两种妊娠期糖尿病诊断标准与妊娠结局的关系

Comparison of pregnant outcomes using two different diagnostic criteria of gestational diabetes mellitus

目的了解妊娠期糖代谢异常不同诊断标准与妊娠结局的关系。方法选取定期产检并住院分娩、50 g糖筛查异常后行75 g葡萄糖耐量试验(OGTT)的孕妇302例,根据国内董志光等和1997年美国糖尿病协会(ADA)两种诊断标准对孕妇进行分组:符合国内董志光等妊娠期糖尿病(GDM)和糖耐量减低(GIGT)标准的76例列为A组;不符合董志光等标准但符合1997年ADA诊断标准的43例列为B组;两种标准均不符合的视为OGTT正常,从中随机选取80例列为C组;对3组母儿妊娠结局进行分析比较。结果①以董志光等标准诊断妊娠期糖代谢异常76例,占筛查阳性数的25.2%,其中GDM 55例(18.2%),GIGT 21例(6.9%)。以1997年ADA标准诊断妊娠期糖代谢异常119例,占筛查阳性数的39.4%,其中GDM 68例(22.5%),GIGT51例(16.9%)。②A组妊娠期高血压疾病、羊水过多、胎膜早破、巨大儿、新生儿窒息及新生儿低血糖的发生率、剖宫产率均高于B组和C组,差异有统计学意义(P<0.05、P<0.01);B组和C组间母儿并发症的发生率差异均无统计学意义(P>0.05)。结论按董志光等诊断标准,糖筛查异常人群中将有14.2%的糖代谢异常者被漏诊,但发生妊娠期高血压疾病、羊水过多、胎膜早破、巨大儿、产后出血、新生儿窒息、新生儿低血糖等的风险以及剖宫产率并无明显增加;如按1997年ADA诊断标准,则增加14.2%的孕妇需要处理,这会增加孕妇的心理和经济负担。

Objective To evaluate the influence of different diagnostic criteria of gestational diabetes mellitus（GDM） using oral glucose tolerance test（OGTT） on pregnant outcome.Methods 302 pregnant women who delivered with abnormal 50 g oral glucose screening test received 75 g OGTT,then 199 cases of them were divided into 3groups according to different diagnostic criteria： group A included those who meet Zhiguang Dong′s criteria of GDM and GIGT,group B included those who only meet the American Diabetes Association′s（ADA′s） criteria and group C included those who did not meet two criteria.The outcome of mother and neonate of the three groups were compared.Results ① The rate of abnormal OGTT was 25.2%（GDM 18.2%,GIGT 6.9%,55 vs 21 cases） according to Dong′s criteria.While the rate of abnormal OGTT was 39.4%（GDM 22.5%,GIGT 16.9%,68 vs 51 cases） according to ADA′s criteria.② The incidence of pregnancy induced hypertension,polyhydramnios,premature rupture of membranes,cesarean section,macrosomia,neonatal asphyxia,neonatal hypoglycemia in group A was significantly higher than that of group B and group C（P0.05 or P0.01）.But There was no difference in the rate of maternal and neonate complications between group B and group C.Conclusion 14.2% of women with GDM or GIGT will be lost when applying Dong′s OGTT criteria.But the risks of maternal and neonate complications and the rate of cesarean section do not increase.If the ADA′s criteria is applied,this group of pregnant women need treatment increased 14.2%,thus may result in more psychologically and economically burden.