2014—2018年郑州市某医院妊娠期糖尿病巨大儿发生影响因素和妊娠结局分析  

Analysis of influencing factors and pregnancy outcomes of macrosomia among pregnant women with diabetes in a hospital in Zhengzhou City from 2014 to 2018

作　　者：陈玉荣[1] 段小凯 刘春凡[1] 杨晓[3] 姜艳丽[4] 张振香[3] 杜少斐 CHEN Yu-rong;DUAN Xiao-kai;LIU Chun-fan;YANG Xiao;JIANG Yan-li;ZHANG Zhen-xiang;DU Shao-fei(Hanghaidonglu Community Health Service Centre of Zhengzhou First People's Hospital,Zhengzhou,He'nan 450000,China;不详)

机构地区：[1]郑州市第一人民医院航海东路社区卫生服务中心,河南郑州450000 [2]郑州市第一人民医院全科医学科 [3]郑州大学护理与健康学院,河南郑州450000 [4]郑州市第一人民医院护理部 [5]郑州市第一人民医院内分泌科

出　　处：《中华全科医学》2021年第6期959-963,共5页Chinese Journal of General Practice

基　　金：河南省医学科技攻关项目(2018020734,2018020730,2018020733);河南省医学教育研究项目(Wjlx2017221)。

摘　　要：目的对妊娠期糖尿病(gestational diabetes mellitus, GDM)巨大儿影响因素和妊娠结局进行分析,探讨降低GDM巨大儿的有效方法。方法将2014年1月—2018年12月郑州市某医院住院分娩的单胎GDM孕妇1 135例作为研究对象,分巨大儿组(体重≥4 000 g, 175例)和非巨大儿组(体重<4 000 g, 960例),进行回顾性分析。结果本研究中发生GDM巨大儿发生率为15.42%,与孕妇糖尿病家族史、孕前BMI、增长体重、空腹血糖存在关联(均P<0.05)。GDM巨大儿组并发孕妇妊娠高血压,出现手术产、早产、新生儿低血糖、胎儿窘迫以及产后出血不良妊娠结局显著高于非GDM巨大儿组(均P<0.05)。研究发现,GDM巨大儿出现新生儿低血糖的危险系数是非巨大儿的1.599倍(95%CI:0.938~2.726),发生妊娠高血压的危险系数是非巨大儿的1.756倍(95%CI:1.132~2.723),出现产后大出血的危险系数是非巨大儿的2.489倍(95%CI:1.385~4.471)。结论 GDM巨大儿可增加手术产、早产、胎儿窘迫、妊娠高血压和产程中大出血等不良妊娠结局。因此对于有上述危险因素孕妇应尽早筛查口服葡萄糖耐量试验(oral glucose tolerance test, OGTT),改变传统饮食结构及不良生活方式,科学控制孕期体重增长及血糖水平,做好GDM孕妇孕期、产时及产褥期的全程护理干预,从而有效降低本地区GDM巨大儿发生率,减少不良妊娠结局风险。Objective To analyse the influencing factors and pregnancy outcomes of fetal macrosomia in women with gestational diabetes mellitus(GDM) and discuss effective methods for reducing the incidence of this disease. Methods A total of 1 135 single pregnancy women with GDM who were admitted to Zhengzhou First People’s Hospital from January 2014 to December 2018 were retrospectively analysed. They were divided into macrosomia group(175 cases with body weight of ≥4 000 g) and non-macrosomia group(960 cases with body weight of<4 000 g). Results The incidence of GDM macrosomia was 15.42%, and this disease was found to be associated with family history of diabetes in pregnant women, pre-pregnancy BMI, gain too much pregnancy weight and high fasting blood glucose(all P<0.05). The pregnant women in the macrosomia group were with a high incidence of gestational hypertension, surgical delivery and adverse pregnancy outcomes of premature delivery, neonatal hypoglycemia, fetal distress and postpartum haemorrhage, which were significantly higher than those in the non-GDM macrosomia group(all P<0.05). The risk factors of neonatal hypoglycemia in the GDM macrosomia group was 1.599 times(95% CI:0.938-2.726), 1.756 times(95% CI:1.132-2.723) and 2.489 times(95% CI:1.385-4.471) that in the non-macrosomia group. Conclusion GDM macrosomia can increase adverse pregnancy outcomes, such as surgery, preterm delivery, fetal distress, pregnancy hypertension and massive haemorrhage during labour. Pregnant women must be screened for oral glucose tolerance test(OGTT), their traditional diet and lifestyle must be changed, their weight gain and increase in blood sugar levels during pregnancy must be strictly limited and nursing intervention should be implemented during the entire process of intrapartum and puerperium to control the risk factors of GDM. These steps can effectively reduce the incidence of GDM macrosomia and reduce the risk of adverse pregnancy outcomes.

关 键 词：妊娠期糖尿病 巨大儿 影响因素 结局 护理干预 

分 类 号：R714.256[医药卫生—妇产科学] R715.3[医药卫生—临床医学]