妊娠晚期孕妇血清尿素氮/肌酐比值与妊娠并发症及胎儿体重的关系研究

Association of maternal serum BUN/Cr ratio in late pregnancy with pregnancy complications and fetal weight

摘要

目的 探讨妊娠晚期孕妇血尿素氮(BUN)/肌酐(Cr)比值与妊娠并发症及胎儿体重的关系。方法 纳入2024年9月至2024年12月宁波大学附属妇女儿童医院收治的2 286名妊娠≥28周的待产孕妇,入院后查空腹血清BUN和Cr水平。根据血清BUN/Cr比值分为三组:<15.0组(n=1 001),15.0~19.9组(n=740)和≥20.0组(n=545)。比较三组妊娠期高血压疾病(HDCP)、妊娠期糖尿病(GDM)、甲状腺功能减退、羊水过少、早产、胎儿生长受限(FGR)的患病率及胎儿出生体重的差异,并分析母体血清BUN/Cr比值与胎儿体重的相关性。结果 三组间HDCP患病率差异有统计学意义(χ²=265.582,P<0.05),BUN/Cr比值≥20.0组孕妇HDCP患病率最高,比值<15.0组孕妇最低;BUN/Cr≥20.0组孕妇GDM患病率最高,BUN/Cr<15.0孕妇最低(χ²=27.066,P<0.05);血清BUN/Cr比值≥20.0组的孕妇与其余两组相比,甲状腺功能减退、羊水过少和早产的占比更高(χ²分别为34.246、7.175、42.680,均P<0.05);三组间FGR患病率差异有统计学意义(χ²=118.618,P<0.05),BUN/Cr≥20.0组FGR患病率最高,BUN/Cr<15.0组则最低;各组胎儿出生体重差异有统计学意义(F=58.715,P<0.05),BUN/Cr比值≥20.0孕妇胎儿出生体重最低;校正潜在混杂因素后,较高的母体血清BUN/Cr比值为FGR的独立危险因素(OR=1.222,95%CI:1.182~1.263),母体血清BUN/Cr比值与胎儿出生体重呈负相关(r=-0.301,P<0.05)。结论 妊娠晚期血清尿素氮/肌酐比值升高的孕妇其妊娠并发症如妊娠期高血压疾病、妊娠期糖尿病等患病率较高且胎儿出生体重较低,孕妇血清尿素氮/肌酐比值有望成为预测妊娠不良结局和胎儿低出生体重的潜在生物标志物。

Abstract

Objective This study aimed to examine the association between the maternal blood urea nitrogen (BUN) to creatinine (Cr) ratio during late pregnancy and the occurrence of pregnancy complications as well as fetal birth weight. Methods A total of 2 286 pregnant women with ≥28 weeks of gestation who were admitted to the Women and Children's Hospital of Ningbo University between September 2024 and December 2024 were enrolled. Fasting serum BUN and Cr levels were measured upon admission. Participants were categorized into three groups according to their serum BUN/Cr ratio: <15.0 (n=1 001), 15.0-19.9 (n=740), and ≥20.0 (n=545). The incidences of hypertensive disorders complicating pregnancy (HDCP), gestational diabetes mellitus (GDM), hypothyroidism, oligohydramnios, preterm birth, and fetal growth restriction (FGR), as well as fetal birth weight, were compared across groups. Correlation analysis was performed to assess the relationship between maternal BUN/Cr ratio and fetal birth weight. Results Significant differences were observed in the incidence of HDCP among the three groups (χ²=265.582, P<0.05), with the highest incidence noted in the ≥20.0 group and the lowest in the <15.0 group. The incidence of GDM was highest in the BUN/Cr ≥20.0 group and lowest in the BUN/Cr <15.0 group (χ²=27.066, P<0.05). The ≥20.0 group also showed higher rates of hypothyroidism, oligohydramnios, and preterm birth compared with the other two groups (χ²=34.246, 7.175 and 42.680, respectively P<0.05). The incidence of FGR differed significantly among groups (χ²=118.618, P<0.05), being highest in the ≥20.0 group and lowest in the <15.0 group (P<0.05). Fetal birth weight also varied significantly (F=58.715, P<0.05), with the ≥20.0 group exhibiting the lowest birth weight. After adjusting for confounders, the group with highter maternal BUN/Cr ratio remained an independent risk factor for FGR (OR=1.222, 95%CI: 1.182-1.263), and it was negatively correlated with fetal birth weight (r=-0.301, P<0.05). Conclusion An elevated maternal serum BUN/Cr ratio in late pregnancy is associated with a higher risk of pregnancy complications and lower fetal birth weight. The maternal BUN/Cr ratio may serve as a potential biomarker for predicting adverse pregnancy outcomes and low birth weight.

关键词

妊娠晚期 / 并发症 / 出生体重 / 尿素氮 / 肌酐

Key words

late pregnancy / complication / birth weight / urea nitrogen / creatinine

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基金资助

宁波市卫生健康科技计划项目(2022Y15)

浙江省医药卫生科技计划项目(2024KY1571)