The Study On The Correlation Between TCM Constitution And Vitamin D In Early Pregnancy And Gestational Diabetes Mellitus In Patients With Polycystic Ovary Syndrome

Purpose:In this study,pregnant women with polycystic ovary syndrome before pregnancy were used as the subject.Through the determination of TCM constitution and vitamin D detection in the first trimester,follow-up on the incidence of gestational diabetes mellitus,to explore the correlation between TCM constitution and vitamin D level of PCOS patients in the first trimester and GDM,the type of TCM constitution susceptible to GDM and the predictive value of vitamin D level in early pregnancy for GDM,so as to provide new ideas for the health care of pregnant women with PCOS during pregnancy and the prevention of GDM from the perspective of "conditioning TCM constitution to treat potential diseases".Method:In this study,109 pregnant women with PCOS from 7 to 13 weeks of gestation who had regular prenatal examination in the obstetrics department of Qianfoshan Hospital of Shandong Province from October 2018 to October 2019 were selected as the research subjects.The subjects filled out the general condition questionnaire and TCM constitution classification and judgment form in the first trimester(7 to 13 weeks gestation),and also tested the serum 25-(OH)D.The subjects were given oral glucose tolerance test(OGTT)of 75g at 24-28 weeks of gestation(the inspection time is no later than January 2020).According to the OGTT results,subjects included in the study were divided into the PCOS-GDM group and the PCOS-non-GDM group.To study the differences between the two groups of pregnant women in TCM constitution types and serum 25-(OH)D levels,and to analyze the correlation between TCM constitution and vitamin D level of PCOS patients in early pregnancy and the incidence of GDM.The collected data were statistically analyzed using SPSS23.0 statistical software.Results:①A questionnaire survey and serum 25-(OH)D test were performed on 109 PCOS patients in the first trimester.During follow-up,5 cases had spontaneous abortion before 24 weeks of pregnancy,and 2 cases had artificial abortion before 24 weeks of pregnancy.Two cases were lost to follow-up.A total of 100 subjects were included in the study,including 46 cases in the PCOS-GDM group and 54 cases in the PCOS-non-GDM group.The general data such as the age and the number of pregnancy of the two groups were analyzed.The general data of the two groups showed no statistical difference and were comparable.②In the early gestational period of PCOS patients,phlegm-dampness constitution accounted for the largest proportion(20%),followed by yang deficiency and yin deficiency.③The main biased constitution of pregnant women in the PCOS-GDM group was phlegm-dampness constitution,accounting for 39.13%,followed by Yin deficiency(10.87%)and Qi depression(10.87%).The main biased constitution of pregnant women in the PCOS-non-GDM group was yang deficiency(16.67%).There were extremely significant differences in the types of TCM constitution between the two groups(P<0.01).④The serum 25-(OH)D levels of PCOS-GDM group and PCOS-non-GDM group in the first trimester were different.The serum 25-(OH)D level of PCOS-GDM group was significantly lower than that of PCOS-non-GDM group(P<0.01).⑤Among the 100 PCOS pregnant women included,60%of them had insufficient vitamin D in the first trimester and those without vitamin D excess.The prevalence of GDM(60%)in PCOS pregnant women in the vitamin D deficient group was higher than that in the vitamin D sufficient group(25%)(P<0.01).⑥The decrease of serum 25-(OH)D level in early pregnancy of PCOS patients will increase the risk of GDM(OR=0.853,P=0.001).The ROC curve shows that the serum 25-(OH)D level of PCOS patients in the first trimester is less than 24.55ng/ml,which is the best predictor of GDM.The area under the curve is 0.738(95%CI:0.638-0.837),sensitivity 0.741,specificity 0.717,Youden index is 0.458,P<0.01,it can be considered that the serum 25-(OH)D level of PCOS patients in the first trimester has a certain diagnostic predictive value for the occurrence of GDM.⑦Logistic regression analysis of the influencing factors of GDM in PCOS patients showed that phlegm-dampness constitution(P=0.038)and vitamin D deficiency(P=0.002)were related to the incidence of GDM and were independent influencing factors of GDM.Phlegm-dampness constitution were susceptible to GDM in PCOS patients,and the risk of GDM in PCOS patients with phlegm and dampness was about 8.440 times that of patients with mild PCOS.The risk of GDM in PCOS patients with insufficient vitamin D was approximately 6.412 times that in PCOS patients with adequate vitamin D.Conclusion:①The type of TCM constitution of PCOS patients in the first trimester is related to the incidence of GDM.Phlegm-dampness constitution is the most common type of constitution in PCOS patients in the first trimester,and it is also the susceptible type of GDM in PCOS patients.②Vitamin D deficiency is common in the first trimester of pregnancy in PCOS patients.Decreasing vitamin D levels will increase the risk of GDM.The serum 25-(OH)D level in early pregnancy has a certain predictive value for the incidence of GDM.Serum 25-(OH)D is less than 24.55ng/ml can be used as a threshold for predicting GDM in PCOS patients from 7 to 13 weeks of pregnancy.③Phlegm-dampness constitution and vitamin D deficiency are independent factors of GDM.PCOS patients should adjust their phlegm-damp constitution in the first trimester and add vitamin D reasonably to prevent GDM.