糖筛查在巨大胎儿防治中的价值探讨

The Significance of Glucose Challenge Test in the Prevention and Treatment of Fetal Macrosomia

目的探讨糖筛查在巨大胎儿防治中的价值。方法以50g糖筛查值≥7.8mmol/L为标准,将87例巨大胎儿分为糖筛查异常41例(Ⅰ组)和糖筛查正常46例(Ⅱ组),随机选择同期出生的、糖筛查值<7.8mmol/L的正常足月儿41例(Ⅲ组)进行对照研究。结果Ⅰ、Ⅱ组孕妇的体重指数(BMI)、身高均高于Ⅲ组。但Ⅰ、Ⅱ组间亦存在差异(P<0.05),Ⅰ组的BMI明显高于Ⅲ组(P<0.001),而Ⅱ组的平均身高明显高于Ⅲ组(P<0.001);Ⅰ、Ⅱ组的剖宫产率及男胎数均高于Ⅲ组,Ⅰ组的剖宫产率与Ⅲ组比较有极显著性差异(P<0.005),而男胎数两组在统计学上无显著差异(P>0.05)。结论重视妊娠期糖尿病的筛查与诊治,加强孕期的营养指导及BMI监测,可降低巨大胎儿的发生率。对糖代谢异常及BMI高值孕妇,如胎儿巨大,放宽剖宫产指征,可避免发生肩难产。

Objective To investigate the significance of glucose challenge test in the prevention and treatment of fetal macrosomia. Methods With GCT value ≥7.8 mmol/L as criteria, 87 macrosomia cases were divided into the CCT positive (41, as Group Ⅰ) and the GCT negative (46, as Group Ⅱ) groups. 41 randomly selected synchronic normal birth cases, with maternal GCT value < 7.8 mmol/L,were used as control group (Group Ⅲ) in the study. Results The BMI and maternal height of Group Ⅰ and Group Ⅱ were higher than those in GroupⅢ. The BMI of Group Ⅰ and the maternal height of Group Ⅱ were significantly greater than those of Group Ⅲ (P<0.001). The cesarean delivery rate and the number of male fetus of Group Ⅰ and Group Ⅱ were also higher than that in Group Ⅲ. There was a significant different in the rate of cesarean delivery between Groups Ⅰ and Ⅲ (P < 0.005), while the number of male fetus in these two groups showed no statistically significant difference (P > 0.05). Conclusions To reinforce GDM screening and diagnosis,BMI monitoring and dietary counseling during pregnancy can reduce the occurrence of macrosomia.In order to prevent shoulder dystocia, cesarean section delivery should be more readily opted for macrosomia in the pregnant women with abnormal glucose metabolism and a high BMI value.