多囊卵巢综合征合并妊娠期糖尿病的临床特点分析

Clinical characteristics of gestational diabetes mellitus women with polycystic ovary syndrome

目的探讨多囊卵巢综合征(PCOS)合并妊娠期糖尿病(GDM)的临床特点。方法2006年2月至2008年5月在北京妇产医院诊断的PCOS合并GDM孕妇28例作为研究对象,将同期诊断无PCOS的GDM孕妇60例以及75g糖耐量试验正常(NGT)的孕妇60例作为对照组。比较3组的孕前一般情况,血糖、血脂及胰岛素抵抗情况及围产结局。结果PCOS组孕前BMI(26.33±3.89)明显高于单纯GDM和NGT组,差异有统计学意义(P均<0.01)。PCOS组孕前超重率(71.42%)、不良孕史发生率(35.71%)、使用体外受精-胚胎移植(IVF-ET)技术例数(8例)明显高于单纯GDM,差异有统计学意义(P分别为<0.01、<0.05、<0.01)。PCOS组诊断孕周(22.78±5.23)较单纯GDM组平均提前3.74周,两组比较有统计学意义,P<0.05。PCOS组孕妇平均空腹胰岛素水平(20.66±10.04)mU/L明显高于单纯GDM组(15.11±6.9)mU/L,P<0.01。3组均无胎死宫内及新生儿畸形发生,子痫前期、早产、巨大儿、胎膜早破,新生儿低血糖等的发生率无统计学意义,P>0.05。结论PCOS合并GDM孕妇,经过合理治疗围产期母儿并发症发生率并无明显增加。

Objective To investigate clinical characteristics of gestational diabetes mellitus（GDM） women with polycystic ovary syndrome. Methods Twenty-eight GDM women with PCOS were considered as the study group from Feb,2006 to May, 2008 in Beijing Obstetrics and Gynecology Hospital;60 GDM women without PCOS and 60 pregnant women with normal oral glucose tolerance test（NGT） were considered as the control groups. We compared pre-pregnancy clinical data, fasting glucose, fasting serum insulin, blood lipid, HOMA-IR and perinatal outcomes among the three groups. Resuits Pre-pregnancy BMI was significantly higher in the study group, compared to the two control groups （ P 〈 0. 01 ）. There was statistical significance in prevalence of pre-pregnancy overweight, poor pregnancy history （ infertility, early pregnancy loss） and using IVF-ET numbers among three groups, P 〈 0. 01, P 〈 0.05, P 〈 O. 01 respectively. GDM women had fewer gestational weeks than GDM women without PCOS, P 〈 0.05. Serum concentrations of Fins were higher in GDM women with PCOS compared with those without PCOS, P 〈0. 01. No statistical significances were found in fetal death and neonatal congenital abnormality, preeclampsia, premature delivery, macrosomia and so on among the three groups, P 〉 0. 05. Conclusion Perinatal complications of mothers and infants are not significantly increased through proper management in GDM women with PCOS.