早期干预GDM高危因素孕妇对妊娠结局的影响

The Effect of the Earlier Intervention Treatment of the Pregnant Women with Gestation Diabetes Mellitus Risk Factor on Pregnant Outcome

目的:探讨早期干预妊娠期糖尿病(GDM)高危因素孕妇对妊娠结局的影响。方法:本实验同时采用前瞻性和回顾性研究的方法,对2007年8月至2008年12月所有我院就诊的妊娠妇女首次产前检查时,进行GDM发病风险评估。高危因素包括:家族糖尿病史、巨大儿分娩史、不良孕产史、肥胖、高龄孕妇等。医生对具有上述高危因素者提出两项建议:①建议尽早行血糖检测,如初次筛查未发现,于妊娠24～28周、32～34周复查。②孕12周后即开始合理饮食调节及适量运动治疗、控制孕期体重过度增长。然后将具有高危因素的患者分为两组:A组为遵从医嘱者:B组为未遵从医嘱者。并对两组孕妇随后的GDM发病状况、妊娠结局比较做统计分析。结果:具有上述高危因素,接受医生建议早期进行饮食调节和运动治疗的孕产妇, GDM的发生率、特别是需胰岛素治疗发生率明显降低,与未遵从医生建议的孕妇组有显著差异(p<0.05)。②未遵从医嘱组巨大儿、剖宫产率、产后出血率、新生儿窒息、新生儿高胆红素血症等发病率明显增加。结论:①具有GDM高危因素的孕妇早期进行饮食和运动治疗干预,能显著降低GDM发病率、母儿并发症发生率,明显改善妊娠结局。

Objective To explore the effect of the earlier treatment on the pregnant women with gestation diabetes mellitus high risk factor. Methods This is a prospective study and retrospective cohort study.We have carried out GDM risk assessment for all pregnant women in our hospital from August 2007 to December 2008 in the first prenatal examination, diabetes in the family, macrosomia and a history of perinatal complications, overweight and obesity, age~〉30, were identified as risk factors for GDM.Two proposals were put forward for those pregnant women with above risk factors： 1. The glucose tolerance screening was done in first trimester, if the initial screening is negative, the screening was reviewed at 24-28 weeks, 32-34 weeks of gestation. 2. the reasonable diet treatment and regular exercise would be performed from 12 weeks of gestation to control excessive growth of body weight during pregnancy. Then the patients with high-risk factors were divided into two groups, group A：a group of persons to comply with doctor＇s advice, group B： a group who did not comply with doctor＇s advice for the earlier treatment at the same time. Subsequent incident of GDM of two groups of pregnant women and complication incidents of mothers and infants were analyzed between the 2 groups. Results GDM incident, especially in the incident of insulin therapy in group A were significantly lower than those in group B. All of the complication incidents of mothers and infants, including incidents of pregnancy induced macrosomia, cesarean delivery, postpartum hemorrhage, neonatal asphyxia, neonatal hyperbilirubinemia were significantly lower than those in group B（P 〈 0.05）. Conclusion Early intervention treatment（include diet treatment and exercise） for the GDM high risk pregnant women can apparently decrease incidents of GDM and complication incidents of GDM mothers and their infants, improve perinatal outcome.