探讨孕妇人体质量指数(BMI)、C反应蛋白(CRP)及糖化血红蛋白(HbA1c)水平，与其发生妊娠期糖尿病(GDM)的关系，以及上述3项指标对预测GDM的价值。

选择2016年12月至2018年12月，于南京市中西医结合医院进行干预治疗和分娩的100例GDM孕妇为研究对象，将其纳入GDM组；选择同期与GDM组在同一家医院进行产前检查和分娩的60例健康孕妇作为对照，纳入对照组。采用成组t检验和χ²检验，对2组孕妇空腹血糖(FPG)、餐后2 h血糖(2 h PPG)、BMI、CRP及HbA1c水平，以及2组孕妇围生结局指标的发生率，进行统计学比较；采用Pearson相关性分析，对GDM组孕妇的BMI、CRP、HbA1c分别与其FPG及2 h PPG的相关性进行分析。本研究遵循的程序，符合2013年修订的《世界医学协会赫尔辛基宣言》要求，与所有受试者均签署临床研究知情同意书。

① GDM组孕妇的FPG、2 h PPG、BMI、CRP及HbA1c水平分别为(7.8±1.0) mmol/L、(11.0±1.6) mmol/L、(25.8±1.2) kg/m²、(12.8±2.9) mg/L及(8.5±1.7)%，均显著高于对照组孕妇的(5.6±0.6) mmol/L、(7.6±1.1) mmol/L、(22.2±1.1) kg/m²、(7.7±2.4) mg/L及(4.0±1.0)%，并且差异均有统计学意义(t＝14.139、13.394、17.455、10.726、16.705，均为P<0.001)。② Pearson相关性分析结果显示，GDM孕妇的BMI、CRP及HbA1c水平分别与FPG、2 h PPG，均呈正相关关系(r＝0.438、0.408，P<0.001；r＝0.389、0.410，P<0.001；r＝0.413、0.442，P<0.001)。③GDM组孕妇早产、胎膜早破、羊水过多、分娩巨大儿、胎儿窘迫及产后出血发生率，分别为21.1%、23.3%、22.2%、17.8%、16.7%、12.2%，均显著高于对照组孕妇的6.0%、8.0%、6.0%、4.0%、4.0%、2.0%，并且差异均有统计学意义(χ²＝5.542、P＝0.019，χ²＝5.152、P＝0.023，χ²＝6.161、P＝0.013，χ²＝5.446、P＝0.020，χ²＝4.834、P＝0.028，χ²＝4.286、P＝0.038)。GDM组孕妇分娩新生儿的1 min Apgar评分为(7.1±0.7)分，低于对照组健康孕妇分娩新生儿的(8.3±1.0)分，并且差异有统计学意义(t＝8.469，P<0.001)。

孕妇BMI、CRP及HbA1c水平与GDM相关，应加强对孕妇这3项指标的早期监测，以早期预测GDM的发生。

To explore the correlations among the body mass index (BMI), levels of C-reactive protein (CRP), glycosylated hemoglobin (HbA1c) and gestational diabetes mellitus (GDM) of pregnant women, as well the predictive values of these 3 indexes for GDM.

A total of 100 pregnant women with GDM were selected as research subjects and included in GDM group, who received intervention treatment and gave birth in Nanjing Integrated Traditional Chinese and Western Medicine Hospital from December 2016 to December 2018. Meanwhile, a total of 60 healthy pregnant women who had prenatal examinations and gave birth at the same hospital were selected and included in control group. The levels of fasting plasma glucose (FPG), 2 h postprandial blood glucose (2 h PPG), BMI, CRP and HbA1c of pregnant women, also the incidence rates of indexes of perinatal outcomes of pregnant women were statistically compared between two groups by independent-samples t test and chi-square test. The correlation among BMI, CRP, HbA1c, respectively, with FPG and 2 h PPG of the pregnant women in GDM group were analyzed by Pearson correlation analysis. This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and all participants confirmed and signed consent forms for clinical trials.

① The levels of FPG, 2 h PPG, BMI, CRP and HbA1c of pregnant women in GDM group were (7.8±1.0) mmol/L, (11.0±1.6) mmol/L, (25.8±1.2) kg/m², (12.8±2.9) mg/L and (8.5±1.7)%, respectively, which were all much higher than those of (5.6±0.6) mmol/L, (7.6±1.1) mmol/L, (22.2±1.1) kg/m², (7.7±2.4) mg/L and (4.0±1.0)% in control group, and the differences were statistically significant (t=14.139, 13.394, 17.455, 10.726, 16.705, all P<0.001). ② Pearson correction analysis showed those indexes of BMI, CRP and HbA1c of GDM pregnant women had positive correlation with FPG and 2 h PPG, respectively, (r=0.438, 0.408, P<0.001; r=0.389, 0.410, P<0.001; r=0.413, 0.442, P<0.001). ③ The incidence rates of preterm birth, premature rupture of membranes, polyhydramnios, deliver macrosomia, fetal distress and postpartum hemorrhage of pregnant women in GDM group were 21.1%, 23.3%, 22.2%, 17.8%, 16.7%, 12.2%, respectively, which were all much higher than those of 6.0%, 8.0%, 6.0%, 4.0%, 4.0%, 2.0% in control group, and the differences were statistically significant (χ²=5.542, P=0.019; χ²=5.152, P=0.023; χ²=6.161, P=0.013; χ²=5.446, P=0.020; χ²=4.834, P=0.028; χ²=4.286, P=0.038). The 1-minute Apgar score of newborns birthed by pregnant women in GDM group was (7.1±0.7) scores, which was lower than that of (8.3±1.0) scores in control group, and the difference was statistically significant (t=8.469, P<0.001).

The levels of BMI, CRP and HbA1c of pregnant women are associated with the occurrence of GDM, and early monitoring of these 3 indexes are recommended to predict GDM earlier.