【摘要】 目的 探讨妊娠期糖尿病妇女不同糖耐量试验结果与不良妊娠结局的关系，为进一步提供个体化的诊治提供依据。方法 选择 2017年 1月 1日至 2018年 12月 30日在福建省妇幼保健院产科建档并住院分娩的孕妇为研究对象，妊娠 24 ～ 28周时行 75 g 口服葡萄糖耐量试验（oral glucose tolerance test,OGTT），按照《妊娠合并糖尿病诊治指南（2014）》确诊为妊娠期糖尿病孕妇，根据 OGTT 结果将孕妇分为空腹血糖异常、糖负荷异常、复合异常 3 组，比较 3 组母儿并发症的发生率。结果 共有5 026例孕妇纳入研究，其中空腹血糖异常、糖负荷异常、复合异常分别占15. 70%、71. 05%和13. 25%。多元回归分析显示，空腹血糖异常组大于胎龄儿（large for gestational age,LGA）和巨大儿发生率分别是糖负荷异常组的 1. 49 倍（OR = 1. 49,95% CI:1. 23 ～ 1. 80）和 1. 70 倍（OR = 1. 70,95% CI:1. 23 ～ 2. 36），复合异常组胎膜早破、剖宫产、LGA、巨大儿、妊娠期高血压发生率分别是糖负荷异常组的 1. 27 倍（OR = 1. 27,95% CI:1. 06 ～ 1. 52）、1. 53 倍（OR = 1. 53,95% CI:1. 29 ～ 1. 81）、1. 81 倍（OR =1. 81,95% CI:1. 49 ～ 2. 20）、2. 35倍（OR = 2. 35,95% CI:1. 71 ～ 3. 22）及 2. 08倍（OR = 2. 08,95% CI:1. 56 ～ 2. 78）。空腹血糖异常组中，孕前体质指数（body mass index,BMI）≥24 kg/m~2的孕妇，其妊娠期高血压疾病（OR = 6. 01,95% CI:1. 47 ～ 24. 67）、胎膜早破（OR = 2. 72,95% CI:1. 31 ～ 5. 67）、剖宫产（OR = 2. 10,95% CI:1. 04 ～ 4. 27）、巨大儿（OR = 4. 18,95% CI:1. 42 ～12. 27）等不良结局的发生风险高于BMI < 24 kg/m~2的孕妇，差异具有统计学意义（P < 0. 05）；糖负荷异常组中，BMI≥24 kg/m~2的孕妇妊娠期高血压疾病（OR = 2. 39,95% CI:1. 70 ～ 3. 35）、剖宫产（OR = 1. 91,95% CI:1. 58 ～ 2. 31）、LGA(OR = 1. 61,95% CI:1. 28 ～ 2. 04）、巨大儿发生（OR = 1. 94,95% CI:1. 30 ～ 2. 90）等不良结局发生风险高于 BMI < 24 kg/m~2的孕妇，差异具有统计学意义（P < 0. 05）。结论 妊娠期糖尿病孕妇糖耐量结果与不良妊娠结局相关。联合孕前 BMI评估，空腹血糖异常组和糖负荷异常组在孕前BMI≥24 kg/m~2时，不良妊娠结局的风险增加。更多还原

【Abstract】 Objective To explore the relationship between different glucose tolerance results and adverse pregnancy outcomes among women with gestational diabetes mellitus（GDM）,so as to provide evidence for further individualized diagnosis and treatment.Methods Pregnant women who registered and delivered in the obstetrics department of Fujian Maternity and Child Health Hospital from January 1^st,2017 and December 30^th,2018 were recruited as research subjects. They received 75 g oral glucose tolerance test（OGTT）at 24-28 weeks of gestation. They were diagnosed as GDM according to the “Standars of Medical Care in Gestational Diabetes Mellitus （2014）”. They were divided into three groups:fasting-abnormal,post-load abnormal and combined abnormal based on OGTT results. The incidence of maternal and infant adverse outcomes was compared between three groups.Results A total of 5026 pregnant women were enrolled in the study,among which fasting-abnormal group,post-load abnormal group and combined abnormal group accounted for 15. 70%,71. 05% and 13. 25%,respectively. Multiple regression analysis showed that the incidence of large for gestational age（LGA）and macrosomia in the fasting-abnormal group were 1. 49 times（OR = 1. 49,95% CI:1. 23-1. 80）and 1. 70 times（OR = 1. 70,95% CI:1. 23-2. 36）as high as those in the post-load abnormal group,respectively. The incidences of premature rupture of membranes,cesarean section,LGA,macrosomia and gestational hypertension in the combined abnormal group were 1. 27 times（OR = 1. 27,95% CI:1. 06-1. 52）,1. 53 times（OR = 1. 53,95% CI:1. 29-1. 81）,1. 81 times（OR = 1. 81,95% CI:1. 49-2. 20）,2. 35 times（OR = 2. 35,95% CI:1. 71-3. 22）,and 2. 08 times（OR = 2. 08,95% CI:1. 56-2. 78）as high as those in the post-load abnormal group. In the fasting-abnormal group,pregnant women with pre-pregnancy body mass index（BMI）≥24 kg/m²had higher risk of adverse outcomes,such as gestational hypertension（OR = 6. 01,95% CI:1. 47-24. 67）,premature rupture of membranes（OR = 2. 72,95% CI:1. 31-5. 67）,caesarean section（OR = 2. 10,95% CI:1. 04-4. 27）,macrosomia（OR = 4. 18,95% CI:1. 42-12. 27）than those of women with BMI < 24 kg/m²,and the differences were statistically significant（P < 0. 05）. In the post-load abnormal group,the incidence of hypertensive disorders（OR = 2. 39,95% CI:1. 70-3. 35）,caesarean section（OR = 1. 91,95% CI:1. 58-2. 31）,LGA（OR = 1. 61,95% CI:1. 28-2. 04）,macrosomia（OR = 1. 94,95% CI:1. 30-2. 90）were higher among women with BMI≥24 kg/m²than those of women with BMI < 24 kg/m²,and the differences were statistically significant（P < 0. 05）.Conclusion The results of glucose tolerance in pregnant women with GDM are associated with adverse perinatal outcomes. Combined with pre-pregnancy BMI assessment,pre-pregnancy BMI≥24 kg/m²will increase adverse pregnancy outcomes in the fasting-abnormal group and post-load abnormal group.更多还原