妊娠期糖尿病早期诊断及治疗对妊娠结局的影响

Effect of Early Diagnosis and Treatment of Gestational Diabetes Mellitus on the Outcome of Pregnancy

目的比较妊娠期糖尿病(GDM)早期诊断,干预治疗与中晚期诊断,干预治疗对妊娠结局的影响。方法采用前瞻性的研究方法,对2006年4月～2009年11月来笔者医院就诊的孕妇,2417人作为研究对象,首次产前检查时,进行糖筛查,如初次筛查无异常,于妊娠24～28周复查。24周以前确诊为GDM的为A组26例,24～28周确诊为GDM的为B组69例。对两组患者采用饮食控制,运动治疗和胰岛素等治疗干预,并对两组孕妇的母儿结局进行分析。结果 A组的血糖值和胰岛素使用率较B组明显升高,差异有显著性(P<0.05),A组的妊娠期高血压疾病和新生儿低血糖发生率较B组高,差异有显著性(P<0.05)。结论早发型GDM孕妇是高风险人群,其妊娠并发症及母儿围生结局较差,早期糖筛查有利于早期发现部分GDM,但因社会资源消耗较大,是否应对所有的孕妇进行早期糖筛查还有待进一步研究。

Objective To compare early diagnosis and treatment with middle - late diagnosis and treatment of gestational diabetes mellitus （GDM） effect on the pregnancy outcome. Methods with prospective research method,2417 pregnant women who visited our hos- pital from April 2006 to November 2009 were chose to attend our study. They did the glucose screening in the first prenatal visit. If glucose screening was normal,they would recheck in 24 - 28 gestational week. 26 patients diagnosed with GDM before 24 weeks were divided to group A and 69 patients diagnosed with GDM during 24 - 28 weeks were divided to group B. Two groups were treated with diet control,ex- ercise and insulin treatment,then the effcet of pregnant women and fetal were analyzed. Results Glucose level and insulin therapy inci- dence in group A was significantly higher than in group B ,the difference was significant（ P 〈 0.05 ）. Pregnancy hypertensive and hypogly- cemia of newborn in group A were more frequent than group B, and the difference was significant （ P 〈 0.05 ）. Conclusion Pregnant women with early - onset GDM were high - risk groups, had higher complications of pregnancy and poorer maternal and fetal outcome. Early sugar screening was helpful to discover GDM,but social resource consumption was large. Whether to cope all pregnant women with early sugar screening still need further study.