妊娠期糖尿病按两种诊断标准治疗后妊娠结局分析  

Comparison of two different diagnostic criteria for gestational diabetes mellitus on pregnancy outcome

作　　者：迟鑫姝[1] 金镇[1] 王晓岩[1] 练思语[1] 艾婉婷[1] 孙磊[1] 孙倩[1] 姜洁璇[1] 

机构地区：[1]中国医科大学附属盛京医院妇产科,辽宁沈阳110004

出　　处：《中国实用妇科与产科杂志》2013年第9期733-736,共4页Chinese Journal of Practical Gynecology and Obstetrics

基　　金：国家自然科学基金(81170591);沈阳市科学技术计划资助项目(F11-262-9-46)

摘　　要：目的比较按两种诊断标准确诊为妊娠期糖尿病(GDM)的孕产妇血糖控制满意后的妊娠结局,以及分析对轻度高血糖的GDM患者进行血糖干预后的妊娠结局。方法回顾性分析2005年3月至2012年1月中国医科大学附属盛京医院产科门诊GDM患者共444例,按照美国国家糖尿病数据组(NDDG)标准和国际糖尿病与妊娠研究组(IADPSG)标准对GDM孕妇进行诊断分组,其中达到IADPSG标准但未达到NDDG标准(IADPSG non NDDG)组152例,既达到NDDG也达到IADPSG妊娠期高血糖标准(NDDG/IADPSG)组292例。同期选取正常孕妇492例为对照组。比较各组血糖控制满意后的妊娠结局。结果 (1)GDM组的妊娠期高血压疾病、羊水过多、大于胎龄儿和新生儿高胆红素血症发生率高于对照组(P<0.05);早产、产褥感染、产后出血、新生儿窒息和低血糖发生率与对照组差异无统计学意义(P>0.05)。(2)IADPSG non NDDG组的妊娠期高血压疾病、早产、羊水过多、产褥感染、大于胎龄儿、新生儿窒息、新生儿低血糖和新生儿高胆红素血症率发生率低于IADPSG/NDDG组,差异无统计学意义(P>0.05);IADPSG non NDDG组的产后出血发生率高于IADPSG/NDDG组,差异无统计学意义(P>0.05)。结论与NDDG标准比较,IADPSG标准诊断的妊娠期高血糖发生率增加,轻度高血糖的GDM患者多可通过单纯饮食控制达到血糖满意,进而在一定程度上改善母儿不良妊娠结局。Objective To compare with two different diagnostic criteria for gestational diabetes mellitus （GDM）on preg- nancy outcome after satisfactory glycemic control, especially for mild hyperglycemia GDM. Methods 936 Women un- derwent oral glucose-tolerance testing at 24 to 28 weeks of gestation. Participants were stratified into the following 4 groups,all GDM were 444; including GDM fulfilled the IADPSG as well as NDDG criteria （IADPSG/NDDG） were 292 and GDM fulfilled the IADPSG but not by NDDG criteria （IADPSG non NDDG） were 152, normal glucose tolerance by both IADPSG and NDDG were 492. All GDM pregnant women can be well controlled, by treatment（ including glucose mo- nitoring, dietary therapy and/or insulin therapy）. Results （ 1 ） The women from all GDM group had a higher incidence of gestational hypertension, birth weight 〉 90 percentile, polyhydramnions and hyperbilirubinemia compared with the con- trol group;but puerperal infection, premature birth, postpartum hemorrhage neonatal asphyxia and neonatal hypoglycemia had no significant difference ; （2） In comparison with the IADPSG non NDDG group, women from IADPSG/NDDG group had a higher rate of gestational hypertension, birth weight 〉 90 percentile, polyhydramnions, puerperal infection, prema- ture birth, neonatal asphyxia, hyperbilirubinemia and neonatal hypoglycemia, a lower rate of postpartum hemorrhage, but with no significant difference. Conclusion Compare to NDDG criteria, IADPSG criteria increases the diagnosis of gesta- tional hyperglycemia. Mild hyperglycemia GDM can be well controlled by diet therapy, and to a certain extent, improving maternal and fetal adverse pregnancy outcome.

关 键 词：妊娠期糖尿病 诊断标准 妊娠结局 

分 类 号：R714.256[医药卫生—妇产科学]