Association and clinical significance of the thickness of fetal heart wall in the third trimester with the control status of HbA1c level among Gestational diabetes mellitus women
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摘要:
目的观察孕晚期胎儿心脏室壁厚度与妊娠期糖尿病孕妇HbA1c水平控制状态的关联并讨论其临床意义。 方法随机择2015年1月~2019年6月我院接受孕检的罹患妊娠期糖尿病的122例单胎妊娠孕妇及其胎儿为研究对象。收集母亲孕早期、孕中期以及孕晚期HbA1c信息，借助超声检测收集孕晚期胎儿心室壁厚度信息等相关资料信息，分析孕晚期胎儿心脏室壁厚度与母亲孕期HbA1c水平控制状态的关联情况。 结果孕早期受试对象的HbA1c水平为（5.80±1.60）%，孕中期为（5.91±1.61）%，孕晚期为（5.97±1.86）%，3个时期测定水平差异无统计学意义（P>0.05），不同孕期HbA1c控制情况分布特征差异无统计学意义（P>0.05）；孕早期、孕中期和孕晚期不同HbA1c控制水平的孕妇，在孕晚期经超声测定胎儿的心室壁厚度和室间隔厚度比较可见，孕早期和孕中期不同HbA1c控制水平的胎儿舒张晚期、收缩晚期左右心室以及室间隔的厚度差异无统计学意义，但是绝对数字可见血糖水平控制不佳的孕妇胎儿心室壁和室间隔厚度均相对更高；孕晚期母亲血糖水平对胎儿收缩晚期左心室壁厚度影响相对较大，孕晚期母亲HbA1c控制水平不佳者均可见胎儿收缩晚期左心室壁厚度更大（P < 0.05）；孕晚期母亲HbA1c水平控制不良与孕晚期胎儿测定的舒张晚期左心室厚度、收缩晚期左心室厚度以及舒张晚期室间隔厚度呈正相关关系（r=0.404、0.361、0.332，P < 0.05）。 结论罹患妊娠糖尿病的孕妇，血糖控制不佳会影响引发胎儿心室壁和室间隔增厚，有可能对胎儿心脏发育造成不良影响，基于此建议尽量有效控制孕妇血糖水平处于良好范围，特别是孕晚期控制血糖水平，以便减低胎儿和新生儿的心脏损害。 Abstract:ObjectiveTo observe the correlation between the thickness of the fetal heart wall in the third trimester and the control status of HbA1c levels in pregnant women with diabetes in gestation and discuss its clinical significance. MethodsA total of 122 single pregnant women suffering from gestational diabetes and their fetuses in our hospital from January 2015 to June 2019 were randomly selected as the research objects. The maternal HbA1c information in the first, second and third trimester of pregnancy and the fetal ventricular wall thickness information in the third trimester of pregnancy were collected by ultrasound detection. The correlation between fetal heart wall thickness and maternal HbA1c level control state were analyzed during the pregnancy. Use SPSS software to complete statistical analysis. ResultsThe HbA1c level of the subjects in the first trimester in the study was (5.80±1.60)%, the HbA1c% level in the second trimester was (5.91±1.61)%, and the third trimester was (5.97±1.86)%. There was no significant difference between the three periods (P>0.05). No statistically significant differences were found in the distribution characteristics of HbA1c control during different pregnancy periods. Among pregnant women with different HbA1c control levels in the first, second and third trimesters of pregnancy, the fetal ventricular wall thickness and interventricular septal thickness were measured by ultrasound during the third trimester. It can be seen that the fetuses with different HbA1c control levels in the first and second trimesters have late diastolic and contractile. There is no statistically significant difference in the thickness of left and right ventricles and interventricular septum. But the absolute figures show that the fetal ventricular wall and interventricular septal thickness of pregnant women with poorly controlled blood glucose levels are relatively higher. Thickness has a relatively large impact. The results of this study show that the mothers with poor control of HbA1c in the third trimester can see that the left ventricular wall thickness in the late fetal contraction is greater (P < 0.05); on the basis of the foregoing analysis, this study uses related analysis, HbA1c level control in the second and third trimesters of pregnancy and fetal ventricular wall thickness measured in the third trimester were correlated, and the results suggest that poorly controlled HbA1c levels in the third trimester and the late diastole measured in the third trimester fetus Ventricular thickness, left ventricular thickness in late systole, and late diastolic septum thickness were positively correlated (r=0.404, 0.361, 0.332, P < 0.05). ConclusionPoor blood glucose control in pregnant women suffering from gestational diabetes can cause thickening of the fetal ventricular wall and septum, which may adversely affect the fetal heart development. Therefore, it is suggested that the blood glucose level of pregnant women should be controlled in a good range as far as possible, especially in the third trimester of pregnancy, so as to reduce the heart damage of fetus and newborn. -
表 1 受试对象基本特征分布[n(%)]
Table 1. The distribution feature for the participants
指标 年龄 < 35岁（n=107) 年龄>35岁（n=15) 合计（n=122) χ2/t P 孕前BMI(kg/m2, Mean±SD) 21.97±1.86 22.19±2.32 22.08±2.15 0.416 0.678 消瘦组 21 (19.63) 2(13.33) 23 (18.85) 0.438 0.932 正常组 56 (52.34) 8 (53.33) 64 (52.46) 超重组 23 (21.50) 4 (26.67) 27(22.13) 肥胖组 7 (6.54) 1 (6.67) 8 (6.56) 孕前血压(mmHg，Mean±SD) 舒张压 82.08±8.36 83.26±7.22 83.09±7.75 0.520 0.604 收缩压 119.09 ± 9.35 121.12 ± 11.09 120.47± 10. 15 0.769 0.443 
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表 2 受试对象孕期HbA1c水平控制情况分布
Table 2. The distribution of the HbA1c level among the pregnant women
时期 HbAlc (%, Mean±SD) 控制不佳[n(%)] 控制良好[n(%)] 孕早期 5.80±1.60 51 (41.80) 71 (58.20) 孕中期 5.91 ± 1.61 56 (45.90) 66 (54.10) 孕晚期 5.97 ± 1.86 55 (45.08) 67 (54.92) χ2/F 0.320 0.465 0.465 P 0.729 0.792 0.792
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表 3 不同孕早期HbA1c水平孕母孕晚期胎儿心室壁厚度及相关参数分布特征（mm, Mean±SD）
Table 3. The status of fetal heart wall in the first trimester among different HbA1c level Gestational diabetes mellitus women
孕早期(12周以内） 合计水平(n=122) 控制不佳(n=51) 控制良好(n=71) χ2/t P 舒张晚期左心室壁厚度 2.53±0.51 2.54 ± 0.54 2.51 ± 0.47 0.162 0.872 收缩晚期左心室壁厚度 2.40±0.44 2.41 ± 0.47 2.39 ± 0.40 0.078 0.938 舒张晚期右心室壁厚度 2.61 ± 53 2.62 ± 0.52 2.59 ± 0.60 0.209 0.835 收缩晚期右心室壁厚度 3.26±0.60 3.28 ± 0.65 3.23 ± 0.52 0.110 0.913 舒张晚期室间隔厚度 3.31±0.56 3.32 ± 0.53 3.28 ± 0.60 0.138 0.890 收缩晚期室间隔厚度 4.62±0.53 4.63 ± 0.56 4.60±0.55 0.037 0.970
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表 4 不同孕中期HbA1c%水平孕母孕晚期胎儿心室壁厚度及相关参数分布特征（mm, Mean±SD）
Table 4. The status of fetal heart wall in the middle trimester among different HbA1c level Gestational diabetes mellitus women
孕中期(12~28周） 合计水平(n=122) 控制不佳(n=56) 控制良好(n=66) χ2/t P 舒张晚期左心室壁厚度 2.58 ± 0.59 2.94± 0.60 2.86 ± 0.52 0.789 0.432 收缩晚期左心室壁厚度 2.46 ± 0.51 2.48 ± 0.53 2.45 ± 0.54 0.078 0.938 舒张晚期右心室壁厚度 2.65 ± 0.51 2.67 ± 0.54 2.60±0.47 0.209 0.835 收缩晚期右心室壁厚度 3.32 ± 0.61 3.34± 0.56 3.29 ± 0.64 0.110 0.913 舒张晚期室间隔厚度 3.35 ± 0.70 3.38 ± 0.62 3.31 ± 0.71 0.138 0.890 收缩晚期室间隔厚度 4.70±0.81 4.71 ± 0.86 4.69 ± 0.75 0.037 0.970
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表 5 不同孕晚期HbA1c%水平孕母孕晚期胎儿心室壁厚度及相关参数分布特征（mm, Mean±SD）
Table 5. The status of fetal heart wall in the third trimester among different HbA1c level Gestational diabetes mellitus women
孕晚期(28周以后） 合计水平(n=122) 控制不佳(n=55) 控制良好(n=67) χ2/t P 舒张晚期左心室壁厚度 2.58 ± 0.59 2.94±0.60 2.45±0.49 1.957 0.053 收缩晚期左心室壁厚度 2.50±0.54 2.81±0.60 2.19±0.41 2.933 0.004 舒张晚期右心室壁厚度 2.68 ± 0.56 2.70±0.62 2.65±0.43 0.228 0.822 收缩晚期右心室壁厚度 3.36 ± 0.58 3.38±0.52 3.29±0.60 0.296 0.768 舒张晚期室间隔厚度 3.40±0.74 3.42±0.73 3.37±0.76 0.130 0.897 收缩晚期室间隔厚度 4.75 ± 0.71 4.77±0.68 4.68±0.75 0.237 0.813
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表 6 不同孕晚期HbA1c控制水平孕母孕晚期胎儿心室壁厚度等及相关参数相关性的相关分析
Table 6. Correlation for the status of fetal heart wall in the third trimester and the HbA1c level for Gestational diabetes mellitus women
因素 孕早期HbAlc控制不良 孕中期HbAlc控制不良 孕晚期HbAlc控制不良 V P r P r P 舒张晚期左心室壁厚度 0.152 0.095 0.177 0.051 0.404 0.000 收缩晚期左心室壁厚度 0.098 0.283 0.159 0.080 0.361 0.000 舒张晚期右心室壁厚度 0.113 0.215 0.176 0.053 0.155 0.088 收缩晚期右心室壁厚度 0.175 0.054 0.069 0.450 0.128 0.160 舒张晚期室间隔厚度 0.163 0.073 0.133 0.144 0.332 0.001 收缩晚期室间隔厚度 0.075 0.412 0.128 0.160 0.104 0.254
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