目的  探讨精子DNA碎片指数（DFI）对体外受精-胚胎移植（IVF-ET）胚胎发育及妊娠结局的影响，为优化男性生育力评估及辅助生殖治疗策略提供依据。方法  回顾性分析2023年1月—2024年1月于徐州市妇幼保健院接受IVF-ET治疗的126对不孕夫妇，根据男方DFI检测结果分为低碎片组（DFI≤15%，n=42）、临界组（15%＜DFI＜30%，n=45）和高碎片组（DFI≥30%，n=39）。比较三组患者受精相关指标、胚胎发育指标及妊娠结局指标的差异，并分析DFI与各指标的相关性。结果  低碎片组双原核率（2PN）率、优质胚胎率及囊胚形成率均高于临界组和高碎片组（P＜0.001），低碎片组1PN率、多PN率均低于临界组和高碎片组（P＜0.001）；三组种植率、临床妊娠率、早期流产率比较差异无统计学意义（P＞0.05），但高碎片组活产率低于低碎片组（P＜0.05）。相关性分析结果表明，DFI与优质胚胎率（r=-0.412，P＜0.001）、囊胚形成率（r=-0.387，P＜0.001）、活产率（r=-0.287，P=0.012）呈负相关，与早期流产率（r=0.206，P=0.059）、种植率（r=-0.215，P=0.058）、临床妊娠率（r=-0.203，P=0.072）无显著相关性。结论  精子DNA碎片指数是影响IVF-ET胚胎发育及妊娠结局的重要因素，高DFI主要通过降低胚胎发育潜能及增加流产风险导致活产率下降，临床需对高DFI患者进行干预以改善治疗结局。

       Objective  To investigate the impact of sperm DNA fragmentation index（DFI）on embryo development and pregnancy outcomes of in vitro fertilization-embryo transfer（IVF-ET），and to provide a basis for optimizing male fertility assessment and assisted reproductive treatment strategies．Methods  A retrospective analysis was performed on 126 infertile couples undergoing IVF-ET treatment at the Reproductive Medicine Center of Xuzhou Maternal and Child Health Hospital from January 2023 to January 2024．According to the male DFI test results，they were divided into three groups：low fragmentation group（DFI≤15%，n=42），critical group（15% ＜ DFI ＜ 30%，n=45），and high fragmentation group（DFI≥30%，n=39）．Differences in fertilization-related indicators，embryo development indicators，and pregnancy outcome indicators were compared among the three groups，and the correlation between DFI and each indicator was analyzed．Results  The 2 pronuclei rate（PN）rate，high-quality embryo rate，and blastocyst formation rate in the low fragmentation group were significantly higher than those in the critical and high fragmentation groups（P＜0.001）．The 1PN  rate and multi-PN  rate in the low fragmentation group were significantly lower than those in the critical and high fragmentation groups（P＜0.001）．There was no significant difference in the three groups of implantation rate，clinical pregnancy rate and early abortion rate（P＞0.05），but the live birth rate of high fragment group was significantly lower than that of low fragment group（P＜0.05）．The results of correlation analysis showed that DFI was significantly negatively correlated with the rate of high quality embryos（r=-0.412，P＜0.001），blastocyst formation rate（r=-0.387，P＜0.001）and live birth rate（r=-0.287，P=0.012），but not with the rate of early abortion（r=0.206，P=0.059），implantation rate（r=-0.215，P=0.058）and clinical pregnancy rate（r=-0.203，P=0.072）．Conclusions  Sperm DFI is an important factor affecting embryo development and pregnancy maintenance in IVF-ET．High DFI leads to a decrease in live birth rate mainly by reducing embryo developmental potential and increasing the risk of early abortion．Clinically，early intervention is needed for patients with high DFI to improve treatment outcomes．

目的 探讨妊娠期糖尿病（GDM）患者孕24~28周的75 g 口服葡萄糖耐量试验（OGTT）血糖异常项数及妊娠晚期分娩前血糖值与妊娠结局的关系。方法 选择2019年11月—2020年5月在广州医科大学附属妇女儿童医疗中心进行产检并在孕24~28周确诊的167例GDM患者为研究对象,将孕24~28周75 g OGTT结果中仅其中1项时间点血糖异常的孕妇为GDMⅠ组（92例）,2项异常为GDMⅡ组（48例）,3项异常为GDMⅢ组（27例）,比较三组血糖异常项数GDM患者的人口学特点;并分析GDM患者一般人口学特征与妊娠晚期分娩前血糖监测均值的关系,及血糖值对不良妊娠结局的影响。结果 75 g OGTT血糖异常项数与孕前不同的体质指数（BMI）及妊娠晚期的糖化血红蛋白（HbA_1c）间比较差异均有统计学意义（P<0.05）。孕前BMI指数水平对妊娠晚期的空腹血糖、餐后1 h血糖、餐后2 h血糖比较差异均有统计学意义（P<0.05）;75 g OGTT血糖异常项数对空腹血糖及餐后2 h血糖比较差异有统计学意义（P<0.05）;③空腹血糖不同水平组在新生儿低血糖、胎膜早破、早产不良结局中比较,差异有统计学意义（P<0.05）。餐后2 h不同血糖水平间组在新生儿低血糖及胎膜早破中比较,差异有统计学意义（P<0.05）。结论 孕前BMI指数与妊娠中期75 g OGTT的血糖筛查结果有关,75 g OGTT试验中血糖异常项数越多不良妊娠结局的发生概率越大,妊娠期进行规范化的运动饮食干预和必要时的药物干预后可改善妊娠晚期的HbA_1c水平。

Objective To investigate the relationship between abnormal blood glucose items in the 75 g oral glucose tolerance test（OGTT）at 24-28 weeks of pregnancy and the blood glucose levels before delivery in the third trimester of pregnancy and pregnancy outcomes in gestational disbetes mellitus（GDM）patients. Methods All 167 GDM patients diagnosed at 24-28 weeks of gestation in Women and Children's Medical Center Affiliated to Guangzhou Medical University from November 2019 to May 2020 were enrolled as subjects．The pregnant women with only 1 abnormal blood glucose item among the 75 g OGTT results were classified as GDMⅠ group（92 cases）,with 2 abnormal items were GDMⅡ group（48 cases）,and with 3 abnormal items were GDM Ⅲ group（27 cases）．The demographic characteristics of the three groups of GDM patients were compared．The relationship between the general demographic characteristics of GDM patients and the mean value of blood glucose monitoring before delivery in the third trimester was analyzed,and the influence of blood glucose monitoring on adverse pregnancy outcomes was also analyzed．Results ①With different BMI and HbA_1c,there were significant differences in 75 g OGTT blood glucose items（P<0.05）．BMI level had statistically significant effects on fasting blood glucose,1-hour postprandial blood glucose and 2-hour postprandial blood glucose in the third gestational trimester（P<0.05）．②With different number of abnormal blood glucose items,there were significant in fasting blood glucose and 2 hours postprandial blood glucose（P<0.05）．③There were statistically significant differences in the outcomes of neonatal hypoglycemia,premature rupture of membranes and preterm delivery in different fasting blood glucose groups（P<0.05）．There were statistically significant differences in neonatal hypoglycemia and premature rupture of membranes between different 2 hours postprandial blood glucose（P<0.05）. Conclusions BMI can affect the blood glucose screening results of 75g OGTT in the second trimester．The more abnormal blood glucose items in the 75g OGTT test,the greater the probability of adverse pregnancy outcome．Standardized exercise diet intervention and necessary drug intervention during pregnancy can improve the HbA_1c level in the third trimester．

目的 分析妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇接受胰岛素治疗对妊娠结局的影响及安全性。方法 将2018年7月—2020年7月接诊且行常规治疗的50例GDM孕妇作为对照组,将同期接诊且在对照组基础上行胰岛素治疗的50例GDM孕妇作为观察组,对组间血糖控制效果、生活质量(SF-36)、治疗效果、不良妊娠结局、不良反应展开分析。结果 (1)组间血糖指标在治疗前无明显差异(P＞0.05);治疗后,观察组血糖控制效果优于对照组(P<0.05);(2)观察组SF-36评分高于对照组,且治疗效果(96.00%)优于对照组(82.00%,P<0.05);(3)观察组出现3例不良妊娠结局(6.00%),对照组出现11例不良妊娠结局(22.00%,P<0.05);(4)观察组发生3例不良反应(6.00%),对照组发生2例不良反应(4.00%,P＞0.05)。结论 对GDM孕妇实施胰岛素治疗,可以改善孕妇血糖水平,减少不良妊娠结局,提高孕妇生活质量,安全可靠,值得推广。

Objective To analyze the effect and safety of insulin therapy on pregnancy outcome in pregnant women with gestational diabetes mellitus (GDM). Methods A total of 50 pregnant women with GDM who received conventional treatment from July 2018 to July 2020 were induded in the control group, and 50 pregnant women with GDM who received insulin treatment on the basis of the control group were induded in the observation group. Results (1) There was no significant difference in blood glucose index between two groups before treatment(P＞ 0.05); after treatment, the blood glucose control effect of the observation group was better than that of the control group(P<0.05); (2) SF-36 score of the observation group was higher than that of the control group, and the treatment effect (96.00%) was better than that of the control group (82.00%,P<0.05); (3) there were 3 cases of adverse pregnancy outcomes (6.00%) in the observation group and 11 cases (22.00%) in the control group; (4) there were 3 cases of adverse reactions (6.00%) in the observation group and 2 cases (4.00%) in the control group(P＞ 0.05). Conclusion Insulin therapy for pregnant women with GDM could improve the blood glucose level of pregnant women, reduced adverse pregnancy outcomes, improved the quality of life of pregnant women, which is safe and reliable, and is worthy of promotion.

目的 探讨子午流注开穴法对薄型子宫内膜患者妊娠结局的影响。方法 将同期在门诊行B超监测排卵、指导受孕的薄型子宫内膜患者80例随机分为两组,每组各40例,观察组采用子午流注开穴法及药物治疗,对照组则单纯给予药物治疗。比较两组治疗前后的子宫内膜厚度、子宫内膜形态、子宫内膜血流搏动指数(PI)、血流阻力指数(RI)及临床妊娠率(PR)。结果 两组治疗后子宫内膜厚度与同组治疗前均有不同程度的改善(P<0.05),治疗后子宫内膜厚度两组间比较差异有统计学意义(P<0.05)。观察组治疗后A型子宫内膜的比例较治疗前增加,差异有统计学意义(P<0.05);与对照组比较,差异有统计学意义(P<0.05)。观察组临床妊娠率为27.5%,对照组临床妊娠率为10%,两组相比较差异有统计学意义(P<0.05)。结论 子午流注开穴法在薄型子宫内膜患者中的应用有效促进子宫内膜容受性的建立,从而改善其妊娠结局。

Objective To explore the effects of selection points by earth meridian ebb-flowing rule on infertile women suffering from thin endometrium. Methods 80 patients with thin endometrium who were monitored ovulation and guided pregnancy under B-mode ultrasound were randomly divided to two groups: the observation group and the control group, 40 patients for each group. The observation group was treated with selection points by earth meridian ebb-flowing rule and medication, while the control group was treated with medication only. The endometrial thickness, endometrial morphology, endometrial blood flow Pulsation Index (PI), Resistance Index (RI) and Clinical Pregnancy Rate (PR) before and after treatment were compared between the two groups. Results After treatment, the endometrial thickness was improved in both groups, which was statistical significant between the two groups(P<0.05). The proportion of type A endometrium in the observation group was increased compared with that before treatment and the control group, the difference was statistical significant(P<0.05). The clinical pregnancy rate was 27.5% in the observation group and 10% in the control group, and the difference between the two groups was statistically significant(P<0.05). Conclusion The application of selection points by earth meridian ebb-flowing rule in patients with thin endometrium may effectively promote the establishment of endometrial receptivity and improve the pregnancy outcome.

目的 比较细胞因子TGF-β、IL-10、TNF-α、Th17在不同妊娠结局的妊娠期亚临床甲减孕妇血清中的差异,探索细胞因子在不同妊娠结局中的作用。方法 随机选择2018年1月—2018年12月在我院就诊的66例确诊为因妊娠期亚临床甲减而出现不良妊娠结局的孕妇与同期妊娠结局正常的66例孕妇进行病例对照研究,比较不同妊娠结局孕妇的血清TGF-β、IL-10、TNF-α、Th17的差异;结果 ① 亚临床甲减组的TPOAb、TgAb、TRAb阳性率高于正常妊娠组,同时TNF-α、Th17均高于正常妊娠组,而TGF-β、IL-10均低于正常妊娠组,差异有统计学意义(P<0.05)。② 因子分析发现:在TPOAb、TgAb、TRAb、TGF-β、IL-10、TNF-α、Th17七个影响妊娠期亚临床甲减不良妊娠结局的相关因素中,TGF-β、IL-10、TNF-α、Th17在第1影响因子,特征值达2.347;TPOAb、TgAb、TRAb是次要影响因子,特征值为1.162。结论 TGF-β、IL-10、TNF-α、Th17与妊娠期亚临床甲状腺功能减退症的不良妊娠结局有密切关系,TGF-β、IL-10、TNF-α、Th17是影响妊娠期亚临床甲减不良妊娠结局的主要因子;TPOAb、TgAb、TRAb是影响妊娠期亚临床甲减不良妊娠结局的次要因子。

Objective To compare the serum levels of TGF-β, IL-10, TNF-α and Th17 in pregnant women with subclinical hypothyroidism in different pregnancy outcomes. Methods A case-control study was conducted in 66 pregnant women with adverse pregnancy outcomes due to subclinical hypothyroidism during pregnancy and 66 pregnant women with normal pregnancy outcomes during the same period. The differences of serum TGF-β, IL-10, TNF-α and Th17 among pregnant women with different pregnancy outcomes were compared. Results ①The positive rates of TPOAb, TgAb and TRAb in subclinical hypothyroidism group were higher than those in normal pregnancy group, and TNF-α and Th17 were higher than those in normal pregnancy group, while TGF-βand IL-10 were lower than those in normal pregnancy group (P<0.05). ②Factor analysis found that TPOAb, TgAb, TRAb, TGF-β, IL-10, TNF-α and Th17 were the factors related to adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy. TGF-β, IL-10, TNF-α and Th17 were the main influencing factors with a characteristic value of 2.347; TPOAb, TgAb and TRAb were the second influencing factors,with a characteristic value of 1.162. Conclusion ①TGF-β, IL-10, TNF-α, Th17 are closely related to the occurrence and pregnancy outcome of subclinical hypothyroidism in pregnancy. ②TGF-β, IL-10, TNF-α and Th17 are the main factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy;TPOAb, TgAb and TRAb are the secondary factors affecting the adverse pregnancy outcomes of subclinical hypothyroidism in pregnancy,

目的 通过比较二胎孕妇和初产孕妇心电图变化探讨其对妊娠结局的影响。方法 随机选取300例孕妇,其中150例二胎孕妇为观察组,150例初产孕妇为对照组。观察2组孕妇异常心电图的类型及发生率,分析异常心电图与妊娠结局的关系。结果 初产孕妇组异常心电图35例,心电图异常发生率为23.3%,二胎孕妇组异常心电图50例,心电图异常发生率为33.3%,两组心电图异常发生率差别有统计学意义(P<0.05)。二胎孕妇组窦性心动过速、室性早搏及ST-T改变的发生率显著高于初产孕妇组,差异有统计学意义(P<0.05)。二胎孕妇心电图异常组的剖宫产率和早产率均高于二胎孕妇心电图正常组、初产孕妇心电图正常组,差别有统计学意义(P>0.05)。结论 二胎孕妇易合并心电图异常改变,心电图异常会增加剖宫产和早产的发生率,临床医生在诊治此类患者时应提高警惕。

Objective To observe the relationship between electrocardiogram(ECG) and pregnancy outcomes of the second pregnant women. Methods Pregnant women were divided into two groups by parity history: the second pregnancy group and the Primipara group. The incidence of abnormal electrocardiogram was recorded, then the pregnancy outcome including the delivery mode and the premature birth rate were followed up. Results The incidence of abnormal ECG in the second pregnancy group was significantly higher than that in primipara group(P<0.05) and the incidences of Nodal tachycardia, Premature ventricular contraction, ST-T changes in the group of the second pregnancy were higher than that in the group of Primipara (P<0.05). The incidence of cesarean delivery and premature birth in the second pregnancy group with abnormal ECG group was significantly higher than that in pregnant women with normal ECG group (P<0.05). Conclusion The second pregnant women are more likely to have ECG abnormality, the pregnant women with abnormal ECG are easily suffer from cesarean delivery and premature birth.

目的 探讨孕期生殖道菌群变化特征及其与不良妊娠结局的相关性。方法 选取2015年1月—2015年9月期间在我院妇产科门诊进行常规产科检查的90例孕妇为研究对象,根据孕期分为孕早期组28例(孕周＜14周),孕中期组29例(孕周14～28周),孕晚期组33例(29～42周)。采集阴道分泌物或宫颈分泌物,对生殖道菌群进行检测。比较三组生殖道菌群分布情况。根据细菌检测结果分为阳性组与阴性组,分别为44例、46例。观察两组不良妊娠结局发生情况,分析生殖道菌群变化特征及其与不良妊娠结局的相关性。结果 90例孕妇中,细菌检测阳性44例,占48.89%,依次为解脲脲原体20例(45.45%)、假丝酵母菌属9例(20.45%)、肠杆菌属8例(18.18%)、葡萄球菌属3例(6.82%)、阴道加德纳菌属2例(4.55%)与衣原体2例(4.55%);孕早期、孕中期、孕晚期孕妇生殖道菌群分布情况相比,差异无统计学意义(P＞0.05);细菌检测阳性者胎膜早破、产褥感染、新生儿感染、早产发生率高于细菌检测阴性者,差异有统计学意义(P＜0.05);不同菌属类型者不良妊娠结局相比,差异无统计学意义(P＞0.05)。结论 孕期生殖道菌群以解脲脲原体、假丝酵母菌属、肠杆菌属为主,细菌检测阳性者不良妊娠结局发生率高,而不同菌属类型与不良妊娠结局无关。

Objective To investigate the correlation between change characteristics of pregnant genital tract flora and adverse pregnancy outcomes. Methods 90 pregnant women received routine obstetric examination in our obstetrics and gynecology of hospital from January 2015 to September 2015 were selected as research object. According to duration of pregnancy, they were divided into 28 cases of early pregnancy group (gestational weeks<14 weeks), 29 cases of middle pregnancy group (14~28 weeks) and 33 cases of late pregnancy group (29~42 weeks). The vaginal or cervical secretions were collected, and genital tract flora was detected. The genital tract flora distribution of three groups were compared. According to bacteria detection results, patients were divided into 44 cases of positive group and 46 cases of negative group. The adverse pregnancy outcomes of two groups were observed, and the correlation between change characteristics of pregnant genital tract flora and adverse pregnancy outcomes was analyzed. Results Among 90 pregnant women, there were 44 cases of positive bacteria (48.89%), which included 20 cases of ureaplasma urealyticum(45.45%), 9 cases of Candida (20.45%), 8 cases of enterobacter (18.18%), 3 cases of staphylococcus (6.82%), 2 cases of vaginal gardnerella (4.55%) and 2 cases of chlamydia (4.55%); There was no statistical difference in the genital tract flora distribution among early, middle, late pregnancy group (P>0.05); The incidence of premature rupture of membrane, puerperal infection, neonatal infection and premature birth in patients with positive bacteria was higher than that in patients with negative bacteria (P<0.05); There was no statistical difference in the adverse pregnancy outcomes in patients with different types of bacterial genus (P>0.05). Conclusion Pregnant genital tract flora are mainly ureaplasma urealyticum, candida and enterobacter, and the incidence of adverse pregnancy outcomes in patients with positive bacteria is higher, but different types of bacterial genus has no correlation with adverse pregnancy outcomes.

目的 探讨宫腔积血对于中晚期妊娠结局的影响以及影响的因素。方法 结合477例中晚期宫腔积血孕妇的临床资料分析,根据妊娠结局分为正常妊娠结局组(NP)及不良妊娠结局组(AP)。结果 AP的平均孕周(23.22±6.87周)明显大于NP(16.11±4.76周),两组有明显差异性(P<0.001)。两组首次B超宫腔积血平均体积分别为8.01(2.22~28.67)(NP),13.05(3.54~26.34)mL(AP)(P=0.001),但相邻第二次测量结果两组相差不大(P=0.230)。AP组中胎盘下血肿的比率(53.4%)明显大于NP组(24.2%),而绒毛膜下血肿比率(44.0%)明显小于NP(73.8%),两组有明显差异性(P<0.001)。宫缩也是影响因素之一,在AP组可扪及宫缩的病例(88例55.3%)明显高于NP(38例11.9%),两组有明显差异性(P<0.001)。但在阴道流血率方面两组没有明显差异(P=0.407)。结论 妊娠中晚期宫腔积血可能会导致不良妊娠结局,而首次出现的孕周,急性大量宫腔出血、宫腔积血位置以及是否伴有宫缩都是影响妊娠结局的重要因素。

Objective To study the poor pregnancy outcomes of patients with intrauterine hematoma in the second and third trimesters, and discuss the risk factors. Methods We analyzed the clinical data of 477 patients who underwent routine examination in our hospital from January 2010 to June 2016 and classified them into normal pregnancy (NP) group and adverse pregnancy (AP) group according to their pregnancy outcomes. Results Gestational age at first detection of hematoma of AP group(23.22±6.87 weeks) was more than NP group (16.11±4.76 weeks)(P<0.001). The volumes of hematoma during the first detection were significantly different between the two groups (P=0.001).The average hematoma volume were 8.01(2.22-28.67)(NP),13.05(3.54-26.34)mL(AP)respectively. However, the hematoma volumes recorded in the second B-ultrasound examination were not significantly different between the two groups (P=0.230). In the AP group, the incidence of retroplacental hematoma (53.4%) was significantly higher than in the NP group (24.2%), while the incidence of subchorionic hematoma (44.0%) was significantly lower than in the NP group (73.8%)(P<0.001). The incidence of palpable contractions in the AP group (62.8%) was significantly higher than in the NP group (12.1%), P<0.001. However, the incidence of vaginal bleeding was similar (P=0.407). Conclusion Intrauterine hematoma in the second and third trimester may lead to adverse pregnancy outcomes. Risk factors for poor pregnancy outcomes are included gestational age at first diagnosis, acute and large intrauterine bleeding, location of hematoma and accompanying contraction.

目的 探讨影响自然周期供精人工授精妊娠的因素。方法 回顾性分析2007年4月—2013年4月期间在广东省计划生育专科医院行自然周期供精人工授精的6161个周期,其中妊娠组1454周期,对照组4707个周期。采用单因素分析及多因素Logistic回归分析女方年龄、不孕年限、子宫内膜厚度、类型及冻融复苏后前向运动精子总数与AID妊娠结局的关系。结果 年龄越大,不孕年限越长,妊娠率越低(P＜0.001); A型子宫内膜妊娠率25.94%较AB型的23.87%及B型的21.54%都高(P=0.001);妊娠组冻融复苏后前向运动精子总数均值(28.95±6.86)×10⁶较对照组的(28.26±6.98)×10⁶高(P=0.001);年龄(OR=1.614,P＜0.001)、不孕年限(OR=1.194,P=0.012)、子宫内膜分型(OR=1.258,P=0.001)影响妊娠率。结论 女方年龄、不孕年限、子宫内膜形态及冻融复苏后前向运动精子总数是影响自然周期供精人工授精妊娠的因素。

Objective To explore the parameters affecting the pregnancy rate from 6161 natural cycles of artificial insemination by donor(AID). Methods Consecutive cases of 6161 natural cycles of AID from April,2009 to April 2013 in Guangdong provincial family planning special hospital were analyzed retrospectively.1454 pregnant cycles were defined as observation group and the other 4707 non pregnant cycles were classified as control group.Related factors in effect of pregnancy rate of AID were analyzed by logistic regression analysis. Results The rate of pregnancy decreased with the increase of women ages and the infertility duration(P＜0.001).And the pregnancy rate of ICI among the women with type A endometrium was the highest among the three types of endometrium(25.94%vs23.87%vs21.54%,P=0.001).The sum of the forward moving sperm after freezing and thawing recovery of observation group is higher than control group(28.95±6.86)×10⁶vs (28.26±6.98)×10⁶.The value of OR of age,infertility duration and types of endometrium were 1.614,1.194 and 1.258,respectively. Conclusion Age of women,infertility duration,types of endometrium as well as the sum of the forward moving sperm after freezing and thawing recovery played an important role in pregnancy rate of natural cycles of AID.

       目的   探讨高龄妊娠期糖尿病（GDM）产妇糖耐量的特点及其与妊娠结局的关系。方法   选择2020年1月1日—2024年12月31日在广州市第一人民医院规律产检并分娩的高龄产妇727例，包括高龄初产妇226例（GDM 78例）和高龄经产妇501例（GDM 131例），按照75 g OGTT血糖异常项数进行分组：一项血糖异常产妇为GDM I组（高龄初产妇38例，高龄经产妇68例）；两项血糖异常产妇为GDM Ⅱ组（高龄初产妇26例，高龄经产妇51例）；三项血糖异常产妇为GDM Ⅲ组（高龄初产妇14例，高龄经产妇12例）；75 g OGTT正常高龄产妇为对照组。收集研究对象一般资料、75g OGTT血糖及相关妊娠结局进行分析比较。结果   高龄初产妇GDM发生率（34.51%）较高龄经产妇GDM发生率（26.15%）高，差异具有统计学意义（P=0.021）；高龄初产妇GDM Ⅲ型宫内感染（28.57%）、产后出血（14.29%）发生率最高，差异具有统计学意义（P=0.037、0.039）；高龄初产妇GDM I型早产（23.68%）发生率最高，差异具有统计学意义（P=0.013）。高龄初产妇及经产妇GDM Ⅱ型的羊水过多、甲状腺功能减退、宫内感染、早产发生率均呈上升趋势。结论   高龄妊娠糖尿病产妇随OGTT血糖异常项增多出现不良妊娠结局风险升高，其中高龄初产妇的早产、宫内感染及产后出血的发生率更高，因此，针对高龄初产妇，应更加注重孕期血糖及健康管理，以减少不良妊娠结局的发生。

       Objective  To analyze glucose tolerance characteristics in elderly pregnant women with gestational diabetes mellitus（GDM）and relationship with pregnancy outcomes．Methods  From January 1，2020，and December 31，2024，727 elderly pregnant women who underwent routine prenatal examinations and delivered in Guangzhou First People’s Hospital were recruit．Among them，226 were elderly primiparas and 501 were elderly multiparas．GDM was diagnosed in 78 elderly primiparas and 131 elderly multiparas．Based on the results of the 75 g oral glucose tolerance test（OGTT），GDM cases were classified as follows：GDM I（one abnormal glucose value；38 elderly primiparas，68 elderly multiparas），GDM II（two abnormal values；26 elderly primiparas，51 elderly multiparas），and GDM Ⅲ（three abnormal values；14 elderly primiparas，12 elderly multiparas）．Elderly pregnant women with normal OGTT results served as the control group．General clinical data and pregnancy outcomes were collected．The prevalence and characteristics of GDM in elderly primiparas and multiparas were analyzed．Results  The incidence of GDM was significantly higher in elderly primiparas than in elderly multiparas（P=0.021）．The incidence of intrauterine infection and postpartum hemorrhage was highest in elderly primiparas with GDM Ⅲ（P=0.037，0.039）．The incidence of preterm birth was highest in elderly primiparas with GDM I（P=0.013）．The incidence of polyhydramnios，hypothyroidism，intrauterine infection，and preterm birth showed an increasing trend in both elderly primiparas and multiparas with GDM II．Conclusions  Elderly primiparas with more severe glucose tolerance abnormalities are at a higher risk of adverse pregnancy outcomes．Enhanced blood glucose monitoring and comprehensive health management during pregnancy are crucial for reducing the incidence of adverse outcomes in this population．