The relationship between blood glucose control level of gestational diabetes mellitus and the incidence of neonatal hyperbilirubinemia
Objective To explore the relationship between blood glucose control level of gestational diabetes mellitus(GDM)and the incidence of neonatal hyperbilirubinemia(NHB).Methods A total of 100 pregnant women with GDM treated in The Second People's Hospital of Huai'an from March 2017 to March 2021 were selected as the study subjects and included in the GDM group.Another 100 pregnant women without GDM during the same period,matched for gestational age and age at delivery,were selected into the control group.The GDM group was divided into the NHB group(n=30)and non-NHB group(n=70).The occurrence of complications was compared between the GDM group and the control group,and the relationship between blood glucose control level and the occurrence of NHB were analyzed.Multiple Logistic regression was used to analyze factors influencing the occurrence of NHB in newborns delivered by pregnant women with GDM.The diagnostic efficacy of blood glucose control level in the diagnosis of NHB was assessed using the area under the curve(AUC)of the receiver operating characteristic(ROC).Using Python 3.6 to build an artificial neural network model based on Softmax strategy,and evaluate the model.Results The incidence rates of NHB,macrosomia and neonatal distress complications in the GDM group were significantly higher than those in the control group,and the differences were statistically significant(X2 values were 9.765,5.207 and 7.236,respectively,P＜0.05).In the GDM group,21 pregnant women had fasting blood glucose levels＞7.8mmol/L,among whom 11 newborns had NHB,accounting for 52.4％,37 pregnant women had fasting blood glucose levels between 6.1-7.8mmol/L,among whom 14 newborns had NHB,accounting for 37.8％,42 pregnant women had fasting blood glucose levels＜6.1 mmol/L,among whom 5 newborns had NHB,accounting for 11.9％.Univariate analysis showed that factors related to the occurrence of NHB included:pregnant women's fasting blood glucose before delivery and neonatal birth length(t values were 2.243 and 2.368,respectively),as well as neonatal Apgar 5-minute score＜7 points,poor fasting blood glucose control,lack of breastfeeding,premature rupture of membranes,fetal asphyxia,neonatal infection,first meconium passage time＞24 hours,premature infants,and initiation of breastfeeding＞24 hours(X2 values were 9.580,11.758,8.129,20.003,24.536,30.014,5.563,7.233 and 6.994,respectively).The differences between the NHB group and the non-NHB group were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that premature rupture of membranes,poor fasting blood glucose control,fetal asphyxia,neonatal infection,prenatal fasting blood glucose,neonatal Apgar 5min score＜7 points,premature infants,first meconium passage time＞24 hours,lack of breastfeeding,and initiation of breastfeeding＞24 hours were all independent risk factors for NHB.ROC curve analysis showed that the AUC of predicting neonatal NHB based on fasting blood glucose control level was 0.876,with a sensitivity of 86.9％and specificity of 78.3％.The artificial neural network model showed that premature rupture of membranes,poor fasting blood glucose control,fetal asphyxia and neonatal infection had relatively high weights.ROC curve analysis showed that AUC was 0.869(95％CI:0.795-0.947),with a sensitivity of 89.5％and specificity of 98.3％when the critical value was set at 0.627 for predicting NHB occurrence in newborns delivered by GDM pregnant women.Conclusion GDM increases the incidence of NHB,macrosomia and neonatal distress complications.The better the blood glucose control in pregnant women with GDM,the lower the incidence of NHB.Premature rupture of membranes,poor fasting blood glucose control,fetal asphyxia,neonatal infection,prenatal fasting blood glucose,neonatal Apgar 5-minute score＜7,premature infants,first meconium passage time＞24 hours,lack of breastfeeding,and initiation of breastfeeding＞24 hours are independent influencing factors of NHB.The artificial neural network model has a high efficacy in predicting the occurrence of NHB in newborns delivered by GDM pregnant women,providing a basis for clinically reducing the risk of NHB.
万方数据
维普
