规范化诊疗干预妊娠期糖尿病的结局观察

Observe the Outcome of Gestational Diabetes Underwent the Standardized Diagnosis and Treatment

目的探讨规范化诊疗干预妊娠期糖尿病后对其结局的影响。方法2010-01-2011-11在本院分娩的符合IADPSG诊断标准而不符合NDDG诊断标准确诊的308例GDM孕妇未给予规范化诊疗干预作未治疗组，2011-12-2012-12在本院分娩的符合IADPSG诊断标准而不符合NDDG诊断标准确诊的195例GDM孕妇给予规范化诊疗干预作为治疗组，以同期我院分娩的按照IADPSG诊断标准糖代谢正常的4509例孕妇为对照组。比较治疗组与未治疗组、治疗组与对照组间的不良妊娠结局及产后随访糖脂代谢异常的差别。结果2010-01-2011-11按照NDDG诊断标准GDM发生率4．47％，2011-12-2012-12按照IADPSG诊断标准GDM发生率13．84％，两组发病率有统计学差异（P〈0．05）。308例未治疗组妊娠结局妊娠期高血压疾病、胎儿宫内窘迫、巨大胎儿、新生儿低血糖、剖宫产率分别为12．67％、22．08％、14．29％、6．49％、73．70％，均明显高于治疗组，有统计学差异（P〈0．05）。两组GDM孕妇羊水过多、产后大出血无统计学差异（P〉0．05）。治疗组妊娠结局与对照组比较无统计学差异（P〉0．05）。产后随访率治疗组为87．01％，未治疗组为13．6％，有统计学差异（P〈0．05）。产后糖脂代谢异常发生率治疗组与未治疗组有统计学差异（P〈0．05），治疗组与对照组比较无统计学差异（P〉0．05）。结论规范化诊断妊娠期糖尿病，更多的GDM孕妇被诊断，对其进行规范化干预，即可有效改善不良妊娠结局及产后糖脂代谢异常。

Objective To explore the effects on outcomes in gestational diabetes mellitus （GDM） women underwent standardized diagnosis and treatment. Methods In our hospital fromJanuary 2010 to November 2011 308 cases of preg- nant women diagnosed GDM according to IADPSG but not with NDDG diagnostic criteria did not give a standardized man- agement treatment as ＂no treatment group＂, from December 2011 to December 2012 195 cases diagnosed according to IADPSG but not with NDDG diagnostic criteria did give a standardized management treatment as ＂treatment group＂, while 4509 cases according to IADPSG diagnosis standard without abnormal glucose metabolism during the same period as control group. Observed their difference of poor pregnancy outcome and glucose and lipid metabolism abnormality after childbirth. Results From January 2010 to November 2011 the incidence of GDM was 4. 47%, while from December 2011 to December 2012 the incidence of GDM was 13.84%, The two groups have significant difference incidence （P 〈 0. 05）. The poor pregnancy outcome in no treatment group were significantly higher than those in the treatment group, there was statistically significant difference （ P 〈 0. 05 ）. The two group of GDM pregnant women hydramnios, postpartum hemorrhage showed no significant difference （ P 〉 0.05 ）. Compared the treatment group with the control group the out- comes had no significant difference （P 〉 0. 05）. Conclusions With standardized diagnosis of gestational diabetes, there were more pregnant women diagnosised. Given standardized intervention to them would improve pregnancy outcome andreduce glucose and lipid metabolism abnormality after child- birth.