广西医学

目的探讨妊娠期糖尿病（GDM）产妇与非GDM产妇分娩巨大儿的影响因素。方法纳入分娩巨大儿的143例产妇和分娩正常体重新生儿的157例产妇作为研究对象，根据孕期是否患GDM，将前者分为GDM巨大儿组、非GDM巨大儿组，将后者分为GDM对照组及非GDM对照组。使用多因素二元Logistic回归模型分析GDM产妇和非GDM产妇分娩巨大儿的影响因素。结果无论是否患GDM，孕前体质指数、孕晚期载脂蛋白A水平和孕期胆固醇差值增加是产妇分娩巨大儿的危险因素（P<0.05），而孕晚期胆固醇水平较高则是产妇分娩巨大儿的保护因素（P<0.05）。在GDM产妇中，孕早期LDL水平、孕中期OGTT前血糖水平较高是其分娩巨大儿的危险因素（P<0.05），孕期HDL差值较高则是其分娩巨大儿的保护因素（P<0.05）。在非GDM产妇中，胎儿为男性、孕期总增重较高、分娩孕周较大、孕晚期LDL水平较高是其分娩巨大儿的危险因素，而孕晚期 HDL水平较高、孕期LDL差值较大则是其分娩巨大儿的保护因素（P<0.05）。结论 GDM产妇与非GDM产妇分娩巨大儿的影响因素不完全相同。对于GDM产妇，尤其空腹血糖高者，应合理控制血糖并密切监测，关注血脂变化；对于非GDM产妇，应在孕期注意体重管理，避免增重过度，并监测血脂，以降低巨大儿的发生率。

Objective To explore the influencing factors for macrosomia delivery in puerperae with gestational diabetes mellitus (GDM) versus in puerperae without GDM. Methods A total of 143 puerperae with macrosomia delivery and 157 puerperae with normal birth weight neonates delivery were enrolled as the research subjects, and the former was assigned to GDM macrosomia group or non-GDM macrosomia group, as well as the latter to GDM control group or non-GDM control group according to whether suffering from GDM or not during pregnancy. The multivariate binary Logistic regression model was used to analyze the influencing factors for macrosomia delivery in puerperae with or without GDM. Results With or without GDM, increased pre⁃pregnancy body mass index, elevated apoprotein A level in late pregnancy, and increased cholesterol difference during pregnancy were the risk factors for macrosomia delivery in puerperae (P<0.05), whereas relatively high cholesterol level in late pregnancy was the protective factor for macrosomia delivery in puerperae (P<0.05). In GDM puerperae, high levels of LDL in early pregnancy and pre-OGTT blood glucose in pregnant metaphase were the risk factors for their macrosomia delivery (P<0.05), whereas high HDL difference during pregnancy was the protective factor for their macrosomia delivery (P<0.05). In non-GDM puerperae, male fetus, high total gestational weight gain, great gestational age at delivery, and high LDL level in late pregnancy were the risk factors for their macrosomia delivery, whereas high HDL level in late pregnancy, high LDL difference during pregnancy were the protective factors for their macrosomia delivery (P<0.05). Conclusion The influencing factors for macrosomia delivery are not exactly same between GDM puerperae and non-GDM puerperae. For GDM puerperae, especially for those with high fasting blood glucose, their blood glucose should be appropriately controlled and closely monitored, and blood lipid changes should be paid attention to. For non-GDM puerperae, their body weight management during pregnancy should be paid attention to avoid excessive weight gain, and blood lipid should be monitored to reduce the incidence rate of macrosomia.

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