妊娠期糖代谢异常对巨大儿发生率及其他相关问题的影响

Influences of abnormal carbohydrate metabolism during pregnancy

目的 通过大样本资料研究妊娠期糖代谢异常对巨大儿发生的影响。 方法 回顾性研究1995年 1月至 2 0 0 1年 3月在北京大学第一医院妇产科产前进行了妊娠糖尿病 (gestationaldiabetesmelli tus ,GDM )的相关检查并分娩的 865 6例孕妇的临床资料。 结果 (1) 865 6例孕妇分娩巨大儿 70 0例 ,发生率 8.1%。 (2 )糖代谢异常孕妇巨大儿发生率为 12 .5 % (69/5 5 2 ) ,显著高于糖代谢正常孕妇的 7.8%(63 1/810 4) (P <0 .0 1)。 (3 )非GDM孕妇中 ,5 0g葡萄糖负荷试验 (glucosechallengetest ,GCT)异常孕妇的巨大儿发生率为 10 .7% (177/165 1) ,GCT正常者为 7.0 % (4 5 4/64 5 3 ) ,二者比较差异有显著性 (P <0 .0 1)。(4 )A2 型GDM孕妇巨大儿发生率为 13 .8% ,显著高于A1型的 6.0 % (P <0 .0 1)。 (5 ) 2 5岁以下孕妇巨大儿发生率为 5 .9% ,3 5岁以上孕妇的巨大儿发生率为 9.9% ,糖代谢异常的高龄孕妇巨大儿发生率为 18.2 %。 (6)孕 2 6～ 2 8周时孕妇的平均体重指数 (BMI)为 (2 4.9± 2 .9) ,BMI≥ 2 7.8组孕妇巨大儿发生率为16.2 % ,显著高于其他孕妇的 6.3 % ,糖代谢正常但BMI≥ 2 7.8的孕妇巨大儿发生率为 15 .9% ,与同时为GDM的 18.3 %的巨大儿率无统计学差异。 结论 (1)尽管对妊娠期糖尿病进行?

Objective To investigate the impact of the gestational diabetes mellitus and abnormal glucose challenge test (GCT) on macrosomia. Methods Clinical data of 8656 pregnant women who had antenatal care and delivered in the Department of Obstetrics and Gynecology of the First Hospital of Peking University from Jan 1995 to Mar 2001 were retrospectively analyzed. All of them underwent 50 g GCT. Results The incidence of macrosomia was 8.1% (700/8656). The incidence of macrosomia in GDM or IGT women was 12.5%(69/552), which was significantly higher than that of other women with normal glucose level 7.8%(631/8104, P <0.01). Significant difference was shown between the incidence of macrosomia in abnormal and normal GCT group [10.7%(177/1651) vs 7.0% (454/6453), P <0.01]. The macrosomia rate in women with GDM type A 2 (13.8%) was significantly higher than that of women with GDM type A 1 (6.0%, P <0.01). The rate of macrosomia among the women under age of 25 (5.9%) was lower than of the women over 35 (9.9%, P <0.01). The macrosomia rate in elder women with GDM or IGT (18.2%) was higher than that of women without. The average body mass index (BMI) of the women between 26～28 gestational weeks was (24.9±2.9). The women with BMI ≥27.8 had a macrosomia rate of 16.2% which was higher than that of the others (6.3%, P <0.01). The obese women without GDM or IGT had a similar rate of macrosomia (15.9%) to women with GDM (18 3%). Conclusions Women with GIGT or GDM remain have a higher rate of macrosomia although the the glucose level was under control, especially in GDM type A 2. More attention should be paid to its management and surveillance. Abnormal GCT, older age and obesity are important high risk factors for macrosomia besides GDM or IGT.