妊娠晚期B族链球菌定植与糖代谢及母婴结局的关联

Association of group B streptococcus colonization in late pregnancy with carbohydrate metabolism andmaternal and neonatal outcomes

    摘要
  • 摘要:
    目的 探讨妊娠晚期B族链球菌（GBS）定植的危险因素，分析其与妊娠期糖代谢指标及母婴结局的关联。
    方法 回顾性分析2023年8月－2025年6月泰安市妇幼保健院1 691例妊娠晚期孕妇临床资料，根据GBS筛查结果分为GBS阳性组（113例）和GBS阴性组（1 578例），分析GBS定植的危险因素、糖代谢指标与GBS定植和载量的关联以及GBS定植及载量分层与母婴结局的关系。
    结果 GBS总体定植率为6.68%。妊娠期高血糖（OR=1.585）、妊娠期高血压疾病（OR=1.892）及阴道清洁度异常（OR=1.614）是GBS定植的危险因素（P＜0.05）。妊娠前期糖尿病组GBS定植率为24.00%（6/25），高于妊娠期糖尿病组（P＜0.05）。GBS阳性组口服葡萄糖耐量试验时间-血糖曲线下面积（AUC）为13.64（12.30，15.01），高于阴性组（P＜0.05）；妊娠期高血糖组Ct值为28.43（26.04，32.95），低于非高血糖组（P＜0.05）。GBS定植可增加早产、胎儿窘迫、新生儿肺炎和病理性黄疸风险（P＜0.05）；高载量组（Ct值＜28）复合不良母婴结局发生率为41.94%（13/31），高于低载量组（P＜0.05）。
    结论 GBS定植的危险因素包括妊娠期高血糖、妊娠期高血压疾病及阴道清洁度异常，妊娠期高血糖与GBS载量升高相关。GBS定植（尤其是高载量）会增加不良母婴结局的风险。

     

    Abstract:
    OBJECTIVE  To explore the risk factors for group B streptococcus （GBS） colonization in late pregnancy and analyze its association with gestational carbohydrate metabolism markers and maternal and neonatal outcomes.
    METHODS  A retrospective analysis was conducted on the clinical data of 1 691 pregnant women in the late pregnancy who were admitted to the Taian Maternity and Child Health Hospital from Aug. 2023 to Jun. 2025. Based on the results of GBS screening, they were divided into the GBS-positive group （113 cases） and the GBS-negative group （1 578 cases）. The study analyzed the risk factors for GBS colonization, the association between carbohydrate metabolism markers and GBS colonization and load, as well as the relationship between GBS colonization and load stratification and maternal and neonatal outcomes.
    RESULTS  The overall colonization rate of GBS was 6.68%. Gestational hyperglycemia （OR=1.585）, gestational hypertension （OR=1.892） and abnormal vaginal cleanliness （OR=1.614） were risk factors for GBS colonization （P＜0.05）. The GBS colonization rate in the pregestational diabetes mellitus group was 24% （6/25）, which was higher than that in the gestational diabetes mellitus group （P＜0.05）. The area under the curve （AUC） of the oral glucose tolerance test time-blood glucose curve in the GBS-positive group was 13.64 （12.30, 15.01）, which was higher than that in the negative group （P＜0.05）. The Ct value in the gestational hyperglycemia group was 28.43 （26.04, 32.95）, which was lower than that in the non-hyperglycemia group （P＜0.05）. GBS colonization increased the risk of premature delivery, fetal distress, neonatal pneumonia and pathological jaundice （P＜0.05）. The incidence of combined adverse maternal and neonatal outcomes in the high-load group （Ct value ＜28） was 41.94% （13/31）, which was higher than that in the low-load group （P＜0.05）.
    CONCLUSIONS  The risk factors for GBS colonization include gestational hyperglycemia, gestational hypertension and abnormal vaginal cleanliness. Gestational hyperglycemia is associated with increased GBS load. GBS colonization （especially high load） increases the risk of adverse maternal and neonatal outcomes.

     

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