妊娠期糖代谢异常对母儿结局影响的前瞻性对照研究

A Controlled Study for Pregnant Outcomes in Women with Abnormal Gestational Glucose Tolerances

目的 探讨妊娠期糖代谢异常 (GDM和GIGT)经过及时诊断和规范处理 ,其对母儿预后的影响。方法 前瞻性收集我院 2 0 0 2年 1～ 12月 ,糖代谢异常单胎妊娠孕妇 2 15例作为研究组 ,其中GDM 10 9例 ,GIGT 10 6例 ;选择同期糖代谢正常的单胎孕妇 2 6 10例为对照组 ,比较两组孕妇、围生儿的最终结局。结果 妊娠期糖代谢异常的发生率已高达 7 6 1% ,其中GDM的发生率为 3 86 % (10 9/ 2 82 5 ) ,GIGT的发生率为 3 75 % (10 6 / 2 82 5 ) ,91 0 0 %(195 / 2 15 )的糖代谢异常孕妇接受了治疗。GDM组巨大儿发生率为 13 80 %、妊高征发生率为 14 70 % ,明显高于对照组的 7 5 4 %、 7 90 % ,差别有显著性意义 (P <0 0 5 )。GIGT组孕妇各种并发症的发生率与对照组比较差别无显著性意义 (P >0 0 5 )。GDM和GIGT组新生儿红细胞增多症的发生率分别为 3 6 0 %、 2 80 % ,明显高于对照组的0 6 5 % ,差别有显著性意义 (P <0 0 5 ) ,而两组新生儿其他合并症发生率间的差别无显著性意义 (P >0 0 5 )。结论 妊娠期糖代谢异常发生率明显升高 ,通过严格规范产前管理 ,GDM组巨大儿、妊高征发生率仍高于糖代谢正常孕妇 ;GIGT孕妇及围生儿结局明显改善 ,除新生儿红细胞增多症外 ,其他母、儿并发症与糖代谢正常者相近。

Objective To study the effect on the maternal and fetal outcomes in women with GDM & GIGT which was diagnosed in time and managed standard.Methods To collect the pregnant outcomes of all single pregnant women in The First Hospital of Beijing University from Jan. 2002 to Dec. 2002. In order to compare the final result of the pregnant women and perinatal infants, 215 cases with abnormal gestational glucose tolerances (109 cases diagnosed as GDM and 106 cases diagnosed as GIGT) were collected as study group. The control group was 2610 single pregnant women with normal glucose tolerance (NGT)Results The incidence of abnormal gestational glucose tolerances was 7.61% including 3.86% with GDM and 3.75% with GIGT, among them, 91% (195/205) accepted the strict glycemic control and obstetric care. Women with GDM were more likely to develop PIH (14.7% vs.7.9%, P<0.05) and macrosomia (13.8% vs. 7.54%) compared with those of NGT. But, there were no significant difference pregnant outcomes found in women with GDM compared with women with GIGT. Only the incidence of neonate hypercytocemia is significantly higher in women with GDM and GIGT (GDM 3.6% ,GIGT 2.8% vs. NGT 0.65%, P<0.05).Conclusion The rate of women with GDM and GIGT increase obviously. Through the strict management before having child, the rate of PIH and macrosomia in women of GDM is still higher than those of NGT. The result of the maternal and perinatal infants outcomes in women with GIGT is improved apparently except the increase of red cells, the complication of maternal and fetal outcomes is almost similar to those with NGT.