Analysis Of Maternal And Neonatal Outcomes Of Early-onset Preeclampsia Combined With Gestational

PurposeThe incidence of preeclampsia and gestational diabetes is increasing year by year.The earlier the onset gestational week is,the more likely it is to cause serious maternal and neonatal complications,leading to poor perinatal outcomes and that the risk of postpartum cardiovascular and cerebrovascular diseases and the risk of pregnancy-induced hypertension in the next pregnancy is higher.However,the pathogenesis is still unclear.At present,there are few studies on the effect of EOPE combined with GDM on the perinatal outcome.This study analyzed the clinical features and maternal and neonatal outcomes of early-onset preeclampsia complicated with GDM,and explored the risk factors of GDM on EOPE that affect maternal and neonatal outcomes,and provided guidance for clinical work.MethodA total of 114 patients with early-onset preeclampsia who gave birth at Qilu Hospital of Shandong University from January 2017 to December 2019 were collected.According to whether they had gestational diabetes,the patients were divided into EOPE+GDM group(53 cases),simple EOPE group(61 cases).This study compared the basic clinical information,maternal complications and neonatal prognosis of the two groups of patients,to explore the impact of GDM on patients with early-onset preeclampsia.At the same time,according to the clinical characteristics and adverse pregnancy outcomes of the patients,through univariate and multivariate logistic regression analysis,the high-risk factors for the adverse maternal and child outcomes of pregnant patients with early-onset preeclampsia were found.All pregnant women met the diagnostic criteria for early-onset preeclampsia and gestational diabetes.ResultA total of 114 patients with early-onset preeclampsia were included in this study.The median age of all patients was 34 years,the median age of the EOPE+GDM group was 35 years,and the median age in the EOPE-only group was 33 years,which was no statistical difference.The median parity in the EOPE+GDM group and the EOPE alone group was the same,which was no significant difference in the proportion of primipara between the two groups(P>0.05).The median BMI of the EOPE+GDM group was 27.32,the median BMI of the EOPE alone group was 26.75,which was not statistically significant(P>0.05).There were 4 patients(7.5%)in the EOPE+GDM group received assisted reproductive technology for pregnancy,and 4 patients(6.6%)in the EOPE only group received assisted reproductive technology pregnancy,which was no statistically significant(P>0.05).There were 3 patients(5.7%)in the EOPE+GDM group received anticoagulant drugs,and 2 patients(3.3%)in the EOPE alone group received anticoagulant drugs,that was no statistically significant(P>0.05).In this study,the clinical symptoms of the EOPE+GDM group included headache,dizziness,blurred vision,abdominal pain,chest tightness,and asthma,that there were 18 cases(34%),5 cases(9.4%),2 cases(3.8%),and 6 cases(11.3%)in the EOPE+GDM group,and that there were 26 cases(42.6%),8 cases(13.1%),3 cases(4.9%),and 8 cases(13.1%)in the EOPE-only group,which was not statistically significant(P>0.05).The EOPE+GDM group was compared with the EOPE-only group that clinical symptoms in the EOPE group alone were more obvious,but the difference was not statistically significant(p>0.05).The systolic blood pressure of the EOPE group was slightly higher than that of the GDM group,with statistical difference(p<0.05),and the prenatal diastolic blood pressure(p>0.05).Urinary protein(p=0.293),ALT(p=0.705),AST(p=0.727),BUN(p=0.156),CR(p=0.249),PLT(p=0.903),albumin(p=0.867),which were not statistically significant.The levels of FBG(p=0.021),TG(p<0.001)and VLDL-C(p=0.002)in the EOPE+GDM group were higher than those in the GDM group,which were statistically significant(p<0.05).A total of 53 cases of maternal adverse complications occurred in all patients in this study,including 22(41.5%)cases in the EOPE+GDM group and 31(50.8%)cases in the EOPE group.Compared with the EOPE group,the EOPE+GDM group had no significant difference in the rates of heart failure,placental abruption,HELLP syndrome,severe pleural and ascites,therapeutic induction of labor,and ICU admission(P>0.05).In this study,there was no statistical difference in the values of ALT,AST,BUN,CR,PLT,and albumin(p>0.05).The highest systolic blood pressure in the EOPE group was higher than that in the EOPE+GDM group,and the difference was statistically significant(P<0.05)A univariate logistics analysis of the mother’s adverse pregnancy outcomes found possible related risk factors,including pre-pregnancy BMI(p=0.029)and albumin(p=0.016).At the same time,a multivariate logistics analysis showed that BMI and hypoalbuminemia before pregnancy were high-risk factors for the mother’s adverse pregnancy outcome.A univariate logistics analysis of adverse pregnancy outcomes in newborns found that possible related factors include albumin(p=0.003)and CR(p=0.029).In this study,a univariate analysis of the mother’s adverse pregnancy outcomes found possible related risk factors,including:pre-pregnancy BMI(p=0.029)and albumin(p=0.016).A multivariate analysis was conducted at the same time,and it was found that pre-pregnancy BMI and hypoalbuminemia were high-risk factors for the mother’s adverse pregnancy outcome.Possible related factors found in the neonatal adverse pregnancy outcome included albumin(p=0.003)and CR(p=0.029)).Conclusion1.BMI is a high-risk factor to predict adverse pregnancy outcomes in EOPE combined with GDM.As BMI increases,the risk of adverse maternal and neonatal outcomes increases.2.Pregnant women with hypoalbuminemia are at higher risk of adverse pregnancy outcomes.3.When EOPE is combined with GDM,it is more prone to abnormal lipid metabolism than EOPE alone.4.When EOPE merged with GDM,the clinical manifestations were more inclined to EOPE.