妊娠期糖尿病巨大儿106例临床分析

Clinical analysis of 106 cases of macrosomia in women with gestational diabetes mellitus

目的探讨妊娠期糖尿病(GDM)巨大儿发生情况及母婴结局。方法对本院分娩单胎1166例GDM孕妇及新生儿资料进行回顾性统计分析,106例分娩的巨大儿及孕妇作为研究组,其余1060例为对照组,比较孕妇年龄、身高、孕期增重、孕期增加BMI、产前BMI、孕周、孕产次、妊娠及围产儿并发症的情况。结果研究组孕妇身高、孕期增重、孕期增加BMI、产前BMI、孕周和产次均明显高于对照组(P<0.01);孕妇软产道损伤发生率高于对照组(P<0.05),羊水过多发生率明显多于对照组(P<0.01);围产儿结局研究组死胎、产伤及新生儿肺炎发生率高于对照组(P<0.05),尤其肺炎发生率差异极显著(P<0.01);比较两组至少发生一项母婴并发症,显示GDM孕妇分娩巨大儿主要影响围产儿结局(P<0.01),而对妊娠并发症影响无统计学意义(P>0.05)。结论确诊为妊娠期糖尿病的孕妇应适当控制孕期增重,积极预防巨大儿的发生,减少相关母婴并发症。

Objective To explore the occurrence of macrosomia in women with gestational diabetes mellitus（GDM） and the maternofetal outcomes.Methods Clinical data of 1166 pregnant women with singleton and their newborns were enrolled in the study.106 macrosomias and their mothers were selected as study group and 1060 newborns with normal birth weight and their mothers as control group.The pregnant women age,height,weight gain during pregnancy,body mass index（BMI） gain during pregnancy,antenatal BMI,gestational age,the number of pregnancy and accouchement and maternofetal outcomes were observed.Results The maternal height,weight gain,BMI gain,antenatal BMI,gestational age and the number of accouchement in study group were significantly higher than that in control group（P0.01）.The incidence of soft birth canal injury was higher than that in control group（P0.05）.The incidence of hydramnios was significantly higher than that in control group（P0.01）.The incidence of stillbirth、birth injury and neonatal pneumonia were higher than that in control group（P0.05）,especially in neonatal pneumonia（P0.01）.To compare the two groups which appeared at least one maternofetal complication,it is macrosomia in women with GDM that mainly affects fetal outcomes（P0.01）,however,there is no statistical significance in pregnancy complications（P0.05）.Conclusion The women with GDM should control weight gain during pregnancy properly and prevent the occurrence of macrosomia actively in order to decrease maternofetal complications.