adverse perinatal outcomes. |
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