Clinical Analysis Of Severe Preeclampsia Combined With Gestational Diabetes Mellitus And Its Effect On Pregnancy Outcome

Objective:The clinical data of pregnant women with severe preeclampsia(S-PE)and gestational diabetes mellitus(GDM)were retrospectively analyzed to investigate the clinical features of S-PE combined with GDM and its impact on pregnancy outcomes,which provided a reference for clinical work and improved maternal and child outcomes.Methods:151 cases of pregnant women with S-PE and GDM who were hospitalized and delivered in our hospital from January 2014 to December 2017 were collected and divided by the different gestational weeks into the early onset severe preeclampsia complicated with gestational diabetes group(EOPE-GDM group,n=35),the pre-term group of late onset severe pre-eclampsia complicated with gestational diabetes(pre-term group of LOPE-GDM,n=40),the term group of late onset severe pre-eclampsia complicated with gestational diabetes(term group of LOPE-GDM,n=76)3 groups.All pregnant women met the relevant diagnostic criteria for S-PE and GDM.We analyzed the three groups in the general clinical data and maternal and child outcomes.Results:(1)General clinical data: The average age of patients in the EOPE-GDM group was older than that of the term group of LOPE-GDM,and the systolic blood pressure of EOPE-GDM group was higher than that of the pre-term group of LOPE-GDM and the term group of LOPE-GDM,and the weight gain during pregnancy of EOPE-GDM group was lower than that of the pre-term group of LOPE-GDM and the term group of LOPE-GDM,difference of which was statistically significant(P<0.05).The pregnant women of EOPE-GDM group were older than that of the term group of LOPE-GDM.The difference was statistically significant(P'<0.0167).(2)Maternal correlational assay in the three groups: the levels of platelet,HbA1 c,and total protein in the EOPE-GDM group were significantly lower than those in the term group of LOPE-GDM,the term group of LOPE-GDM had significantly lower creatinine than the EOPE-GDM group and the pre-term group of LOPE-GDM,the difference of which was significant(P<0.05).(3)Pregnancy outcomes of the three groups: the morbidity of thrombocytopenia,hypo-proteinemia,Hellp syndrome,hypothyroidism in the EOPE-GDM group was significantly higher than those in the term group of LOPE-GDM.The difference was statistically significant(P'<0.0167);The number of hospital stays in the EOPE-GDM group and the pre-term group of LOPE-GDM was significantly higher than that in the term group of LOPE-GDM,the difference of which was significant(P<0.05).(4)Peri-natal outcomes: the S/D value of umbilical artery blood flow in EOPE-GDM group was significantly higher than that in the term group of LOPE-GDM(P<0.05);In the EOPE-GDM group,the morbidity of SGA,neonatal intra-ventricular hemorrhage and neonatal death was significantly higher than that of the term group of LOPE-GDM(P'<0.0167).The incidence of LGA in the EOPE-GDM group was significantly lower than that of the term group of LOPE-GDM,which was statistical significance(P'<0.0167);In the EOPE-GDM group neonatal asphyxia rate at the Apgar 1 minute and 5 minute scores was significantly higher than that in the pre-term group of LOPE-GDM and the term group of LOPE-GDM(P'<0.0167);the rate of neonatal infection and neonatal transference to NICU in the EOPE-GDM group and the pre-term group of LOPE-GDM were significantly higher than that of the term group of LOPE-GDM(P'<0.0167);In the pre-term group of LOPE-GDM the incidence of wet lung of the newborn was significantly higher than that in the EOPE-GDM group and the term group of LOPE-GDM(P'<0.0167);There was a statistically significant difference in the incidence of neonatal anemia in any two groups,besides neonatal anemia in the EOPE-GDM group was significantly higher than that in the pre-term group of LOPE-GDM and the term group of LOPE-GDM(P'<0.0167).Conclusion:1.elderly parturient women are at high risk for EOPE combined with GDM.2.LOPE combined with GDM occupies a higher incidence in patients with S-PE and GDM.3.The clinical manifestations of EOPE combined with GDM was in line with the clinical characteristics of EOPE,and was liable to thrombocytopenia,hypoproteinemia,Hellp syndrome,hypothyroidism,neonatal respiratory distress syndrome,SGA,neonatal asphyxia,neonatal anemia,neonatal Infection,neonatal ventricle hemorrhage,neonatal death and other complications.4.The clinical manifestations of LOPE combined with GDM were mainly based on the clinical features of GDM.During the pregnancy,the control of the blood glucose was poor and the weight gain of the pregnant woman increased significantly.The complications of LGA and neonatal wet lung were prone to occur.5.S-PE with GDM was liable to abnormal umbilical artery blood flow,seriously affected the outcome of pregnancy,and abnormal umbilical arterial blood flow was the higher the risk at the earlier the gestational age.6.For the patients of the EOPE-GDM group and the pre-term group of LOPE-GDM prolonging gestational age to the term due to maternal and child conditions may reduce adverse pregnancy outcomes and improve neonatal outcomes;the patients of the term group of LOPE-GDM after 37 weeks,neonatal complications were significantly reduced and the pregnancy should be terminated in time.