妊娠期糖尿病新诊断标准应用对妊娠结局的影响

Influence of new diagnostic criteria for GDM on pregnancy outcomes

目的探讨妊娠期糖尿病新诊断标准在临床应用中对母儿妊娠结局的影响。方法回顾性对比分析清华大学玉泉医院2011至2012年2 000例孕妇分别应用新旧诊断标准后其妊娠结局改变情况。结果①妊娠期糖尿病(GDM)检出率由旧标准6.60%升高到新标准15.50%;②新标准组妊娠期高血压、羊水过多、早产、巨大儿、胎儿窘迫、新生儿低血糖及剖宫产率均显著低于旧标准组,且差异有统计学意义(x～2值分别为4.475、4.546、6.650、7.992、15.442、16.563、16.733,均P<0.05),而两组胎膜早破、胎儿生长受限及新生儿窒息差异无统计学意义(x～2值分别为1.657、2.168、2.582,均P>0.05);③观察组和正常组分别与研究组比较,母体并发症、胎儿并发症、新生儿并发症和剖宫产发生率均明显降低,其差异均有统计学意义(均P<0.05)。结论新GDM诊断标准应用后增加了GDM检出率,使更多的GDM孕妇被及时诊断并给予临床干预,从而降低母儿并发症及剖宫产率,对改善母儿妊娠结局具有重要意义。

Objective To investigate the influence of new diagnostic criteria for gestational diabetes mellitus （ GDM ） on pregnancy outcomes.Methods Retrospective analysis was conducted to review and compare the changes of pregnancy outcomes of 2 000 women diagnosed with old and new diagnostic criteria for GDM respectively in the period of 2011 to 2012 in Yuquan Hospital Affiliated to Tsinghua University.Results The detection rate of GDM increased from 6.60%with old diagnostic criteria to 15.50% according to new criterion . The rates of hypertensive disorders complicating pregnancy , polyhydramnios, premature delivery, macrosomia, fetal distress, neonatal hypoglycemia and cesarean section were significantly lower in the group diagnosed with new criteria than in the group with old criteria （χ^2 value was 4.475, 4.546, 6.650, 7.992, 15.442, 16.563 and 16.733, respectively, all P〈0.05）, but there were no significance differences in the rates of premature rupture of membrane , fetal growth restriction and neonatal asphyxia （χ^2 value was 1.657, 2.168 and 2.582, respectively, all P〉0.05）.Compared with study group, there were significant differences in the rate of maternal complication , complication of newborn, complication of fetal and cesarean section in observation group and in control group （all P〈0.05）.Conclusion The detection rate of GDM is increased by applying new diagnostic criteria , and more pregnant women of GDM are timely diagnosed and treated, which can reduce the incidence of complications of mother and infant and the rate of cesarean section and then improve maternal and neonatal outcomes of pregnancy .