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目的:研究糖化血红蛋白(HbAlc)水平对妊娠期糖尿病(GDM)孕妇妊娠结局的影响。方法:112例妊娠期糖尿病孕妇作为GDM组、再根据妊娠24~28周时GDM患者空腹血清HbAlc水平分为高水平组(HbAlc≥6.5%,n=43)和低水平组(HbAlc<6.5%,n=69),选取同期产检的95例正常孕妇作为对照组;比较对照组和GDM组孕妇妊娠24~28周时空腹HbAlc水平,GDM组孕妇给予以糖尿病饮食及运动指导干预,两周时再次检测HbAlc水平;分析不同HbAlc水平GDM孕妇早产、剖宫产、羊水过多、妊娠期高血压发生率、分娩孕周和产前体质指数(BMI),比较新生儿出生后1minApgar≤7分、巨大儿、低血糖、高胆红素血症患儿及新生儿体质量。结果:妊娠24~28周时,GDM组HbAlc水平高于对照组(t=9.95,P<0.05);妊娠24~28周时,两组GDM孕妇给予饮食及运动干预,HbAlc水平降低,与干预前比较,差异有统计学意义(t=9.66,P<0.05);干预后,HbAlc高水平GDM孕妇HbAlc恢复正常比例低于低水平GDM孕妇(χ2=4.57,P=0.033);HbAlc高水平组GDM孕妇分娩时孕周比低水平组短,但早产、剖宫产、羊水过多及妊娠期高血压的发生率均高于低水平组孕妇(P<0.05);GDM高水平组新生儿体质量、新生儿出生后1minApgar≤7分、巨大儿、低血糖及高胆红素血症发生率显著高于低水平组(P<0.05)。结论:高表达HbAlc的GDM孕妇的妊娠期结局较差,新生儿的并发症发生率变高,可将HbAlc的监测作为血糖控制及避免产后新生儿并发症的重要指标。
Objective: To study the effect of HbAlc on the pregnancy outcome of pregnant women with gestational diabetes mellitus (GDM). Methods: One hundred and twelve pregnant women with gestational diabetes mellitus as GDM group were divided into high level group (HbAlc≥6.5%, n = 43) and low level group (HbAlc <6.5%) according to fasting serum HbAlc levels in 24- , n = 69). 95 healthy pregnant women were enrolled as the control group. The levels of HbA1c in the pregnant group were compared between the 24th and 28th week of GDM group. The pregnant women in GDM group were given diabetes diet and exercise guidance intervention. The levels of HbA1c in the pregnant women with different HbA1c levels were analyzed again. Preterm birth, cesarean section, polyhydramnios, the incidence of gestational hypertension, birth gestational age and prenatal body mass index (BMI) were analyzed. Huge children, hypoglycemia, hyperbilirubinemia and neonatal body weight. Results: The level of HbAlc in GDM group was higher than that in control group at 24-28 weeks of gestation (t = 9.95, P <0.05). At 24-28 weeks of gestation, both GDM pregnant women were given diet and exercise intervention, HbAlc level was decreased, HbAlc in HbAlc high-level GDM pregnant women returned to normal after intervention was lower than that in low GDM pregnant women (χ2 = 4.57, P = 0.033); HbA1c high level group The gestational weeks of GDM pregnant women were shorter than those with low gestational age, but the incidence of preterm birth, cesarean section, polyhydramnios and gestational hypertension were higher than those of low-level pregnant women (P <0.05); GDM high-level newborn Quality, neonatal 1minApgar ≤ 7 points after birth, macrosomia, hypoglycemia and hyperbilirubinemia was significantly higher than the low-level group (P <0.05). CONCLUSION: GDM pregnant women with high expression of HbA1c have worse pregnancy outcome and higher neonatal complication rate. HbAlc monitoring can be used as an important indicator of blood sugar control and postpartum neonatal complications.