摘要
目的比较妊娠期糖尿病(GDM)不同诊断标准的适宜性。方法通过对北京大学第一医院产科2005年1月至2009年12月期间分娩的、孕周≥28周且接受规范的GDM筛查和诊断的非孕前糖尿病产妇14593例的病历资料进行回顾性分析,比较按照美国国家糖尿病数据组(NDDG)和国际糖尿病与妊娠研究组(IADPSG)诊断标准计算的妊娠期高血糖的发生率及对妊娠结局的影响;并比较对妊娠期高血糖进行管理后不良妊娠结局的改善情况,以同期妊娠分娩的12403例糖代谢正常孕妇为对照。结果(1)妊娠期高血糖的发生率:分别按照NDDG、IADPSG标准,需要干预的妊娠期高血糖的发生率分别为8.9%(1293/14593)和14.7%(2138/14593),两种标准诊断的需要干预的妊娠期高血糖发生率比较,差异有统计学意义(P〈0.05)。(2)妊娠并发症发生情况:不同标准诊断的妊娠期高血糖均将增加巨大儿、大于胎龄儿(LGA)、剖宫产、早产、新生儿低血糖等不良结局的发生率。NDDG、IADPSG标准诊断的妊娠期高血糖和糖代谢正常孕妇巨大儿的发生率分别为8.4%(108/1293)、11.3%(241/2138)和6.7%(835/12403);LGA的发生率分别为9.7%(125/1293)、11.7%(250/2138)和5.5%(687/12403);剖宫产率分别为59.0%(763/1293)、60.4%(1291/2138)和51.6%(6397/12403);早产率分别为11.4%(147/1293)、9.5%(203/2138)和6.3%(777/12403);新生儿低血糖发生率分别为2.6%(33/1293)、2.2%(46/2138)和0.7%(89/12403)。(3)血糖控制方法:按NDDG标准诊断的妊娠期高血糖孕妇中71.3%(922/1293)可以通过单纯饮食控制达到血糖控制满意。结论与NDDG标准比较,IADPSG标准诊断的妊娠期高血糖发生率将明显增加,如果未进行管理其围产期并发症也明显增加;提示在我国采用IADPSG标准更适宜。
Objective To investigate the relationship between gestational hyperglycemia and adverse pregnancy outcomes and find out the optimum diagnostic criteria of gestational diabetes mellitus in China. Methods A retrospective population-based study of 14 593 pregnant women, who delivered between Jan. 2005 and Dec. 2009 and accepted the gestational diabetes mellitus ( GDM ) screening and diagnosis was performed. The prevalence of gestational hyperglycemia according to different criteria was calculated, and the incidence of adverse pregnant outcomes relation to gestational hyperglycemia according to different criteria was analyzed. Results ( 1 ) According to National Diabetes Data Group (NDDG) criteria and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the prevalence of gestational hyperglycemia that intervention required was 8.9% (1293/14 593 ) and 14.7% (2138/14 593 ) respectively; the prevalence of gestational hyperglycemia differed significantly between NDDG and IADPSG criteria ( P 〈 0. 05 ). ( 2 ) The prevalence of macrosomia, large for gestational ages ( LGA), cesarean section, preterm birth and neonatal hypoglycemia etc would increase in gestational glucose metabolic disorders according to any criteria. The prevalence of the complications in gestational hyperglycemia according to NDDG criteria, IADPSG criteria and the patients with normal glucose metabolism is as follows, macrosomia: 8.4% (108/1293), 11.3% (241/2138) and 6.7% ( 835/12 403 ) ; LGA: 9. 7% ( 125/1293 ), 11.7% (250/2138) and 5.5% (687/12 403) ; cesarean section : 59.0% ( 763/1293 ), 60.4% ( 1291/2138 ) and 51.6% ( 6397/12 403) ; preterm birth: 11.4% ( 147/1293 ), 9. 5% ( 203/2138 ) and 6. 3% ( 777/ 12 403) ; neonatal hypoglycemia: 2. 6% ( 33/1293 ), 2. 2% (46/2138) and 0. 7% ( 89/12 403 ). ( 3 ) About 71.3% (922/1293) of the gestational hyperglycemia according to NDDG criteria could be well control only by diet control. Conclusion The prevalence of perinatal complications would increase in gestational hyperglycemia that achieved IADPSG criteria without intervention, so IADPSG criteria is reasonable in China.
出处
《中华妇产科杂志》
CAS
CSCD
北大核心
2011年第8期578-581,共4页
Chinese Journal of Obstetrics and Gynecology
关键词
糖尿病
妊娠
诊断
参考标准
Diabetes,gestational
Diagnosis
Reference standards