关键词: 妊娠期糖尿病, B族链球菌, 妊娠结局, 中性粒细胞与淋巴细胞比值, 糖化血红蛋白, 绒毛膜羊膜炎

Abstract:

Objective To clarify the clinical characteristics of patients with gestational diabetes mellitus （GDM） complicated by group B streptococcus （GBS） infection and its impact on pregnancy outcomes， and to analyze the predictive value of glycated hemoglobin （HbA_1c）， neutrophil-to-lymphocyte ratio （NLR）， and platelet-to-lymphocyte ratio （PLR） in GDM patients complicated by GBS infection and its complication， chorioamnionitis. Methods A retrospective selection was conducted on 277 inpatients diagnosed with GDM who were admitted to the NanhaiMaternal and Child Health Hospital， Foshan City from January 2023 to December 2024. Among these patients， those with GDM combined with GBS infection were assigned to the positive group （n = 75）， while those with GDM but without GBS infection were assigned to the control group （n = 202）. The differences in clinical data， including age， and pregnancy outcomes between the two groups of pregnant women were compared. Multivariate logistic regression analysis was employed to explore the risk factors for GBS infection in GDM patients and the risk factors for chorioamnionitis in GDM patients with GBS infection. The predictive value of the relevant indicators was assessed using the receiver operating characteristic curve （ROC）. Results In the positive group， the levels of HbA_1c， NLR， and PLR were significantly elevated. Moreover， the incidences of premature rupture of membranes and intrauterine distress also showed a significant increase， and these differences were statistically significant （all P < 0.05）. The results of multivariate logistic regression analysis indicated that HbA1c （OR = 2.574， 95%CI： 1.355 ~ 4.889） and NLR （OR = 1.545， 95%CI： 1.318 ~ 1.811） were independent risk factors for GBS infection in patients with GDM （all P < 0.05）. Meanwhile， NLR （OR = 1.694， 95%CI： 1.242 ~ 2.190） was identified as an independent risk factor for chorioamnionitis in GDM patients with GBS infection. The ROC curve results demonstrated that the area under the curve （AUC） of the combined prediction model constructed based on HbA_1c and NLR for predicting GBS infection in GDM patients was 0.800 （95%CI： 0.741 ~ 0.859）， and the AUC of NLR for predicting chorioamnionitis was 0.855 （95%CI： 0.760 ~ 0.951）. The PLR had no significant correlation with GBS infection and its complications （P > 0.05）. Conclusions GBS infection in patients with GDM elevates the risk of adverse pregnancy outcomes among pregnant women. Elevated levels of glycated HbA_1c and NLR are independent risk factors for GBS infection in GDM patients. The NLR holds predictive value for chorioamnionitis in GDM patients with GBS infection. It is advisable to enhance the management of high-risk pregnancies to prevent adverse pregnancy outcomes and mitigate the risk of maternal and infant infections during the perinatal period.

Key words: gestational diabetes mellitus, group b streptococcus, pregnancy outcome, neutrophil-to-lymphocyte ratio, glyc-ated hemoglobin, chorioamnionitis