强化饮食管理的妊娠期糖代谢异常孕妇的产后随访研究

Postpartum Follow-up Research in Intensified Dietary-managed Pregnancy Women with Abnormal Glucose Metabolism

目的探讨强化饮食管理的妊娠期糖代谢异常孕妇产后42d血糖异常的相关因素和预防措施。方法111例孕30周前确诊为妊娠期糖代谢异常包括妊娠期糖尿病(GDM)和妊娠期糖耐量受损(GIGT)孕妇,在营养门诊定期强化饮食管理,于分娩后42d行75g葡萄糖耐量试验(OGTT),按世界卫生组织标准进行再分类,即2型糖尿病(T2DM)、糖耐量减低(IGT)、空腹血糖受损(IFG)和血糖正常。选择同期未接受强化饮食管理的妊娠期糖代谢异常孕妇72例做对照,对比二者的随访率。结果111例中有84例进行了产后42d糖代谢检查,随访率为75.68%(84/111),明显高于未强化饮食管理者的随访率37.50%(27/72),差异有统计学意义(P<0.05)。强化饮食管理的妊娠期糖代谢异常孕妇产后42d有51例(60.71%)血糖正常(Ⅰ组),33例(39.29%)血糖异常(Ⅱ组),其中7例(8.33%)为T2DM、24例(28.57%)为IGT、2例(2.38%)为IFG。GDM孕妇中产后42d糖代谢异常发生率为52.78%(19/36),GIGT孕妇中产后42d糖代谢异常发生率为29.17%(14/48),差异有统计学意义(χ2=4.8081,P<0.05)。多元线性回归分析结果显示,影响产后42d空腹血糖和OGTT餐后2h血糖的因素有糖尿病家族史和确诊时OGTT异常项数。结论强化饮食管理的妊娠期糖代谢异常孕妇产后随访率高;有家族史的GDM孕妇产后血糖异常发生率较高。应重视产后随访,并根据相关因素给予积极干预。

Objective To investigate the related factors and preventive measures of 42 d pathoglycemia in intensified dietary-managed pregnancy women with abnormal glucose metabolism.Methods A total of 111 singleton pregnant women,diagnosed as abnormal glucose metabolism 30 weeks after pregnancy,received intensified dietary-management at nutrition clinic.Oral glucose tolerance test（OGTT） was performed 42 d after parturition,and the patients were reclassified according to WHO diagnosis criteria：Type 2 diabetic mellitus（T2DM）,impaired glucose tolerance（IGT）,impaired fasting glucose（IFG） and normal.Results Eighty-four pregnancy women received OGTT 42 d after parturition,with a follow-up rate of 75.68%（84/111）,significantly higher than patients without intensified dietary-management（37.50%,27/72）,the difference was significant（P〈0.05）.In intensified dietary-managed pregnancy women with abnormal glucose metabolism 42 d after parturition,normal glucose metabolism was noted in 51（60.71%,Ⅰ group）,abnor...更多mal in 33（39.29%,Ⅱ group）,of which T2DM in 7（8.33%）,IGT in 24（28.57%）,IFG in 2（2.38%）.The incidence of abnormal glucose metabolism 42 d after parturition was 52.78%（19/36） in GDM pregnancy women,and 29.17%（14/48） in GIGT,the difference was significant（χ2=4.8081,P〈0.05）.Multiple linear regression analysis showed that the factors affecting post-natal 24 d fasting blood glucose and postprandial 2 h blood glucose were family history of diabetes and OGTT abnormal items at diagnoses.Conclusion Postpartum follow-up rate in intensified dietary-managed pregnancy women with abnormal glucose metabolism is higher,GDM pregnancy women with family histories of diabetes are more likely to develop subsequent diabetes.Importance should be attached to postpartum follow-up,and active intervention should be given based on related factors.