加强妊娠期糖尿病管理对妊娠期糖代谢异常患者的影响分析

Influences of strengthening the management of gestational diabetes mellitus on the pregnant women with abnormal glucose metabolism

目的比较不同时期糖代谢异常孕妇的妊娠期并发症及妊娠结局变化。方法选择1996～2007年糖代谢异常孕妇718例与糖代谢正常孕妇11239例进行比较,第一阶段1996～2001年糖代谢异常孕妇122例为观察组1,糖代谢正常孕妇5967例为对照组1;第二阶段2002～2007年糖代谢异常孕妇596例为观察组2,糖代谢正常孕妇5272例为对照组2。第一阶段未开展葡萄糖筛查,产检生化空腹血糖≥5.6mmol/L,则进行餐后2h血糖检查或葡萄糖耐量试验(OGTT);第二阶段对产检孕妇均在妊娠24～28周行50g葡萄糖筛查,对筛查值≥7.8mmol/L者进行OGTT,并实行妊娠期糖尿病(GDM)管理。结果第一阶段妊娠期糖代谢异常122例,发病率为2.00%,其中糖尿病合并妊娠0.84%,GDM为0.84%,GIGT为0.32%;第二阶段妊娠期糖代谢异常596例,发病率为10.16%,其中糖尿病合并妊娠0.78%,GDM为4.29%,GIGT为5.08%,第一阶段观察组1早产、巨大胎儿、羊水过多及胎儿畸形的发生率分别为12.30%、13.93%、4.10%及3.28%,明显高于对照组1的5.33%、3.62%、0.96%及0.72%,差异有统计学意义(P<0.05);观察组1的妊娠期高血压疾病、胎儿生长受限(FGR)、死胎及新生儿高胆红素血症的发生率分别为9.02%、0.82%、2.46%、8.20%,对照组1分别为6.37%、2.26%、0.99%、13.09%,两组差异没有统计学意义(P>0.05)。第二阶段观察组2早产的发病率11.24%,高于对照组2的8.61%,差异有统计学意义(P<0.05);观察组2妊娠期高血压疾病、巨大胎儿、羊水过多、胎儿畸形、FGR、死胎及新生儿高胆红素血症的发生率分别为7.05%、5.37%、2.68%、1.34%、1.34%、0.67%、6.04%,对照组2分别为5.46%、4.36%、1.99%、2.12%、1.35%、1.23%、5.16%,两组差异没有统计学意义。结论加强妊娠期糖尿病的管理,可减少妊娠并发症,改善妊娠结局。

Objective To compare the pregnancy complications and outcomes between pregnant women with abnormal glucose metabolism and those with normal glucose metabolism before and after the standard management were carried out. Methods The pregnant women with abnormal glucose metabolism were selected for case group and those with normal glucose metabolism during the same period were selected for control group respectively. The first stage is from 1996 to 2001 and the second stage is from 2002 to 2007 because the standard management was carried out in 2002 in our hospital. There were 122 subjects in case group and 5967 subjects in control group in the first stage. The second stage included 596 subjects in ease group and 5272 subjects in control group. The glucose screening test was never carried out in the first stage. The oral glucose tolerance test （OGTT） was taken only when fasting glucose level was more than 5.6 mmol/ L. In the second stage, 50 gram glucose screening test was taken in the antenatal care women in 24th-28th gestational week. When the result was more than 7.8 mmol/L, the OGTT was carded out and the patient would be specially cared. Results There were 122 pregnancy women with abnormal glucose metabolism. The incidence rate was 2. 00%, including 0. 84% in pregnancy with DM, 0. 84% in GDM and 0. 32% in GIGT. There were 596 pregnancy women with abnormal glucose metabolism. The incidence rate was 10. 16% , including 0. 78% in pregnancy with DM, 4.29% in GDM and 5.08% in GIGT. Before the standard management were carded out,the incidence of premature delivery, macrosomia, polyhydramnios and fetal deformity in case group were 12.30%, 13.93%, 4. 10% and 3.28% respectively, which were significantly higher than those in control group as 5.33% ,3.62%, 0. 96% and 0. 72% respectively. There were not any statistically differences of hypertensive disorders in pregnancy, fetal growth restriction, fetal death and neonatal hyperbilirubinemia between the two groups. After the standard management were carried out, there was no difference in the incidence of pregnancy complications and pregnancy outcomes between two groups except that the incidence of premature delivery in case group （ 11.24% ） was higher than that in control group （8.61%）. Conclusions Strengthening the management of pregnant women with abnormal glucose metabolism can decrease the pregnancy complications and improve the pregnancy outcomes.