建立社区妊娠期糖尿病的管理模式

Effective administration model for gestational diabetes mellitus in the community

目的:探讨社区妊娠期糖尿病(GDM)的有效管理模式。方法:对2011年9月1日至2012年8月31日期间在广州市海珠区一所三甲综合医院、一所二甲专科医院接受75g口服葡萄糖耐量试验(OGTT)的20岁以上常驻孕妇4 713例做前瞻性GDM研究,筛查出533例GDM孕妇,通过社区、医院之间相互协作、双向转诊,其中在综合医院分娩的198例为A组,在专科医院分娩的335例为B组,同批随机抽取血糖正常的健康孕妇198例为C组。结果:研究期间该区域GDM的发生率为11.3%。三组孕妇分娩年龄、分娩孕周及OGTT结果比较差异有统计学意义(P<0.05),且随着分娩年龄的增加,孕妇血糖值呈上升趋势,而分娩孕周呈下降趋势。三组孕妇在羊水过多、妊娠期高血压疾病、早产、巨大儿、胎儿生长受限及新生儿窒息发生率方面比较,差异均无统计学意义(P>0.05);在产后出血及剖宫产发生率方面差异有统计学意义,B组的产后出血发生率较高(χ2=7.156,v=2,P=0.028),A组的剖宫产发生率较高(χ2=63.592,v=2,P=0.000)。结论:建立社区妊娠期糖尿病的有效管理模式,可控制GDM相关并发症的发生。

Objective To investigate the effective administration model for gestational diabetes mellitus （GDM） in the community. Methods In a prospective study, the 75 g oral glucose tolerance test （OGTT） was performed in 4 713 resident pregnant women over 20 years old who received antenatal care in a general hospital or a special hospital from Sep. 2011 to Aug. 2012. Five hundred and thirty-three pregnant women were diagnosed as GDM, 198 patients who labored in a general hospital were enrolled in thegroup A, and the rest who labored in a special hospital were enrolled in the group B. 198 cases with non-GDM were enrolled in the group C. Results The incidence of GDM during this study period was 11.3%. The maternal age, gestationl weeks and OGTY results of patients in the three groups were significantly different （P 〈 0.05）. With the increase of maternal age of pregnant women, the blood glucose increased while the gestationl weeks descreased. No significant differencees were shown in prevalence of polyhydramnios, hypertensive disorder complicating pregnancy, premature labor, macrosomia , fetal growth restriction and neonatal asphyxia among the three groups （P 〉 0.05）. However, significant differences were found in the incidence of postpartum hemorrhage and cesarean section. The incidence of postpartum hemorrhage increased significantly in the patients of group B（X^2 = 7.156, v = 2, P = 0.028）. The incidence of cesarean section increased significantly in the patients of group A（X^2 = 63.592, v = 2, P = 0.000）. Conclusion Establishing an effective administration model for gestational diabetes mellitus in the community could control the incidence of GDM associated complications.