筛查标准及管理方式对糖尿病合并妊娠诊治情况的影响  

Effect of screening criteria and management methods on diagnosis and treatment of gestational diabetes mellitus

作　　者：张少凤 沈丽霞[1] 吴艳欣[1] 陈海天[1] Zhang Shaofeng;Shen Lixia;Wu Yanxin;Chen Haitian(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Sun Yat-sen University,Guangdong,Guangzhou)

机构地区：[1]中山大学附属第一医院妇产科,广州510080

出　　处：《中华产科急救电子杂志》2021年第1期49-54,共6页Chinese Journal of Obstetric Emergency（Electronic Edition）

基　　金：国家重点研发计划资助(2018YFC1002900);广东省科学自然基金(2015A030313198);中山大学青年培育项目(17YRPY24);省基础与应用基础研究基金自然科学基金(2021A1515010411)。

摘　　要：目的探讨糖尿病合并妊娠筛查标准和管理方式的改变对妊娠期治疗及妊娠结局的影响。方法回顾分析中山大学附属第一医院1993年1月至2018年12月26年间单胎妊娠并符合国际糖尿病与妊娠研究组(International Association of Diabetes and Pregnancy Study Group,IADPSG)2010年提出的糖尿病合并妊娠诊断标准的813例孕妇的临床资料,包括人口统计学特征、产检信息、孕期情况、分娩结局及新生儿结局等。根据当时实际妊娠期高血糖筛查方式及管理策略将入组人群分为三组:世界卫生组织(World Health Organization,WHO)标准组(1993年1月至2007年8月,299例)、美国糖尿病学会(American Diabetes Association,ADA)标准组(2007年9月至2011年6月,117例)和国际妊娠合并糖尿病研究组(International Association of Diabetes and Pregnancy Study Group,IADPSG)标准组(2011年7月起至今,397例),分析不同筛查标准和管理方式的妊娠期治疗情况及妊娠结局。结果三个标准组人群相比较,IADPSG标准组妊娠终止当次的平均住院天数(19.93 d、10.56 d、6.46 d,t=265.016,P=0.000)和妊娠期住院总天数(24.72 d、15.32 d、9.30 d,t=192.723,P=0.000)均最少。另外,三个组中妊娠期接受地塞米松促胎肺治疗的比例不断的下降(37.50%、38.50%、27.50%,χ^(2)=9.799,P=0.007)。剖宫产的比例(76.60%、67.50%、62.50%)也呈下降的趋势,相应地顺产率(23.40%、32.50%、37.50%)不断的升高(χ~2=15.777,P=0.000)。并且三组中妊娠期高血压或子痫前期的发生率(17.70%、10.30%、9.30%,χ^(2)=11.560,P=0.003)、巨大儿的发生率(12.70%、8.50%、4.80%,χ^(2)=7.148,P=0.001)、新生儿转儿科治疗的比例(44.80%、57.30%、38.30%,χ^(2)=14.100,P=0.001)以及新生儿高胆红素血症的比例(18.10%、17.90%、6.30%,χ^(2)=25.788,P=0.000)呈下降的趋势。结论IADPSG标准筛查和现行管理方式使糖尿病合并妊娠的诊疗更为规范化与全面化,改善了母儿结局。Objective To explore the impact of screening criteria and management changes of pregestational diabetes mellitus on treatment and pregnancy outcomes.Methods A retrospective analysis were carried on the clinical data,which including demographic characteristics,postpartum information,pregnancy status,childbirth status and newborn information,of 813 pregnant women in the First Affiliated Hospital of Sun Yat-sen University in 26 years from January 1,1993 to December 31,2018.They met the PGDM diagnostic criteria proposed by the International Diabetes and Pregnancy Study Group(IADPSG)in2010.According to the actual hyperglycemia screening method and management strategy at that time,the enrolled patients were divided into three groups:World Health Organization(WHO)standard group,American Diabetes Association(ADA)standard group,International Association of Diabetes and Pregnancy Study Group(IADPSG)standard group.Under different screening criteria and management methods,pregnancy treatment and pregnancy outcomes were analyzed.Results Compared with the three groups,the average hospital stay at the termination of pregnancy(19.93,10.56,6.46,t=265.016,P=0.000)and the total number of hospital stays during pregnancy(24.72,15.32,9.30,t=192.723,P=0.000)were the least in the IADPSG standard group.In addition,the proportion of receiving dexamethasone to promote fetal lung therapy during pregnancy was 37.50%,38.50%and 27.50%(χ^(2)=9.799,P=0.007),respectively.The proportion of cesarean section was 76.60%,67.50%and62.50%,respectively.Correspondingly,the normal delivery rate was respectively 23.40%,32.50%,37.50% was in WHO standard group,ADA standard group and IADPSG standard group(χ^(2)=15.777,P=0.000).And the incidence of hypertension during pregnancy or preeclampsia in the three groups(17.70%,10.30%,9.30%,χ^(2)=11.560,P=0.003),the incidence of macrosomia(12.70%,8.50%,4.80%,χ^(2)=7.148,P=0.001),the ratio of neonatal transfer to pediatric department(44.80%,57.30%,38.30%,χ^(2)=14.100,P=0.001)and the ratio of neonatal hyperbilirubin

关 键 词：糖尿病 妊娠 妊娠结局 疾病管理 

分 类 号：R714.256[医药卫生—妇产科学]