2891例妊娠合并糖代谢异常住院分娩患者的围生期结局变化情况分析

Analysis of perinatal outcomes of 2891 hospitalized pregnant women with glucose metabolism disorders

目的了解2001至2011年全国驻军医院收治的2891例妊娠合并糖代谢异常住院分娩患者的围生期结局变化情况及其导致产后出血、孕产妇死亡、新生儿死亡的发生率变化情况。方法通过中国人民解放军总后勤部信息技术中心病例查询系统得到2000年10月至2011年9月间,全国驻军医院收治的妊娠合并糖代谢异常住院分娩患者共2891例临床资料,回顾性分析各年度顺产率、剖宫产率、产后出血率、新生儿病死率、孕产妇病死率的变化。结果(1)妊娠期糖尿病(GDM)患者住院分娩占总住院分娩例数的2.58‰(1631/633355):第1阶段,即2001至2004年,GDM住院分娩的发生率呈持恒状态,平均为1.56‰(269/172936);第2阶段,即2005至2008年,发生率呈上升趋势,平均为4.63‰(1055/227988);第3阶段,即2009至2011年,发生率呈下降趋势,平均为1.32‰(307/232431);(2)近11年,妊娠合并糖耐量异常(GIGT)住院分娩的总发生率呈上升趋势;平均1.99‰(1260/633355)。GIGT住院剖宫产率呈轻度下降趋势,平均64.84%,妊娠合并糖代谢异常孕妇新生儿总死亡率为0.07%(2/2891),其中GDM组为0.12%(2/1631),显著高于GIGT组的0%(0/1260)。妊娠合并糖代谢异常孕妇产后出血总发生率为1.83%(53/2891),整体呈下降趋势,其中GDM组产后出血发生率为2.27%(37/1631),显著高于GIGT组的1.27%(16/1260)。两组的孕产妇死亡的发生率均为0。结论加强对孕前、孕期血糖水平的调控、治疗,早期发现糖耐量受损并对其进行干预,如加强运动、合理饮食治疗和控制体重增长速度,控制血糖在合理水平,从而降低糖尿病的发病几率,避免或减少不良妊娠结局的发生。

Objectives The study was designed to evaluate pregnancy outcomes of 2891 pregnant women with glucose metabolism disorders in garrison hospitals,and the incidence of postpartum hemorrhage,maternal mortality,neonatal mortality.Methods The clinical data of 2891 cases through inquiry system from October 2000 to September 2011 were retrospectively analyzed.The eutocia rate,cesarean section rate,postpartum hemorrhage rate,neonatal mortality rate and maternal mortality rate were studied.Results(1)The total delivery incidence of GDM was 2.58‰(1631/633355).At the first stage,from 2001 to 2004,the delivery incidence of gestational diabetes kept stable at 1.56‰(269/172936);at the second stage,from 2005 to 2008,it was increased gradually with the average incidence of 4.63‰(1055/227988);and at the third stage,from 2009 to 2011,it was decreased gradually,with the average incidence of 1.32‰(307/232431).(2)In recent 11 years,the total delivery incidence of GIGT was increased gradually,with the average incidence of 1.99‰(1260/633355).The cesarean section rate of gestational diabetes metabolic abnormalities showed a mild decrease with the average incidence of 64.84%.The abnormal glucose metabolism rate of gestational diabetes metabolic abnormalities was 0.07%(2/2891),in which the gestational diabetes group was 0.12%(2/1631),which was significantly higher than the group of pregnant women with abnormal glucose tolerance[0%(0/1260)].The incidence of postpartum hemorrhage of pregnant women with glucose metabolism disorders showed a declining state,which was 1.83%(53/2891),in which the rate of gestational diabetes group[2.27%(37/1631)]was significantly higher than the rate of pregnant women with abnormal glucose tolerance group[1.27%(16/1260)].The maternal mortality rates of the two groups were both 0.Conclusion We should pay attention to the control of blood glucose level during pre-pregnancy and pregnancy stage,discover impaired glucose tolerance early and give intervention,such as exercise,proper diet treatment and body weight growth rate control,and keep the blood glucose at a reasonable level.And finally we hope to reduce the risk of the further development of gestational diabetes and the incidence of adverse pregnancy outcomes.