妊娠期糖尿病对母婴影响的临床分析

Clinical Analysis on the Effect of Gestational Diabetes Mellitus on Mothers and Infants

目的探讨妊娠期糖尿病(GDM)对围产期母婴的影响及危害程度,为进一步加强GDM围产期管理,制定有效干预措施提供重要的临床根据。方法 2010—2011年在我院早孕检查、系统管理并住院分娩的孕产妇,采取分组对照比较方法,分别分为GDM、糖尿病合并妊娠和无妊娠糖尿病三组,对三组孕产妇进行对照比较、分析,结果采用统计学χ2检验进行显著性判断。结果 GDM孕产妇产科并发症发生率、剖宫产率及围产儿并发症发生率均明显高于无妊娠糖尿病组,尤其是妊娠高血压疾病(HDP)发病率增加四倍多及围产儿死亡率增加近四倍(P均<0.001),对母婴危害显著增大。结论由于妊娠期糖代谢的生理变化,使有遗传倾向的妇女容易发生耐糖功能减退,从而出现糖尿病。因此,加强孕产妇系统、规范管理和监测工作,对孕妇进行早期的糖筛查,根据糖尿病的发病年龄、病程、是否存在血管合并症及器官受累等情况进行分期,有助于估计病情的严重程度及预后。孕期应用胰岛素控制血糖,密切监测胎儿,适时终止妊娠可获得良好的母婴结局。

OBJECTIVE To investigate the gestational diabetes on and damage degree of influence of perinatal, in order to further strengthen the GDM perinatal management, establish effective intervention measures to provide important clinical references for effective intervention measure. METHODS From 2010 to 2011 in our hospital pregnancy examination, system management and hospital delivery of maternal, adopts comparative method were divided into group control, gestational diabetes, diabetes in pregnancy and without GDM groups were compared, the results using statistical analysis, χ2 test for significance judgment. RESULTS GDM maternal obstetric complications, cesarean section rate and perinatal complication rates were significantly higher than those without diabetes in pregnancy group, especially of pregnancy induced hypertension （HDP） incidence rate increased more than 4 times and the perinatal mortality rate increased nearly 4 times（P〈0.001）, maternal and infant harm to significant increase. CONCLUSIONS The physiological changes due to gestational carbohydrate metabolism, make women genetically predisposed to glucose tolerance impairment, and diabetes. Therefore, strengthening the maternal system, standardized management, monitoring of glucose screening, early pregnant women, according to the age of onset of diabetes, duration, presence of vascular complications, organ involvement were staging, contribute to the severity and prognosis of the disease. Control of blood glucose, insulin close pregnancy fetal monitoring, timely termination of pregnancy can obtain good maternal and neonatal outcomes.