探讨妊娠期糖尿病(GDM)孕妇发生阴道微生态变化及其对妊娠结局的影响。

选取2017年1月至2018年12月，在上海健康医学院附属第六人民医院东院妇产科门诊就诊的132例GDM孕妇为研究对象，纳入研究组。选取同期于本院进行产前检查的132例正常妊娠孕妇作为对照，纳入对照组。根据阴道分泌物6联检查结果，将研究组GDM孕妇，进一步分为阴道微生态失衡亚组(n＝54)与阴道微生态正常亚组(n＝78)。研究组与对照组孕妇阴道微生态失衡率比较，采用χ²检验。2个亚组孕妇孕前体重、孕期体重增加值、空腹血糖、口服葡萄糖耐量试验(OGTT) 2 h血糖、糖化血红蛋白(HbA1c)及糖化白蛋白(GA)水平比较，采用成组t检验。2个亚组孕妇及其分娩新生儿不良妊娠结局发生率比较，采用χ²检验。研究组与对照组孕妇，2个亚组孕妇年龄、孕龄、经产妇与初产妇构成比等一般临床资料分别比较，差异均无统计学意义(P>0.05)。

①研究组与对照组细菌性阴道病(BV)孕妇分别为7例与2例，BV＋滴虫性阴道炎(TV)分别为1例与0例，BV＋外阴阴道念珠菌病(VVC)分别为3例与0例，TV分别为2例与0例，VVC分别为10例与4例，其他类型阴道炎分别为31例与7例。研究组孕妇阴道微生态失衡率为40.9%(54/132)，显著高于对照组的9.8%(13/132)，并且差异有统计学意义(χ²＝33.623、P<0.001)。②阴道微生态失衡亚组GDM孕妇孕期体重增加值为(19.5±2.7) kg、HbA1c为(9.5±1.3)%、GA为(11.2±1.2)%，均分别显著高于阴道微生态正常亚组的(14.3±1.4) kg、(7.3±1.1)%、(8.6±0.9)%，2组分别比较，差异均有统计学意义(t＝3.406、P＝0.020，t＝3.313、P＝0.026，t＝3.014、P＝0.039)。③阴道微生态失衡亚组GDM孕妇早产、产褥期感染发生率分别为22.2%(12/54)与25.9%(14/54)，其分娩新生儿的低出生体重儿、感染发生率分别为20.4%(11/54)、9.3%(5/54)，均分别显著高于阴道微生态正常亚组的9.0%(7/78)、11.5%(9/78)、7.7%(6/78)及2.6%(2/78)，并且差异均有统计学意义(χ²＝4.545、P＝0.008，χ²＝4.591、P＝0.032，χ²＝4.571、P＝0.033，χ²＝4.525、P＝0.033)。

GDM孕妇阴道微生态失衡率显著高于正常妊娠孕妇。孕期体重增加值、HbA1c和GA是影响GDM孕妇发生阴道微生态失衡的重要因素，其异常增高，可使其不良妊娠结局发生率增高。

To explore the vaginal microecological changes of gestational diabetes mellitus (GDM) pregnant women and its influence on pregnancy outcomes.

A total of 132 cases of GDM pregnant women who attended Department of Obstetrics and Gynecology of East Hospital of Shanghai Sixth People′s Hospital Affiliated to Shanghai University of Medicine & Health Sciences from January 2017 to December 2018 were selected as research subjects and were enrolled into study group. Another 132 cases of normal pregnant women who underwent prenatal examinations in the same hospital during the same period were selected as controls and included into control group. According to the results of vaginal secretions 6 joint examination, GDM pregnant women in study group were further divided into abnormal vaginal microecology subgroup (n=54) and normal vaginal microecology subgroup (n=78). The comparison of vaginal microecological imbalance rate between study group and control group was performed by chi-square test. Weight before pregnancy, weight gain during pregnancy, fasting blood glucose, oral glucose tolerance test (OGTT) 2 h blood glucose, glycosylated hemoglobin (HbA1c) and glycosylated albumin (GA) levels between two subgroups were compared by independent-samples t test. The incidence of adverse pregnancy outcomes between pregnant women and their neonates in two subgroups was compared by chi-square test. This study was in line with the requirements of World Medical Association Declaration of Helsinki revised in 2013.

①In study group, there were 7 cases of bacterial vaginosis (BV), 1 case of BV combined with trichomonas vaginitis (TV), 3 cases of BV combined with vulvovaginal candida (VVC), 2 cases of TV, 10 cases of VVC, and 31 cases of other types of vaginitis. And in control group, there were 2 cases of BV, 4 cases of VVC, and 7 cases of other types of vaginitis. The rate of vaginal microecological imbalance was 40.9% (54/132) in study group, which was significantly higher than that of control group 9.8% (13/132), and the difference was statistically significant (χ²=33.623, P<0.001). ②Weight gain during pregnancy, HbA1c and GA levels of GDM pregnant women in abnormal vaginal microecology subgroup were (19.5±2.7) kg, (9.5±1.3)% and (11.2±1.2)%, respectively, which were all significantly higher than those in normal vaginal microecology subgroup, and all the differences were statistically significant (t=3.406, P=0.020; t=3.313, P=0.026; t=3.014, P=0.039). ③In GDM pregnant women of abnormal vaginal microecology subgroup, the incidence rates of premature birth, puerperal infection, low birth weight infant and infection of the infants were 22.2% (12/54), 25.9% (14/54), 20.4% (11/54), and 9.3% (5/54), respectively, which were statistically higher than those in normal vaginal microecology subgroup 9.0% (7/78), 11.5% (9/78), 7.7% (6/78) and 2.6% (2/78), respectively, and all the differences were statistically significant (χ²=4.545, P=0.008; χ²=4.591, P=0.032; χ²=4.571, P=0.033; χ²=4.525, P=0.033).

The vaginal microecological imbalance rate of pregnant women with GDM is higher than that of normal pregnant women. The weight gain during pregnancy, HbA1c and GA are important factors of vaginal microecological imbalance in GDM pregnant women, and their abnormal increase can increase the occurrence of adverse pregnancy outcomes in GDM pregnant women.