妊娠期糖尿病患者孕中晚期糖脂代谢指标与妊娠结局的关联分析OA

Objective To investigate the relationship between changes in glycolipid metabolic indices during mid-to late pregnancy and pregnancy outcomes in patients with gestational diabetes mellitus(GDM),and to evaluate the predictive value of dynamic changes in these indices for adverse pregnancy outcomes.Methods A total of 77 women with GDM who received antenatal care and delivered at Puyang People's Hospital from January 2024 to December 2024 were enrolled.Glycolipid metabolic indices were collected in mid-pregnancy(24～28 gestational weeks)and late pregnancy(36～40 gestational weeks),including fasting plasma glucose(FPG),insulin(INS),C-peptide(CP),glycated hemoglobin(HbA1c),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C).According to pregnancy outcomes,the participants were assigned to a normal outcome group(n=56)and an adverse outcome group(n=21).Differences in the levels of these indices in mid-and late pregnancy,as well as differences in their dynamic changes(Δ values),were compared between groups.Multivariable logistic regression was performed to identify glycolipid metabolic indices associated with adverse pregnancy outcomes,and receiver operating characteristic(ROC)curve analysis was used to assess predictive performance.Results In both mid-pregnancy and late pregnancy,levels of FPG,INS,CP,HbA1c,TC,TG,and LDL-C were higher in the adverse outcome group than in the normal outcome group,whereas HDL-C was lower in the adverse outcome group;the differences were statistically significant(P＜0.05).When the glycolipid metabolic indices in late pregnancy were subtracted from those in mid-pregnancy,the results showed that,with progression to late pregnancy,ΔFPG and ΔHbA1c increased in the adverse outcome group(P＜0.05),whereas they showed a decreasing trend in the normal outcome group(P＜0.05).In addition,the increases in ΔINS,ΔCP,and ΔTG were significantly greater in the adverse outcome group than in the normal outcome group(P＜0.05).There were no statistically significant differences between groups in the magnitudes of change for ΔTC,ΔLDL-C,or ΔHDL-C(P＞0.05).Multivariable logistic regression analysis indicated that the increase in TG,the increase in HbA1c,and the increase in INS were independent risk factors for adverse pregnancy outcomes in women with GDM(P＜0.05).A combined model incorporating ΔTG,ΔHbA1c,and ΔINS showed higher predictive accuracy than any single index alone,with an area under the ROC curve(AUC)of 0.963.The combined model yielded a sensitivity of 0.952 and a specificity of 0.893,both higher than those of each single index.Conclusion Changes in glycolipid metabolic indices have important predictive value for pregnancy outcomes in patients with GDM.Dynamic trends in glycolipid metabolism—particularly ΔTG,ΔHbA1c,and ΔINS—may facilitate earlier and more accurate identification of high-risk women with GDM who are likely to develop adverse pregnancy outcomes,thereby promoting early intervention and individualized clinical management for women with GDM.