基于新标准的妊娠期糖尿病发病现状及围生结局

Occurrence status of gestational diabetes mellitus based on new diagnostic criteria and its perinatal outcomes

目的 探讨采用2014新指南诊断标准后妊娠期糖尿病（GDM）的发生现状及围生结局。方法 回顾性分析2012年1-12月于首都医科大学附属北京妇产医院分娩的11 601例产妇的临床资料,根据75 g口服葡萄糖耐量试验结果,按照2014新指南诊断标准（新标准）及以往NDDG的标准（老标准）进行诊断,符合新标准但老标准未诊断的GDM患者为新标准组（1150例）,符合老标准的孕妇为老标准组（537例）,按照两种诊断标准均未诊断为GDM的孕妇为对照组（6120例）。对诊断为GDM的孕妇采取饮食指导结合运动的个性化管理方案,比较分析各组孕产妇及新生儿的围生期结局。结果 按照新标准诊断GDM 1786例,GDM发生率为15.4%,其中590例符合GDM诊断的老标准,老标准GDM发生率仅为5.1%。老标准组GDM孕妇胰岛素使用率（29.8%）明显高于新标准组（13.5%）,差异有高度统计学意义（P〈0.01）。经管理后,老标准组、新标准组孕妇与对照组在子痫前期、胎膜早破、胎儿宫内窘迫、巨大儿、新生儿低血糖、死胎、新生儿窒息的发生率上差异均无统计学意义（均P〉0.05）;老标准组与新标准组妊娠期高血压及早产发生率均高于对照组（P〈0.05或P〈0.01）,但老标准组、新标准组差异无统计学意义（P〉0.05）。老标准组剖宫产率（52.9%）与新标准组（53.3%）比较差异无统计学意义（P〉0.05）,但二者均高于对照组（45.6%）,差异有高度统计学意义（P〈0.01）;三组在产钳助产率上差异无统计学意义（P〉0.05）。结论 2014标准与老标准诊断的GDM经管理后母儿并发症的发生率接近于正常孕妇,但在妊娠期高血压、早产、剖宫产的发生率上仍高于正常孕妇。

Objective To investigate the occurrence status of gestational diabetes mellitus （GDM） diagnosed based on 2014 criteria and its perinatal outcomes. Methods Clinical data of 11 601 pregnant women in Beijing Obstetrics and Gynecology Hospital, Capital Medical University from January to December in 2012 were analyzed retrospectively and patients were divided into three group by 75 g oral glucose tolerance test （OGTF） according to 2014 criteria （new criteria group, 1150 cases） and the national diabetes data group （NDDG） criteria （old criteria group, 537 cases）, and patients were not be diagnosed GDM according to either NDDG criteria or 2014 criteria were set as the control group （6120 cases）. An individual management program including the diet guidance and exercise was taken to treat the GDM pa- tients. The incidence and the perinatal outcomes among three groups were analyzed and compared. Results 1786 preg- nant women were diagnosed GDM based on 2014 criteria and the incidence of GDM was 15.4%, of which 590 cases met NDDG criteria, and the GDM incidence was 5.1%. Insulin usage of the old criteria group （29.8%） was higher thanthat of the new criteria group （13.5%）, the difference was statistically significant （P 〈 0.01）. After criteriaized managements, there were no significant differ- ences among three groups in incidences of preeelamp- sia, premature rupture of membrane, fetal distress, macrosomia, neonatal hypoglycemia, stillbirth and neonatal asphyxia （all P 〉 0.05）. The incidences of gestational hypertension and preterm deliveryin both new criteria group and old criteria group were in-creased significantly than control group （P 〈 0.05 or P 〈 0.01）, but there were no significant difference between new criteria group and old criteria group （P 〉 0.05）. There was no significant difference in the incidence of cesarean section in old criteria group （52.9%） and new criteria group （53.3%） （P 〉 0.05）, and both were higher than that of the control group （P 〈 0.01）. There were no differences in the incidence of forceps delivery among the three groups （P 〉 0.05）. Conclusion After management, incidences of the most maternal and neonatal complications in GDM pregnant women are similar to those of the non-GDM pregnant women regardless of 2014 criteria or NDDG criteria, but the incidences of gestational hypertension, preterm delivery and cesarean section in GDM pregnant women in both two criteria are higher than those of non-GDM pregnant women.