| ObjectiveTo explore the predictive value of maternal uric acid and maternal blood lipid levels in the second trimester of pregnancy on adverse pregnancy outcomes,in order to better manage the blood lipid and uric acid levels of older pregnant women in the future,calmly cope with the high birth rate of older women under the two child and three child policy,improve the quality of obstetric medical technology,and reduce the adverse effects of abnormal blood lipid and uric acid on pregnant women and perinatal children,To provide scientific basis for ensuring eugenics.MethodsPregnant women who visited the antenatal clinic of Ganzhou maternal and child health hospital from January 2020 to January 2021 were selected,The age of all subjects,the first found increase in blood pressure,gestational weeks,delivery gestational weeks,neonatal birth weight and other general data were collected,as well as the uric acid value and blood lipid indexes measured by fasting venous blood of pregnant women in the second trimester of pregnancy(24-28 weeks of pregnancy).The standard of adult dyslipidemia was used to define cholesterol,triglyceride,high and low density lipoprotein.Whether one of them was abnormal was defined as dyslipidemia.223 patients in this group had normal blood lipid group(i.e.0 dyslipidemia,a total of 129 cases)and dyslipidemia group(any dyslipidemia,a total of 94 cases);They were divided into group A according to blood uric acid(blood uric acid>357)μ Mol/L),group B(serum uric acid≤357 μmol/L).The basic clinical data,blood lipid level,gestational diabetes mellitus(GDM),macrosomia and other complications and adverse pregnancy outcomes were compared.Logistic regression model was used to analyze the related influencing factors of blood lipid and blood uric acid levels during pregnancy,and the value of different abnormal blood lipid and blood uric acid indexes and the number of abnormal items in predicting adverse pregnancy outcomes was analyzed through the subject working curve.All data collected were collected using spss23 0 statistical software for processing.the predictive value was analyzed by subject working curve(P<0.05).Results(1)compared with the normal lipid group,the dyslipidemia group was hypertensive disorder complicating pregnancy(HDCP)(12.8%vs 4.7%),gestational diabetes mellitus(GDM)(23.4%vs 4.7%),pregnancy complicated with hypothyroidism(17%vs 5.4%),intrahepatic cholestasis of pregnancy(ICP)(4.3%vs2.3%),premature delivery(25.5%vs 10.1%),and low birth weight(12.8%vs 7.8%).The incidence of and macrosomia(25.5%vs 10.1%)increased significantly(P<0.05).(2)according to serum uric acid,A group(67 cases)and B group(156 cases)were divided into A group with elevated serum uric acid level,pregnancy induced hypertension(HDCP)(19.4%vs 3.2%),gestational diabetes mellitus(GDM)(23.9%vs 7.7%),gestational hypothyroidism(19.4%vs 6.4%),intrahepatic cholestasis of pregnancy(ICP)(7.5%vs1.3%),premature delivery(3 1.3%vs10.3%).The incidence of low birth weight infants(23.9%vs 3.8%)and macrosomia infants(26.9%vs 12.2%)increased significantly(P<0.05).(3)Abnormal blood lipid indexes and uric acid level>357 μMol/l was used as exposure factor to evaluate the risk of adverse pregnancy outcomes of elderly pregnant women and perinatal infants such as HDCP,GDM,pregnancy with hypothyroidism,ICP,preterm delivery,low birth weight infants and macrosomia.Abnormal blood lipid TG and LDL-C in the second trimester could increase the risk of macrosomia(or=2.324,3.171;P<0.05);Abnormal increase of uric acid in the second trimester of pregnancy increased the risk of HDCP,preterm infants and low birth weight infants(or=1.009,1.005,1.010;P<0.05).After adjusting for age,miscarriage frequency,and pre pregnancy BMI,Logistic regression analysis was used to analyze the relationship between the above related factors and adverse pregnancy outcomes in elderly pregnant women and perinatal infants.The results showed that the levels of serum lipids TG,LDL-C,and uric acid in the second trimester of pregnancy were significantly positively correlated with the risk of adverse pregnancy outcomes in elderly pregnant women and perinatal infants.In terms of blood lipid function,abnormal blood lipid TG in the second trimester of pregnancy is more likely to cause adverse pregnancy in pregnant women and perinatal infants than normal blood lipid TG(OR=1.776,P<0.001;corrected OR=1.717,P<0.001).However,no significant association was found between high TC(OR=0.754,P=0.112;adjusted OR=0.756,P=0.110),high HDL-C(OR=0.913,P=0.701;adjusted OR=0.935,P=0.696),and the incidence of adverse pregnancy in pregnant women and perinatal infants.Pregnant women with LDL-C ≥ 4.14 mmol/L had a higher risk of adverse pregnancy than those with LDL-C<4.14 mmol/L(OR=4.716,P<0.001;adjusted OR=4.541,P<0.001).High uric acid levels(OR=4.251,P<0.001;adjusted OR=4.117,P<0.001)have a significant impact on the risk of adverse pregnancy in pregnant women and perinatal infants.(4)The area under the curve of TG and LDL-C in the diagnosis of macrosomia in the second trimester was 0.755(95%CI:0.677-0.833),0.732(95%CI;0.637-0.828),and the diagnostic boundary values were 1.99mmol/l and 4.185mmol/l.The sensitivity was 97.3%,43%,and the specificity was 44.1%and 97%.The area under the curve of uric acid in the diagnosis of HDCP in the second trimester of pregnancy was 0.812(95%CI;0.740-0.885),the diagnostic limit was 223.74umol/l,the sensitivity was 42.4%,and the specificity was 57.6%.The area under the curve of uric acid in the second trimester of pregnancy was 0.722(95%CI:0.634-0.810),the diagnostic limit was 209.8umol/l,the sensitivity was 86.5%,and the specificity was 56.5%.The area under the curve of uric acid in the second trimester of pregnancy for the diagnosis of low birth weight infants was 0.800(95%CI;0.733-0.868),the diagnostic limit was 222.48umol/l,the sensitivity was 43.8%,and the specificity was 56.2%.(5)The levels of TG,HDL-C,LDL-C,TC and uric acid in dyslipidemia group were significantly higher than those in normal group(0 dyslipidemia)(P<0.05),and increased significantly with the increase of dyslipidemia items(P<0.05).The level of HDL-C decreased significantly with the increase of dyslipidemia items(P<0.05).(6)After logistic regression analysis,it was found that ≥ 3 abnormal blood lipid indexes were independent risk factors for adverse pregnancy outcomes of elderly pregnant women and perinatal infants.The or value was 2.260,95%CI(1.229-4.154),P<0.05.It was difficult to judge the risk of adverse pregnancy outcomes with only one or two blood lipid indexes.Conclusion(1)The levels of TC,TG,LDL-C and serum uric acid in pregnant women with dyslipidemia in the second trimester of pregnancy increased,while the level of HDL-C decreased.(2)The probability of adverse pregnancy outcome increased significantly in elderly pregnant women with abnormal metabolism of blood lipid and blood uric acid.(3)Abnormal metabolism of TG and LDL-C can increase the risk of macrosomia in elderly pregnant women,and increase with the increase of the number of dyslipidemia.(4)Blood lipid TG and LDL-C in the second trimester of pregnancy are independent risk factors for macrosomia.Uric acid in the second trimester of pregnancy is an independent risk factor for HDCP,preterm infants and low birth weight infants.It has certain predictive value for the occurrence of macrosomia,preterm infants,HDCP and GDM.However,the sensitivity and specificity of these metabolic indexes are low,and the value of predicting adverse pregnancy outcomes is limited,which needs to be further expanded in clinical samples.(5)The pregnancy outcome was not only affected by the change of single blood lipid level or blood uric acid level,but also comprehensively observed with a number of abnormal blood lipid indexes;When the number of dyslipidemia exceeds two,it often indicates an increase in the risk of adverse pregnancy outcomes.Clinical attention should be paid to such high-risk pregnant women. |
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