糖代谢异常孕妇380例临床分析

Clinical analysis of 380 cases pregnant women with abnormal glucose metabolism

目的探讨孕妇糖代谢异常与妊娠并发症的关系及应用胰岛素改善妊娠结局的情况。方法380例糖代谢异常孕妇按照糖代谢异常情况分为糖尿病合并妊娠24例（DM组）、妊娠期糖尿病164例（GDM组）、妊娠期糖耐量异常192例（GIGT组），观察三组妊娠并发症发生情况；同时将380例孕妇分成饮食加胰岛素治疗136例（胰岛素组）、单纯饮食控制244例（饮食组）进行妊娠结局对比分析。结果DM组、GDM组、GIGT组的子痫前期发生率分别为41．7％（10／24）、15．9％（26／164）、15．6％（30／192），早产发生率分别为41．7％（10,／24）、18．3％（30／164）、20．7％（38／192），差异均有统计学意义（均P〈0．05）；巨大儿、羊水过多、胎儿宫内窘迫发生率三组比较，差异无统计学意义（均P〉0．05）；DM组新生儿窒息、低血糖的发生率均高于GDM组和GIGT组（均P〈0．01）。胰岛素组新生儿出生体重平均为（2．9±1．3）kg，低于饮食组（3．8±1．0）kg，差异有统计学意义（P〈0．05）。结论孕妇早产、子痫前期发生率、新生儿窒息、低血糖发生率与糖代谢紊乱有关，胰岛素的应用可以改善糖代谢异常孕妇的妊娠结局。

Objective To study the relationship between blood lipid levels, insulin therapy of pregnant women with abnormal glucose metabolism and perinatal outcomes. Methods 380 pregnant women who were diagnosed and treated for abnormal glucose metabolism were enrolled in this study,including 24 cases with diabetes mellitus（DM）, 164 cases with gestation diabetes mellitus （GDM）, 192 cases with gestation impaired glucose tolerance （GIGT）. Among the 380 cases, 136 cases were performed insulin therapy with diet controlling,244 cases diet controlling. Results The incidence of pre-eclampsia and preterm labor in the DM group（41.7% and 41.7% ）was higher than that in GIGT group （15.6% and 20. 7% ）and GDM group （ 15.9 % and 18.3 % ） （P 〈 0. 05 ）. Among the three groups ,the incidence of macrosomia, polyhydranmios and fetal distress had no significant difference（ P 〉 0. 05 ）. While the incidence of neonatal asphyxia, hypoglycemia in the DM group were all higher than that in GDM and GIGT group （ P 〈 0. 01 ）. The newborn weights in insulin therapy group （2891.5 ± 1330.4 g） was lower than that in diet controlling group（3751.2±1025.3 g）（ P 〈 0. 05 ）. Conclusion The blood lipid level of pregnant women with gestational abnormal glucose metabolism is one of the effective indexes to prognose perinatal outcomes. Reducing blood lipid level can decrease the incidence of pre-eclampsia and preterm labor, neonatal asphyxia and hypoglycemia significantly. Diagnosing and beginning therapy as soon as possible and using insulin are important, especially to reduce the rate of macrosomia and newborn weights.