产次对孕妇血脂及妊娠并发症的影响

目的：探讨不同产次对孕妇血脂及妊娠并发症的影响。方法：收集2016年9月-2017年12月在河北省人民医院产检并分娩的孕妇共1 669例，按孕周及年龄分为4组：妊娠中期适龄组527例、妊娠中期高龄组261例、妊娠晚期适龄组636例、妊娠晚期高龄组245例，其中每组根据产次分为初产妇和经产妇，比较各组血脂水平、高密度脂蛋白胆固醇（HDL-C）/总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）/TC、LDL-C/HDL-C比值以及妊娠结局。结果：①妊娠中期适龄组经产妇（与初产妇比较）三酰甘油（TG）、TC和极低密度脂蛋白胆固醇（VLDL-C）水平明显升高（P＜0.05）；妊娠中期高龄组经产妇（与初产妇比较）TG、TC、HDL-C、LDL-C、VLDL-C和HDL-C/TC水平呈升高趋势，但仅HDL-C水平差异有统计学意义（P＜0.05）。②妊娠晚期适龄组经产妇（与初产妇比较）LDL-C、VLDL-C、LDL-C/TC和LDL-C/HDL-C水平显著降低，而HDL-C/TC升高（均P＜0.05）；妊娠晚期高龄组经产妇（与初产妇比较）TG、TC、HDL-C、LDL-C、HDL-C/TC和LDL-C/HDL-C水平呈下降趋势，VLDL-C水平升高，但差异均无统计学意义（P＞0.05）。③与初产妇相比，适龄组经产妇胎膜早破及胎儿窘迫的发病率下降，高龄组妊娠期高血压疾病（HDCP）和妊娠期糖尿病（GDM）、胎儿窘迫发生率下降（P＜0.05）；而适龄组经产妇早产儿和巨大儿发生率升高（P＜0.05）。④高龄组GDM和HDCP发生率高于适龄组（P＜0.05）。结论：产次对血脂有一定程度的影响，可导致妊娠并发症的发生。

Influence of Different Parity on Serum Lipid during Pregnancy and Pregnant Outcome

Objective：To investigate the influence of parity on serum lipid during pregnancy and pregnant outcome. Methods：Totally, 1 669 women who delivered in Hebei General Hospital from September 2016 to December 2017 were recruited. Those women were divided into four groups based on the age and gestational age: the right-age and mid-pregnancy group (527 cases), the advanced-age and mid-pregnancy group (261 cases), the right-age and late-pregnancy group (in the late of pregnancy, 636 cases), the advanced-age and late-pregnancy group (in the late of pregnancy, 245 cases). Each group was divided into two subgroups: the primipara subgroup and the multipara subgroup according to the number of births. The levels of serum lipid, HDL-C/TC, LDL-C/TC and the LDL-C/HDL-C ratio were compared. Results：①The levels of TG, TC, VLDL-C in multipara women of the right-age and mid-pregnancy group were significantly increased (all P＜0.05), while the levels of TG, TC, HDL-C, LDL-C, VLDL-C and HDL-C/TC in multipara women of the advanced-age and mid-pregnancy group were mildly increased, only the significant difference in HDL-C level (P＜0.05), when compared with those primipara women. ②The levels of LDL-C, VLDL-C, LDL-C/TC and LDL-C/HDL-C in multipara women of the right-age and late-pregnancy group were significantly decreased, and the level of HDL-C/TC increased (all P＜0.05), while the levels of TG, TC, HDL-C, LDL-C, HDL-C/TC and LDL-C/HDL-C in multipara women of the advanced-age and late-pregnancy group were mildly decreased (but P＞0.05) and the level of VLDL-C mildly increased (but P＞0.05), when compared with those primipara women. ③Compared with those primipara women, the multipara women of the right-age groups had lower incidences of premature rupture of membranes and fetal distress, while the multipara women of the advanced-age groups had lower incidences of hypertensive disorder complicating pregnancy (HDCP), gestational diabetes mellitus (GDM) and fetal distress (all P＜0.05). However, the incidences of premature and giant babies in those multipara women of the right-age groups were higher than those in the primipara women (both P＜0.05). ④The incidences of HDCP and GDM in both advanced-age groups were significantly higher than those in both right-age groups (all P＜0.05). Conclusions：Parity has a certain degree of effect on serum lipids, which could be related to pregnancy complications.