妊娠期糖代谢异常孕妇妊娠结局的前瞻性对照研究

A Control Study of Pregnant Outcomes in Women with Abnormal Gestational Glucose Tolerances

目的探讨妊娠期糖代谢异常(GDM和GIGT)孕妇的发病情况以及妊娠结局。方法采用前瞻性对照研究的方法,将2005年6月至12月被诊断为糖代谢异常孕妇59例作为研究组,其中GDM 31例,GIGT28例,同时选取OGTT正常孕妇110例为对照组,比较两组孕妇的母儿并发症及妊娠结局。结果妊娠期糖代谢异常组和对照组孕妇的平均年龄(28.4±3.2)岁vs(26.3±3.9)岁、孕前体重指数(BMI)(21.3±3.3)kg/m2vs(20.3±2.8)kg/m2及孕期体重增长(0.45±0.18)kg/周vs(0.38±0.16)kg/周,两组比较,均P<0.05,两组孕妇分娩孕周比较(38.7±0.45)周vs(39.5±0.38)周,无统计学差异。糖代谢异常组巨大儿发生率、剖宫产率以及新生儿高胆红素血症的发生率明显高于对照组(20.3%vs 8.2%、54.2%vs21.8%、20.3%vs 6.4%,P<0.05),但早产、先兆子痫、新生儿低血糖的发生率两组比较无统计学意义;在此基础上,对有统计学意义的指标进一步分组作比较,结果显示:均为GDM孕妇的上述指标明显高于对照组,而GIGT孕妇与对照组上述指标比较尚未被认为有统计学意义。糖尿病母儿的严重不良结局来自于产前的漏诊。结论妊娠期糖代谢异常影响母儿结局,如果所有孕妇能得到GDM的筛查和规范化的管理,有可能预防或减少产伤的发生及其他母儿并发症。

Objective To investigate pregnant outcomes in women with GDM ＆ GIGT. Methods A prospective casecontrol study was performed in 59 women with abnormal gestational glucose tolerance （31 GDM and 29 GIGT） and 110 cases of normal oral glucose tolerance test （OGTT） as control recruited from Jun 2005 to Des 2005 in Taiyuan Maternal and Infant Health Care Hospital. In order to compare the complications of pregnant women and infants between study and control groups. Results Average age of women , Pre-pregnancy body mass index （BMI） ,gestational weight gains were significantly higher in GDM/GIGT than those of control group（ P 〈 0.05）, but gestational age of women with GDM/GIGT was not different between the study group and the control group （P 〉0.05）. The rate of macrosomia , cesarean section and neonatal hyperbilirubinernia in GDM/GIGT group was significantly higher than those in control group （20.3% vs 8.2% ,20.3% vs 6.4% ,54.2% vs 21.8% , P 〈 0.05 ）. No difference was shown in those two groups in preterm birth , pre-eclampsia and neonatal hypoglycemia （ P 〉 0.05）. The severe complications of infants of women with abnormal gestational glucose tolerances resulted from non-diagnose to GDM/GIGT before delivery. Conclusion Women with abnormal gestational glucose tolerances effected the complications of maternal and fetal outcomes, Which was decreased by strict diagnosis and regular management.