目的:探讨妊娠期糖尿病(GDM)孕妇新生儿不良结局高危因素并建立logistic风险模型.方法:选取2020年2月-2022年8月本院产科门诊接收的GDM孕妇196例临床资料,依据新生儿结局分为不良组、良好组.采用logistic回归分析明确GDM孕妇发生不良新生儿结局高危因素,建立logistic风险模型,采用Hosmer-Lemeshow检验判定风险模型拟合优度,受试者工作特征(ROC)曲线探讨风险模型的预测效力.结果:最终纳入的168例孕妇中出现不良新生儿结局44例、未出现124例.不良组与良好组妊娠期高血压疾病、抑郁症状、孕前BMI、孕期增重情况、空腹血糖(FPG)、服糖后1 h血糖(1 h PG)、分娩前糖化血红蛋白(HbA1c)有差异;logistic回归分析显示,妊娠期高血压疾病、抑郁症状、孕期增重过度、分娩前HbA1c水平高均为GDM孕妇发生不良新生儿结局独立危险因素(均P＜0.05).基于独立危险因素建立logistic风险模型,Logit(P)=-15.610+1.472×妊娠期高血压疾病(有=1,无=0)+0.884×抑郁症状(有=1,无=0)+1.014×孕期增重情况(孕期增重过度=2,孕期增重不足=1,孕期增重正常=0)+2.053×分娩前 HbA1c(％),Hosmer-Lemeshow 检验(x2=9.952,P=0.268)拟合优度良好.ROC 曲线显示,logistic风险模型预测GDM孕妇发生不良新生儿结局的曲线下面积为0.792,95％CI 0.707～0.877,最佳预测敏感度77.3％,预测特异度72.6％.结论:GDM孕妇不良新生儿结局高危因素包括妊娠期高血压疾病、抑郁症状、孕期增重过度、分娩前HbA1c水平高,应用其建立的logistic风险模型预测效力较好,为临床干预提供参考.
Estabilish of the risk model of the high-risk factors of the adverse neonatal outcomes of women with gestational diabetes mellitus
Objective:To explore the high-risk factors of the adverse neonatal outcomes of pregnant women with gesta-tional diabetes mellitus(GDM),and to establish a Logistic risk model.Methods:The clinical data of 196 pregnant women with GDM who were admitted to the obstetrics clinic of the hospital from February 2020 to August 2022 were selected.According to the neonatal outcomes,these women were divided into study group(women with adverse neo-natal outcomes)and control group(women without adverse neonatal outcomes).Logistic regression analysis was used to determine the high-risk factors of the adverse neonatal outcomes of the pregnant women with GDM,and Logistic risk model was established.Hosmer-Lemeshow test was used to determine the goodness of fit of the risk model.Re-ceiver operating characteristic(ROC)curve was used to explore the predictive effect of this risk model.Results:A-mong 168 pregnant women,there were 44 cases with adverse neonatal outcomes and 124 cases without adverse neo-natal outcomes.There were significant differences in the hypertensive disorders complicating pregnancy occurrence,the depressive symptoms,the pre-pregnancy BMI value,the weight gain during pregnancy,and the levels of fasting plas-ma glucose(FPG),1-hour plasma glucose(1h PG)and glycosylated hemoglobin(HbA1c)before delivery of the women between the two groups.Logistic regression analysis showed that the hypertensive disorders complicating pregnancy,the depressive symptoms,the excessive weight gain during pregnancy and the high HbA1c level before delivery of the women with GDM were the independent risk factors of their adverse neonatal outcomes(all P＜0.05).A logistic risk model was established based on these independent risk factors,which was Logit(P)=-15.610+1.472 × hyperten-sive disorder complicating pregnancy(yes=1,no=0)+0.884 × depressive symptoms(yes=1,no=0)+1.014 × weight gain during pregnancy(excessive weight gain=2,insufficient weight gain=1).Normal weight gain during pregnancy=0)+2.053 × HbA1c(％)before delivery.Hosmer-Lemeshow test(x2=9.952,P=0.268)had a good goodness of fit for this model.ROC curve showed that the area under the curve of this logistic risk model for predicting the adverse neonatal outcomes of the pregnant women with GDM was 0.792,95％CI=0.707-0.877,the best predictive sensitivity and specificity of this logistic risk model for the adverse neonatal outcomes were 77.3％and 72.6％.Conclusion:The high-risk factors of the adverse neonatal outcomes of the pregnant women with GDM include the hypertensive disorders complicating pregnancy,the depressive symptoms,the excessive weight gain during pregnancy and the high HbA1 c level before delivery.The Logistic risk model established by these high-risk factors of the adverse neonatal outcomes has a good predictive effect,and which can provide evidences for clinical intervention.
万方数据
维普
