| Objective:Through reviewing the blood glucose tested among the healthy pregnant women in 24?28 weeks in oral glucose tolerance test(OGTT),this paper analyzes its relationship with the outcome of the pregnancy.Methods:Those pregnant women were chosen who had done their prenatal checkups and child-delivery in Luhe People's Hospital,Nanjing,during January 2014 and October 2015.Except for the ones with diabetes before pregnancy,combined internal medicine diseases such as liver and kidney,as well as double(multiple)pregnancy,3098 women up to the required standards were selected.Laboratory information system(LIS)were applied to export their 3 time-point OGTT blood glucose value at 24?28 weeks of gestation(FPG,1hpG and 2hPG).These women were divided into two groups with 2227 normal childbirth cases and 871 adverse childbirth cases according to their pregnancy outcomes,compare their OGTT3 time point blood glucose values;two groups with 384 cases in GDM group,2714 cases in control group(non-GDM),OGTT glucose and complications in pregnancy and childbirth were compared;and three groups with 2656 cases in group A between 18 to 29 years old,327 cases in group B between 30 to 34 years old,115 cases group C between 35 to 45 years old according to their pregnant age,OGTT glucose and complications in pregnancy and childbirth were compared.Adopting Logistic regression analysis of 3 time-point OGTT blood glucose level from three age groups and all pregnant women's OGTT,we got a prediction probability respectively and drew a ROC curve to judge the diagnostic effect of OGTT blood glucose on confinement.Results:1.OGTT blood glucose value(FPG,lhPG and 2hPG)of 3098 pregnant women shows non-normal distribution,the statistics is described with medians and quartiles.Adverse birth result of pregnant women's OGTT blood glucose(mmol/1),respectively:4.58(4.33,4.87),7.48(6.36,8.95)and 6.41(5.69,7.42),is significantly higher than that of normal childbirth group:4.47(4.25,4.73),7.05(5.93,8.12)and 6.15(5.41,6.91).Mann-Whitney U test was adopted to check blood glucose value at different points between the two groups,and Z values are:-7.471,-7.801 and-7.045 respectively,thus the difference is statistically significant(p<0.01).2.OGTT blood sugar level in GDM pregnant group OGTT blood glucose(mmol/1)respectively:4.58(4.33,4.87),7.48(6.36,8.95)and 6.41(5.69,7.42),are significantly higher than the control group:4.47(4.25,4.73),7.05(5.93,8.12)and 6.15(5.41,6.91).Mann-Whitney U test was adopted and Z values are:-21.057,-22.721 and-19.207,thus the difference is statistically significant(p<0.01).3.The incidence of hypertensive disorder complicating pregnancy,premature rupture of membranes,premature birth,fetal distress,postpartum hemorrhage,macrosomia and cesarean delivery of the GDM group respectively:7.0%(27/384),13.3%(51/384),3.1%(12/384),4.7%(18/384),10.4%(40/384),29.9%(115/384)and 50.0(192/384),are significantly higher than the control group:0.8%(21/2714),7.8%(211/2714),1.0%(27/2714),1.2%(33/2714),7.4%(200/2714),8.9%(242/2714)and 32.6(884/2714).Using chi-square test to compare each group rates,x2 values are respectively:86.35,13.18,9.27,25.04,4.37,145.94 and 45.08,thus the differences are statistically significant(p<0.05).4.OGTT blood glucose values of the pregnant women at 3 time-point in Group A are:4.54(4.29,4.78),7.32(6.16,8.11)and 6.28(5.6,6.84),in Group B:4.73(4.49,4.91),7.85(7.38,8.57),and 6.78(6.35,7.20),and in Group C:4.83(4.67,4.99),8.53(7.82,8.97)and 7.34(6.66,7.87).OGTT blood glucose values of the three groups at different time-point:Group C>Group B>Group A(using the Mann-Whitney U test,P<0.05),thus the difference is statistically significant.5.The incidence of GDM in 3 groups is respectively:10.3%(273/2656),22.6%(74/327)and 32.2%(37/115),Group C>Group B>Group A,thus the difference is statistically significant(chi-square test,P<0.05).The incidence of hypertensive disorder complicating pregnancy,premature rupture of membranes,premature birth,fetal distress,postpartum hemorrhage,macrosomia and cesarean delivery in Group Ais respectively:1.1%(30/2656),8.3%(220/2656),0.9%(26/2656),1.2%(33/2656),7.8%(206/2656),10.6%(282/2656)and 31.6%(838/2656);the incidence in Group B is respectively:2.8%(9/327),6.7%(22/327),2.8%(9/327),6.7%(22/327),7.0%(23/327),14.5%(48/327)and 50.5%(165/327);and that in Group C is respectively:7.8%(9/115),17.4%(20/115),3.5%(4/115),7.8%(9/115),9.6%(11/115),23.5%(27/115)and 63.5%(73/115).The incidence of cesarean delivery,macrosomia and hypertensive disorder complicating pregnancy in 3 groups is C>B>A,thus the difference is statistically significant(chi-square test,P<0.05);the difference is not statistically significant in the incidence of premature rupture of membranes and fetal distress between Group A and B(P>0.05),while the incidence of Group C is significantly higher than that of Group A and B(P<0.05);the incidence of premature.delivery in Group B is not significantly different from that in Group C(P>0.05)?but significantly higher than group A(P<0.05).6.The GDM group and the control group(non-GDM)in each group(A/B/C)complications in pregnancy and childbirth were compared.In group A,the incidence of premature rupture of membranes,hypertensive disorder complicating pregnancy,macrosomia and cesarean delivery of the GDM group are significantly higher than the control group(P<0.05),postpartum hemorrhage premature birth,fetal distress and premature birth are not significantly different(P>0.05).In group B,the incidence of hypertensive disorder complicating pregnancy,premature birth,fetal distress and macrosomia of the GDM group are significantly higher than the control group(P<0.05),premature rupture of membranes,postpartum hemorrhage and cesarean delivery are not significantly different(P>0.05).In group C,the incidence of premature rupture of membranes,hypertensive disorder complicating pregnancy,premature birth and macrosomia of the GDM group are significantly higher than the control group(P<0.05),postpartum hemorrhage,fetal distress and cesarean delivery are not significantly different(P>0.05).7.Adopting Logistic regression to calculate three age groups(Group A,Group B and Group C)and OGTT blood glucose value(FPG,1hPG and 2hPG)of all pregnant women,we draw the ROC area under curve(AUC)of pregnancy outcome:0.592,0.665,0.865 and 0.611,respectively.Conclusions:1.GDM hyperglycemia is closely related to pregnancy complications,with which the incidence of adverse birth outcome also increases.Therefore,active intervention should be taken in the pregnant women with abnormal glucose tolerance to reduce the maternal complications and improve their pregnancy outcome.2.The incidence of GDM increase with age,the incidence of cesarean delivery,macrosomia and gestational hypertension syndrome also increases with age,and premature rupture of membrane,fetal distress,and premature birth rate performance is more evident in the elderly pregnant women.Therefore,strengthen antenatal and intrapartum care for elderly puerperas to reduce the maternal complications.3.To do oral glucose tolerance test in mid-pregnanct pregnant women is easy and feasible,and OGTT blood sugar value could partly predict the result of childbirth.Therefore,all pregnant women should be included in screening OGTT as required. |
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