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目的研究分析妊娠期代谢综合征(GMS)及其主导危险因素血糖、血脂、体重、血压影响新生儿出生缺陷的发生情况。方法收集2014年1月至2016年12月在杭州市妇产科医院定期产检并分娩的851例不同主导危险因素的妊娠期代谢综合征孕妇,其中246例妊娠期糖尿病(GDM)孕妇为GDM组;263例妊娠合并高脂血症、高胆固醇血症为高血脂组;198例妊娠合并肥胖为肥胖组;144例妊娠高血压为高血压组;995例健康孕妇为对照组,统计各危险因素组别的临床资料及新生儿出生缺陷发生的情况。结果 851例GMS孕妇发生新生儿出生缺陷14例,发生率达1.65%;GDM组出生缺陷5例,比例2.03%,其中先天性心脏病3例,肾缺如1例,短臂1例;高血脂组出生缺陷2例,比例0.76%,其中颜面血管瘤1例,隐睾1例;肥胖组出生缺陷4例,比例2.02%,其中先天性心脏病1例,尿道下裂1例,多趾1例,外耳畸形1例;高血压组出生缺陷3例,比例2.08%,其中先天性心脏病1例,唇裂1例,并趾1例;对照组出生缺陷2例,比例0.20%,先天性髋关节发育不良1例,多指1例。GMS孕妇(GDM组、肥胖组、高血压组、高血脂组)出生缺陷均高于对照组,比较具有统计学意义(P<0.05),GDM组、肥胖组、高血压组高于高血脂组,比较具有统计学意义(P<0.05)。16例新生儿出生缺陷中先天性心脏病排位第一,占比31.25%;泌尿生殖道及手指脚趾畸形排列第二,各占18.75%。结论以高血糖、肥胖、高血压为主导风险因素的GMS会增加新生儿出生缺陷的发生率,尤其是先天性心脏病。提示我们应积极防制妊娠期代谢综合征及其危险因素,以减少新生儿出生缺陷的发生。
Objective To analyze the incidence of gestational metabolic syndrome (GMS) and its leading risk factors such as blood glucose, lipids, body weight and blood pressure in neonates with birth defects. Methods A total of 851 gestational metabolic syndrome pregnant women with different risk factors from January 2014 to December 2016 were enrolled in Hangzhou Obstetrics and Gynecology Hospital. Among them, 246 pregnant women with gestational diabetes mellitus (GDM) ; 263 cases of pregnancy complicated with hyperlipidemia, hypercholesterolemia as hyperlipidemia group; 198 cases of pregnancy complicated with obesity as obesity group; 144 cases of pregnancy-induced hypertension as hypertension group; 995 healthy pregnant women as control group, and statistics of risk factors Group clinical data and neonatal birth defects occurred. Results 851 GMS pregnant women had 14 cases of neonatal birth defects (1.65%), 5 cases of GDM birth defects (2.03%), including 3 cases of congenital heart disease, 1 case of absence of kidney and 1 case of short arm. There were 2 birth defects in the lipid group, with a proportion of 0.76%, including 1 case of facial hemangioma and 1 case of cryptorchidism. There were 4 cases of birth defects in obesity group with a proportion of 2.02%, including 1 congenital heart disease, 1 case of hypospadias, 1 case of external ear deformity, 1 case of external ear deformity, 3 cases of birth defects in hypertensive group, the proportion of 2.08%, of which 1 case of congenital heart disease, cleft lip in 1 case and toe in 1 case; birth defects in control group 2 cases, the proportion of 0.20% congenital Hip dysplasia in 1 case, multi-finger in 1 case. The GDM group, obesity group, hypertension group and hyperlipemia group had higher birth defects than those in the control group (P <0.05). The GDM group, obesity group and hypertension group were higher than hyperlipemia group , More statistically significant (P <0.05). 16 cases of birth defects in congenital heart disease ranked first, accounting for 31.25%; genitourinary tract and finger toe malformation ranked second, each accounting for 18.75%. Conclusions GMS, a risk factor of hyperglycemia, obesity and hypertension, may increase the incidence of neonatal birth defects, especially congenital heart disease. Prompted that we should actively prevent pregnancy-induced metabolic syndrome and its risk factors in order to reduce the incidence of neonatal birth defects.