方秀明 1李冰馨 1刘婧南 1袁玲丹 1宋利格 1金为1
作者信息
- 1. 同济大学医学院,上海 200092||同济大学附属同济医院内分泌代谢科,上海 200065||同济大学医学院骨质疏松和代谢性骨病研究所,上海 200065
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摘要
Abstract
Objective To investigate the effects of urinary ketone level on perinatal complications in pregnant women and fetuses in mid-and late pregnancy.Methods The clinical data of a total of 771 pregnant women who delivered in the Obstetrics Department of Tongji Hospital from January 2022 to January 2023 were retrospectively analyzed.The pregnant women were divided into normoglycemic group and gestational diabetes mellitus(GDM)group according to oral glucose tolerance test results.The participants were further divided into three groups according to the urine ketone body test results:urine ketone-negative group:-/+-;moderate urinary ketones group:+/++;severe urinary ketones group:+++/++++.The differences in general characteristics,blood indices,and maternal-neonatal clinical outcomes were compared among normoglycemic pregnant women and GDM pregnant women with varying levels of urinary ketone bodies.Multivariate logistic was used to analyze the influencing factors of pregnancy outcomes of mothers and infants,and the influencing factors of urine ketone levels were analyzed by ordered multivariate logistic analysis.Results There were 666(86.38％)pregnant women with normal blood glucose and 105(13.62％)with GDM in the study population.Among the normoglycemic pregnant women,the proportions of the urine ketone-negative(Ket-N)group,the moderate urinary ketones(Ket-M)group and the severe urinary ketones(Ket-S)group was 53.60％,36.04％and 10.36％respectively;and it was 31.43％,33.33％and 35.24％in the pregnant women with GDM,respectively.Among the normoglycemic pregnant women,the proportions of the Ket-S group,the Ket-M group and the Ket-S group was 82.73％、13.21％and 4.05％,respectively,in the second trimester of pregnancy;and it was 61.71％,31.23％and 7.06％,respectively,in the third trimester.Among the pregnant women with GDM,the proportions of the Ket-N group,the Ket-M group and the Ket-S group was 65.71％,22.86％and 11.43％,respectively,in the second trimester of pregnancy;and it was 37.14％,27.62％and 35.24％respectively,in the third trimester.Among the normoglycemic pregnant women,the incidences of pre-eclampsia and primary caesarean section in the urine ketone positive group were both higher than those in the urine ketone negative group(both P＜0.05).The incidence of neonatal asphyxia in the Ket-S group was higher than that in the Ket-N group(P＜0.05).In the GDM group,the Ket-S group was transferred to the neonatal ward at a higher rate than the Ket-N group and the Ket-M group(P＜0.05).The results of multivariate Logistic regression analysis of clinic outcomes in pregnant women showed that the initial birth and the elevating alanine aminotransferase(ALT)were risk factors for adverse clinic outcomes(OR=11.912,1.025,both P＜0.05).The results of ordered multivariate Logistic regression analysis of urine ketone levels showed that age,family history of diabetes,GDM,and insulin therapy during pregnancy were risk factors for high levels of ketonuria in pregnant women(OR=1.042,2.244,1.759,7.729,all P＜0.05).Age was a risk factor for high levels of ketonuria in normoglycemic pregnant women(OR=1.048,P＜0.05).Pre-pregnancy body mass index(BMI)and family history of diabetes were risk factors for high levels of ketonuria in pregnant women with GDM(OR=1.249,12.557,both P＜0.05).Conclusion Pregnant women are prone to develop ketonuria in the second and third trimesters.The presence of ketonuria in normoglycemic pregnant women increases the risk of preeclampsia,primary cesarean delivery and neonatal asphyxia.GDM women with ketonuria in the second and third trimesters have an increased risk of neonates being admitted to the neonatal ward.In conclusion,the presence of different levels of ketonuria in the second and third trimesters of pregnancy may increase the risk of adverse perinatal pregnancy outcomes for both pregnant women and fetuses.关键词
妊娠期糖尿病/不良妊娠结局/酮尿症/先兆子痫Key words
gestational diabetes mellitus/adverse pregnancy outcomes/ketonuria/preeclampsia分类
医药卫生
