The Value Analysis Of Late Pregnancy HbA1c On The Pregnancy Outcome For Pregnant Women Not Undergoing Gestation OGTT

Objective:Gestational diabetes mellitus refers to the normal progestational glycometabolism or potential decreased glucose tolerance but only appeared or diagnosed during the stage of pregnancy.Studies have shown that GDM can directly lead to adverse consequences such as fetal macrosomia,fetal distress,neonatal hypoglycemia,neonatal asphyxia,and postpartum hemorrhage,etc,and increase the probability of diabetes in the pregnant women and their offspring.At present,the morbidity of gestational diabetes mellitus' GDM is 6%,and it is gradually increasing.Therefore,the diagnosis and GDM intervening should be actively conducted to reduce adverse pregnancy outcomes.According to the People's Republic of China Health industry standard 2011(diagnostic criteria of gestational diabetes mellitus),in 24-28 weeks of pregnancy the 75 g of glucose tolerance test(OGTT)was conducted,the blood glucose value of FPG and 75 g of OGTT should be less than 5.1mmol/L,10.0 mmol/L,and 8.5mmol/L respectively,1h and 2h after taking sugar orally,8.5mmol/ L,and any abnormal blood glucose should be diagnosed as GDM.However,OGTT has complicated procedure,requiring fasting and repeated blood sampling,and also the examination results are influenced by multiple factors such as the amount of sugar intake,the fat intake,stress,nausea and vomiting after taking sugar,with poor repeata-bility.In the meanwhile,under the current level of diagnosis and treatment,the problems of the insufficient antenatal care in primary hospital,part of pregnant women have weak health consciousness not receiving OGTT or refusing it,and come to visit doctors until full-term pregnancy or later.so the blood glucose level during pregnancy is not clear,bringing out so much inconvenience for the diagnosis and treatment.Glycosylated hemoglobin(HbA1c)is the non-enzymatic combination of 2 beta chain-N ends of valine residues and glucose in hemoglobin.The syn-thesis process is slow and irreversible combing,which persists in the 120 day life-period of red cells and disappears with the vanishing of red blood cells.The synthesis rate is in direct proportion to the concentration of sugar of the environment where red blood cells are located.HbA1 c reflects the average level of blood sugar for nearly 2-3 months instead of the level of instant blood sugar.This inspection is convenient,stable,needs no fasting,and it can be tested at any time.This is a retrospective study,the HbA1c5.5% of late pregnancy acting as the cut-off point,the pregnancy outcome of each group were analyzed,and to explore the value of the late pregnancy glycosylated hemoglobin in pregnancy outcome for pregnant women not undergoing OGTT,to guide the physicians to implement multi-layer management of pregnant women,and improve the maternal and neonatal outcomes by in time intervention according to state of illness.Methods:By using the retrospective study method,400 cases of pregnant women are selected,who were not undergoing OGTT during pregnancy and obstetric delivery in obstetrics department in Cangzhou People's Hospital from May 2017 to November 2017,were treated by HbA1 c after admission,among them 200 cases of HbA1 c equal or greater than 5.5% are treated as the experimental group,the other 200 cases as control group HbA1 c is less that 5.5%.There was no significant difference between the two groups of pregnant women in age,gravidity,parity,gestational weeks,gestational weight gain(P<0.05).Taking the late pregnancy HbA1 c 5.5% as the cut-off point,to explore the effect of glycosylated hemoglobin on the outcome of pregnancy,P<0.05 thus it is considered to be with statistical significance.In addition,in the case group,the incidence of adverse pregnancy outcomes and perinatal complications were compared between the three groups(5.5%?HbA1c<6.0%;6.0%?HbA1c<6.5;HbA1c?6.5%)of pregnant women according to the level of HbA1 c.P<0.05 thus it is considered to be with statistical significance.Results:In the experimental group,the rate of gestational period hypertension disease,polyhydramnios,premature rupture of membranes,amniotic fluid contamination,fetal macrosomia,fetal distress and neonatal hypogly-ce-mia are higher than those of the control group,with statistical difference(P<0.05);the incidence rate of adverse pregnancy outcomes of the experimental group rises with elevation of HbA1 c levels(<5.5%;?5.5-6.5%;?6.5%)the difference in incidence rate of adverse pregnancy outcomes for patients with diversified HbA1 c levels showed statistical significance(P<0.05);there are no statistical difference in postpartum hemorrhage rate of patients in the experimental group and the control group(P>0.05).Conclusion:The level of HbA1 c in late pregnancy is related to the Adverse Pregnancy Outcomes,we can evaluated blood glucose level by HbA1 c for those pregnant women not undergoing OGTT during pregnancy,and provide them with guidance of diagnosis and treatment(delivery way and termination of pregnancy),and conduct clinical intervention timely based on the state of illness thus providing guarantee for the maternal and child safety.