Clinical Study On The Correlation Between Gestational Diabetes Mellitus And Preeclampsia

Gestational diabetes mellitus(GDM) indicates that glucose metabolism is normal or exists impaired glucose tolerance potentially before pregnancy, but the patients are diagnosed diabetes mellitus during pregnancy. Preeclampsia(PE) is one common type of hypertensive disorders in pregnancy and it can be classified into mild preeclampsia and severe preeclampsia according to symptoms and blood platelet、blood pressure、 serum creatinme、urokinase protein、Liver enzymes. With the changing of people’s life-style and the improving of life quality, also the increasing rate of inherited metabolic diseases, the incidence of GDM and PE increasing higher than ever before. On the one hand,pregnancy and diabetes mellitus interact with each other,pregnancy can make diabetes mellitus more serious and make negative DM develope into dominant DM.The influence on maternal body and fetal of DM depend on the situation of controling of blood glucose and whether DM deteriorates.On the other hand,when the gravida suffers preeclampsia,microvasculars keep spasming all the time,seriously influence the health of maternal-fetal in the way of making systemic organs ischemia,also,the outcome even can be fatal.As an important hub of fetal-placental circulation,umbilical artery deliver metabolites and carbon dioxide from fetal body to placenta,finishing material exchange with maternal body. However,when gestational complications such as gestational diabetes mellitus and preeclampsia occur,placental vasculars spasm and decrease the blood perfusion,at the mean time,many virulence factors and too much oxidizing substances are produced in maternal-fetal circulation,they can destroy endothelial cells and influence the fetal blood supply by increasing peripheral vascular impedance,also can lead to fetal growth restriction(FGR) and fetal distress. At the present time,reports concerning the influence on umbilical artery blood waveform of gestational diabetes mellitus superimposed preeclampsia are rare both here and abroad,the auther made retrospective study on the correlation between GDM and PE and their influence on the umbilical artery blood waveform and perinatal outcome.ObjectiveIntegrating previous study results with pertinent literatures, the auther hope to investigate the relationship between gestational diabetes mellitus and preeclampsia and analyze the influence on umbilical artery blood waveform and pregnancy outcome induced by GDM and preeclampsia. It is also expected to supply some information for the clinically prevention of GDM and preeclampsia occurrence and for the improvement of pregnancy outcome induced by GDM and preeclampsia.MethodsA retrospective study was conducted on13908pregnant women who delivered in the third affiliated hospital of Zhengzhou University between January1,2008and May31,2011. Compare and analyze the incidence of preeclampsia among GDM patients and non-GDM patients. Cramp out50single birth pregnant women without interval medicine comorbidity at random and set them as group Ⅰ. Group Ⅱ included50single birth pregnant women suffering from GDM without other interval medicine comorbidities. Group Ⅲ contained46single birth pregnant women combined GDM and preeclampsia, and their gestational age>or=32weeks. The pregnant women’s general situation over the period of delivery were analyzed, dynamic indexes of umbilical artery blood waveform and pregnancy outcome were compared among three groups by statistic methods. Results1The prevalence rate of preeclampsia analysis:The incidence of GDM was3.61%(502/13908) in the whole. The incidence of preeclampsia was5.95%(827/13908) as a whole and was10.36%(52/502),5.78%(775/13406) in GDM and non-GDM pregnant women, respectively. The incidence of mild and severe preeclampsia among GDM and non-GDM pregnant women was5.58%(28/502),4.78%(24/502) and2.95%(396/13406),2.83%(379/13406)(p<0.05, respectively).2Analysis of basic clinical material among three groups:The average pre-pregnant body mass index(BMI), maternal age, the gestational age at delicery, cesarean section rate were compared and differences among the three groups were statistically significant(p<0.05, respectively); No difference was shown among the three groups in gravidity(p>0.05).3Analysis on umbilical artery blood waveform:In group III, the level of S/D, pulsatility index(PI) and resistance index(RI) were all higher than those of group I and Ⅱ (p<0.01, respectively).4Pregnancy outcome:Apgar score at1minute and5minute,birth weight, the rate of neonate intensive care, giant baby natality, the incidence of FGR and premature labor among group Ⅰ、Ⅱ、Ⅲ were all statistically significant(p<0.05, respectively).Conclusions1. Pregnant women with GDM might have higher risk of suffering preeclampsia than those non-GDM gravidas.2. Dynamics of umbilical artery blood waveform are apt to be abnormal when gravida is afflicted with GDM superimposed preeclampsia, GDM combined with preeclampsia seriously influence perinatal outcome.