妊娠期葡萄糖耐量试验2h血糖切点的选择与母儿预后

The relationship between cut-off point of OGTT 2 hour plasma glucose and maternal and fetal outcomes

目的 探讨 75g葡萄糖耐量试验 (OGTT)服糖后 2h的血糖切点对妊娠结局的影响。方法 回顾性分析 ,2 0 0 2年 1月～ 2 0 0 3年 12月在北京大学第一医院产科产前检查并分娩的单胎产妇共 4 6 5 2例 ,孕期均接受 5 0g葡萄糖负荷试验 (GCT)筛查。排除GDM和GIGT的病例 ,将其余 10 18例糖代谢正常产妇按OGTT服糖后 2h的血糖值 (OGTT 2hPG)分OGTT 2hPG <6 7mmol/L组 (I组 ) 4 87例、 6 7mmol/L≤OGTT 2hPG <7 8mmol/L组 (Ⅱ组 ) 32 4例和 7 8mmol/L≤OGTT 2hPG <9 2mmol/L组 (Ⅲ组 ) 2 0 7例 ,比较三组母儿预后的差异。结果 ①三组孕妇的平均年龄 (2 9 7± 3 5 )岁、 (30 1± 3 7)岁和 (30 4± 3 3)岁 ,孕周 (39 4± 2 3)周、 (39 4± 1 5 )周和 (39 3± 1 4 )周 ,差异无显著性 (P >0 0 5 )。②Ⅲ组的剖宫产 (C -S)率为 6 1 8% ,显著高于Ⅰ、Ⅱ组的 4 8 3%和 4 9 1% (P <0 0 5 )。产钳术和先兆子痫的发生率各组间差异无显著性 (P >0 0 5 )。依血糖水平增加 ,三组巨大儿和早产的发生率递增 ,分别为Ⅰ组 9 7%和 4 7% ;Ⅱ组 11 7%和 5 6 % ;Ⅲ组15 5 %和 5 8% ,但差异无显著性 (P >0 0 5 )。③Ⅱ组和Ⅲ组新生儿转科率为 2 2 5 %和 2 7 5 % ,显著高于Ⅰ组的14 0 % (P <0 0 5 )。Ⅲ组新生儿低血糖、

Objective To study the relationship between different cut-off points of OGTT 2 hour plasma glucose (OGTT 2 h PG) and maternal and fetal outcomes. Methods A total of 4 652 women delivered in Peking University First Hospital from Jan.2002 to Dec.2003 who recieved 50 g oral glucose challenge test (GCT) and 75 g oral glucose tolerance test (OGTT) were analyzed retrospectively. Among them, 1 018 normal OGTT women without gestational diabetes mellitus (GDM) or gestational impaired glucose tolerance (GIGT) were divided into three groups (group I, Ⅱ,Ⅲ) by using the OGTT 2 h PG cut-off points of 6.7 mmol/L and 7.8 mmol/L. The maternal and fetal outcomes of the three groups were compared. Results ① Group Ⅰ, Ⅱ and Ⅲ were 487, 324 and 207 cases respectively. There was no significant difference in mean age, gestational week and the proportion of primipara. ② The cesarean section rate in group Ⅲ was 61.8%,which was significantly higher than group Ⅰ (48.3%) and group Ⅱ (49.1%)(P<0.05).There were no significant difference in the rate of forceps delivery and preeclampsia(P>0.05).The incidences of macrosomia and preterm birth increased with increasing glycemia, yet without statistically difference (P>0.05). ③ The neonatal morbidities of group Ⅱ, Ⅲ were 22.5% and 27.5% respectively, significantly higher than group I(14.0%). The incidences of neonatal hypoglycemia and hyperbilirubinemia of group Ⅲ were 2.4% and 12.1%, significantly higher than group I (0.4% and 6.2%(P<0.05)). No significant difference of the incidence of neonatal mortality, birth weight, pneumonia and HIE was observed. Conclusions The cesarean section rate and the morbidity, hypoglycemia and hyperbilirubinemia of neonatal increased with increasing value of the OGTT 2 h PG. The cut-off point of OGTT 2 h PG of 7.8mmol/L is a valuable index of maternal and fetal outcomes.