妊娠期糖尿病孕妇尿酮体持续阳性对母婴临床结局的影响

doi:10.3969/j.issn.1674-8115.2023.03.007

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (3): 314-319.doi: 10.3969/j.issn.1674-8115.2023.03.007

• 论著 · 临床研究 • 上一篇

妊娠期糖尿病孕妇尿酮体持续阳性对母婴临床结局的影响

张越(), 瞿蕾, 谷沁, 朱亦清, 马莉莹, 孙文广()

上海交通大学医学院附属国际和平妇幼保健院营养科，上海市胚胎源性疾病重点实验室，上海 200030

收稿日期:2022-11-22 接受日期:2023-03-15 出版日期:2023-03-28 发布日期:2023-03-28
通讯作者: 孙文广 E-mail:1597590593@qq.com;sunwenguang68@126.com
作者简介:张　越（1995—），女，住院医师，硕士；电子信箱：1597590593@qq.com。
基金资助:
国际和平妇幼保健院临床研究计划(CR2018SY04)

Effect of continuous positive urine ketone body on clinical outcomes of pregnant women with gestational diabetes mellitus and newborn

ZHANG Yue(), QU Lei, GU Qin, ZHU Yiqing, MA Liying, SUN Wenguang()

Shanghai Key Laboratory of Embryo Original Diseases, Department of Nutrition, The International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China

Received:2022-11-22 Accepted:2023-03-15 Online:2023-03-28 Published:2023-03-28
Contact: SUN Wenguang E-mail:1597590593@qq.com;sunwenguang68@126.com
Supported by:
Clinical Research Program for The International Peace Maternity & Child Health Hospital(CR2018SY04)

摘要/Abstract

摘要：

目的·探讨妊娠期糖尿病（gestational diabetes mellitus，GDM）孕妇尿酮体持续阳性对母婴结局的影响。方法·选取2021年1月—2022年1月于上海交通大学医学院附属国际和平妇幼保健院营养门诊就诊并于该院分娩的168例GDM孕妇为研究对象。根据产检尿酮体的检测结果，将其分为酮体阳性组（56例，孕妇确诊GDM后出现3次及以上产检尿酮体阳性）和酮体阴性组（112例，孕妇确诊GDM后产检尿酮体持续阴性）。收集孕妇的一般资料（临床资料、实验室检测指标）和孕妇及其新生儿的临床结局指标，并进行比较分析。结果·2组孕妇的临床资料、实验室检测指标间差异均无统计学意义，其中孕前体质量指数、确诊GDM前的体质量变化、糖尿病家族史、GDM史、孕早期的总胆固醇和三酰甘油水平、孕中期的空腹血糖和胰岛素水平对尿酮体的生成均无影响。孕妇临床结局指标分析的结果显示，确诊GDM后的体质量变化（P=0.000；RR=6.000，95% CI 1.251~28.777）、确诊GDM后的体质量增长速率（P=0.000；RR=1.829，95% CI 1.132~2.953）的组间差异均具有统计学意义。新生儿临床结局指标分析的结果显示，新生儿住院率的组间差异具有统计学意义（P=0.023；RR=2.167，95% CI 1.059~4.434）；其中，酮体阳性组新生儿有4例不良事件发生，酮体阴性组则无此类不良事件。结论·GDM孕妇尿酮体持续阳性可能会增加其体质量增长不足和新生儿住院的风险，建议临床及时发现并干预。

关键词: 妊娠期糖尿病, 酮体, 新生儿结局, 孕妇结局

Abstract:

Objective ·To explore the effect of continuous positive urine ketone body in pregnant women with gestational diabetes mellitus (GDM) on the maternal and infant outcomes. Methods ·A total of 168 GDM pregnant women who attended the Nutrition Clinic of the International Peace Maternal & Child Health Hospital, Shanghai Jiao Tong University School of Medicine from January 2021 to January 2022 and gave birth in the hospital were selected as the study subjects. According to the difference of urine ketone body test results in prenatal examination, they were divided into ketone body-positive group (56 cases, the pregnant women had ketone body test positive for three times or more after the diagnosis of GDM) and ketone body-negative group (112 cases, the ketone body test was continuously negative after the diagnosis of GDM). The general information included clinical data and laboratory indicators of pregnant women and clinical outcomes of pregnant women and their newborns were collected and compared. Results ·There were no statistically significant differences in clinical data and laboratory indicators of pregnant women between the two groups, among which the body mass index before pregnancy, weight change before diagnosis of GDM, family history of diabetes mellitus, history of GDM, total cholesterol and triacylglycerol levels in the early pregnancy, fasting blood glucose and insulin levels in the middle pregnancy had no significant correlation with the production of urine ketone body. The results of clinical outcome indicators of pregnant women showed that there were statistically significant differences in weight change (P=0.000; RR=6.000, 95% CI 1.251?28.777) and rate of weight gain (P=0.000; RR=1.829, 95% CI 1.132?2.953) after diagnosis of GDM between the two groups. The results of neonatal clinical outcome indicators showed that there was statistically significant difference in the neonatal hospitalization rate (P=0.023; RR=2.167, 95% CI 1.059?4.434) between the two groups; among them, there were 4 adverse events in the ketone body positive group and no such adverse events in the ketone body negative group. Conclusion ·The continuous positive urine ketone body of pregnant women with GDM may increase the risk of insufficient weight gain in pregnant women and neonatal hospitalization. It is recommended to timely detect and intervene in clinical practice.

Key words: gestational diabetes mellitus (GDM), ketone body, neonatal outcome, pregnant women's outcome

中图分类号:

R459.3

张越, 瞿蕾, 谷沁, 朱亦清, 马莉莹, 孙文广. 妊娠期糖尿病孕妇尿酮体持续阳性对母婴临床结局的影响[J]. 上海交通大学学报（医学版）, 2023, 43(3): 314-319.

ZHANG Yue, QU Lei, GU Qin, ZHU Yiqing, MA Liying, SUN Wenguang. Effect of continuous positive urine ketone body on clinical outcomes of pregnant women with gestational diabetes mellitus and newborn[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(3): 314-319.

图/表 4

参考文献 17

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Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t/U value	P value
Height/cm	160 (158, 163)	162 (159, 166)	3 690.500	0.061
Pro-gestational weight/kg	55 (51, 61)	57 (51, 61)	3 208.000	0.808
Pro-gestational BMI/(kg·cm^-2)	21.5 (20.0, 23.4)	21.1 (19.6, 23.2)	3 044.000	0.757
Weight change before diagnosis of GDM/kg	8.53±3.36	7.89±2.95	1.223	0.224
Family history of DM/n (%)	9 (16.1)	19 (17.0)	0.021	0.884
History of GDM/n (%)	3 (5.4)	4 (3.6)	0.019	0.891
Early pregnancy/(mmol·L^-1)
TC	4.45±0.75	4.46±0.70	0.048	0.962
TAG	1.34 (1.00, 1.63)	1.32 (1.02, 1.71)	3 203.000	0.822
HDL-C	1.80 (1.54, 2.15)	1.84 (1.63, 2.12)	3 320.000	0.536
LDL-C	2.49±0.60	2.46±0.57	0.343	0.732
Middle pregnancy
HbA1c/%	5.29±0.26	5.32±0.25	0.959	0.339
0 h OGTT/(mmol·L^-1)	4.81±0.52	4.70±0.50	1.256	0.211
1 h OGTT/(mmol·L^-1)	9.97±1.32	9.90±1.28	0.325	0.745
2 h OGTT/(mmol·L^-1)	8.32±1.35	8.32±1.26	0.002	0.998
0 h INS/(mU·L^-1)	6.85 (4.90, 10.30)	6.80 (4.83, 9.50)	3 006.500	0.663
1 h INS/(mU·L^-1)	56.55 (40.20, 73.70)	64.85 (48.05, 87.83)	3 706.000	0.055
2 h INS/(mU·L^-1)	59.85 (42.93, 88.75)	58.10 (40.80, 87.15)	3 128.500	0.980

Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t/U value	P value
Height/cm	160 (158, 163)	162 (159, 166)	3 690.500	0.061
Pro-gestational weight/kg	55 (51, 61)	57 (51, 61)	3 208.000	0.808
Pro-gestational BMI/(kg·cm^-2)	21.5 (20.0, 23.4)	21.1 (19.6, 23.2)	3 044.000	0.757
Weight change before diagnosis of GDM/kg	8.53±3.36	7.89±2.95	1.223	0.224
Family history of DM/n (%)	9 (16.1)	19 (17.0)	0.021	0.884
History of GDM/n (%)	3 (5.4)	4 (3.6)	0.019	0.891
Early pregnancy/(mmol·L^-1)
TC	4.45±0.75	4.46±0.70	0.048	0.962
TAG	1.34 (1.00, 1.63)	1.32 (1.02, 1.71)	3 203.000	0.822
HDL-C	1.80 (1.54, 2.15)	1.84 (1.63, 2.12)	3 320.000	0.536
LDL-C	2.49±0.60	2.46±0.57	0.343	0.732
Middle pregnancy
HbA1c/%	5.29±0.26	5.32±0.25	0.959	0.339
0 h OGTT/(mmol·L^-1)	4.81±0.52	4.70±0.50	1.256	0.211
1 h OGTT/(mmol·L^-1)	9.97±1.32	9.90±1.28	0.325	0.745
2 h OGTT/(mmol·L^-1)	8.32±1.35	8.32±1.26	0.002	0.998
0 h INS/(mU·L^-1)	6.85 (4.90, 10.30)	6.80 (4.83, 9.50)	3 006.500	0.663
1 h INS/(mU·L^-1)	56.55 (40.20, 73.70)	64.85 (48.05, 87.83)	3 706.000	0.055
2 h INS/(mU·L^-1)	59.85 (42.93, 88.75)	58.10 (40.80, 87.15)	3 128.500	0.980

Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t/U value	P value
Late pregnancy
TC/(mmol·L^-1)	6.13±1.07	6.14±1.15	0.054	0.957
TAG/(mmol·L^-1)	3.53 (2.75, 4.76)	3.33 (2.60, 4.20)	2 816.000	0.282
HDL-C/(mmol·L^-1)	1.88±0.38	1.92±0.38	0.573	0.494
LDL-C/(mmol·L^-1)	3.21 (2.55, 3.93)	3.35 (2.71, 4.15)	3 425.500	0.330
GA/%	12.35±0.87	12.60±0.98	1.581	0.116
Pregnancy outcome
Week of delivery/week	39 (38, 39)	39 (38, 39)	2 862.000	0.335
Vaginal delivery/n (%)	33 (58.9)	66 (58.9)	0.000	1.000
Weight change after diagnosis of GDM/kg	2.77±3.03	4.39±2.18	3.977	0.000
Rate of weight gain after diagnosis of GDM /(kg·week^-1)	0.22±0.24	0.35±0.32	3.720	0.000

Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t/U value	P value
Late pregnancy
TC/(mmol·L^-1)	6.13±1.07	6.14±1.15	0.054	0.957
TAG/(mmol·L^-1)	3.53 (2.75, 4.76)	3.33 (2.60, 4.20)	2 816.000	0.282
HDL-C/(mmol·L^-1)	1.88±0.38	1.92±0.38	0.573	0.494
LDL-C/(mmol·L^-1)	3.21 (2.55, 3.93)	3.35 (2.71, 4.15)	3 425.500	0.330
GA/%	12.35±0.87	12.60±0.98	1.581	0.116
Pregnancy outcome
Week of delivery/week	39 (38, 39)	39 (38, 39)	2 862.000	0.335
Vaginal delivery/n (%)	33 (58.9)	66 (58.9)	0.000	1.000
Weight change after diagnosis of GDM/kg	2.77±3.03	4.39±2.18	3.977	0.000
Rate of weight gain after diagnosis of GDM /(kg·week^-1)	0.22±0.24	0.35±0.32	3.720	0.000

Item	Ketone body-positive group (n=56)	Ketone body-negative group (n=112)	χ² /t value	P value
Newborn birth weight/g	3 356.25±352.54	3 281.70±404.68	1.173	0.242
Low body weight infant/n (%)	1 (1.8)	2 (1.8)	0.000	1.000
Macrosomia/n (%)	2 (3.6)	5 (4.5)	0.000	1.000
Neonatal hospitalization/n (%)	13 (23.2)	12 (10.7)	4.605	0.023

妊娠期糖尿病孕妇尿酮体持续阳性对母婴临床结局的影响

Effect of continuous positive urine ketone body on clinical outcomes of pregnant women with gestational diabetes mellitus and newborn

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