妊娠期糖尿病患者终止妊娠时机与新生儿结局的关系

Relationship between pregnancy termination timing and neonatal outcomes in patients with gestational diabetes

目的探讨妊娠期糖尿病（GDM）患者终止妊娠时机与新生儿结局的关系。方法回顾性分析该院2014年7月至2016年7月收治的120例GDM患者的临床资料,总结不同孕期终止妊娠对新生儿结局产生的影响。结果 120例GDM患者中,合并妊娠期高血压26例（21.67%）、HELLP综合征17例（14.17%）,发生胎膜早破18例（15.00%）、羊水过多11例（9.17%）、早产43例（35.83%）;GDM孕妇在妊娠37~〈40周时终止妊娠,围生儿死亡及新生儿患病显著低于妊娠28~〈37周组和大于或等于40周组,差异均有统计学意义（P〈0.05）;妊娠37~〈40周组巨大儿发生率显著高于28~〈37周及大于或等于40周,而大于或等于40周终止妊娠的新生儿发病率显著高于妊娠37~〈40周组,差异均有统计学意义（P〈0.05）;血糖控制满意组围生儿死亡、巨大儿发生率及新生儿患病率显著低于血糖控制不满意组,差异均有统计学意义（P〈0.05）。结论 GDM终止妊娠的最佳时机为妊娠37~〈40周,将血糖水平控制在正常范围是治疗GDM的关键,也是减少母体并发症发生率、新生儿患病率及死亡率的主要因素。

Objective To investigate the relationship between pregnancy termination timing and neonatal outcomes in the patients with gestational diabetes mellitus（GDM）. Methods The clinical data of 120 patients with GDM in our hospital from July 2014 to July 2016 were retrospectively analyzed. The influence of pregnancy termination at different pregnant stages on the neonatal outcomes was summarized. Results Among 120 cases of GDM,there were 26 cases（21.67%） of complicating hypertension,17 cases（14.17%） of complicating HELLP syndrome,18 cases（15.00%）of premature rupture of fetal membranes,11 cases（9.17%）of polyhydramnios and 43 cases（35.83%） of premature delivery;the incidence rates of perinatal death and neonatal morbidity in terminating pregnancy at 37-40 pregnant weeks were significantly lower than those at 28-37 weeks mortality and ≥40 weeks,the difference was statistically significant（P〈0.05）;the macrosomia occurrence rate in the 37-40 gestational weeks group was significantly higher than that in the 28-37 gestational weeks group and ≥ 40 gestational weeks group,while neonatal morbidity incidence in terminating pregnancy at ≥40 gestational weeks was significantly higher than that in the 37-40 gestational weeks group,the difference was statistically significant（P〈0.05）;the occurrence rates of perinatal death,macrosomia and neonatal morbidity in the blood glucose control satisfaction group were significantly lower than those in the blood glucose control unsatisfaction group,the difference was statistically significant（P〈0.05）. Conclusion The optimal terminating pregnancy timing in GDM patients is 37-40 gestational weeks. Controlling blood glucose level at normal range is the key to treat GDM and is also the main factor for decreasing the occurrence rate of maternal complications,neonatal morbidity and death rate.