孕期规范化干预对妊娠期糖尿病患者围生结局及产后3个月糖代谢转归的影响

Effect of standardized intervention during pregnancy on perinatal outcomes and glucose metabolism outcomes at three months after delivery in patients with gestational diabetes mellitus

目的探讨规范化干预治疗对妊娠期糖尿病(GDM)患者围产结局的影响及对产后3个月糖代谢转归的影响。方法选取2013年12月-2015年12月在该院治疗的124例GDM患者为研究对象,分为规范化治疗组(96例)与未规范化治疗组(28例)。回顾性分析两组人群产科并发症与新生儿并发症发生情况,分析产后1周及产后3个月时基本情况与血糖控制情况;探讨产后3个月糖代谢异常的影响因素。结果规范化治疗组剖宫产率、早产与羊水过多发生率、新生儿窒息、巨大儿、新生儿呼吸窘迫、新生儿高胆红素血症发生率均较未规范化治疗组显著降低,差异均有统计学意义(均P<0.05)。产后1周和产后3个月规范化治疗组空腹血糖水平、糖化血红蛋白水平及口服葡萄糖耐量2 h血糖水平均显著低于未规范化治疗组(P<0.05);规范化治疗组糖耐量受损发生率显著低于未规范化治疗组,差异有统计学意义(P<0.05)。孕期规范化治疗、产后母乳喂养及产后膳食干预均有助于糖代谢异常转归为正常水平;高血脂不利于血糖代谢异常的转归。结论 GDM患者孕期规范化治疗能够显著降低围生期母婴并发症,有利于改善妊娠结局、控制产后血糖及糖代谢异常的转归。

Objective To explore the effect of standardized intervention during pregnancy on perinatal outcomes and glucose metabolism outcomes at three months after delivery in patients with gestational diabetes mellitus（ GDM）. Methods A total of 124 patients with GDM treated in the hospital from December 2013 to December 2015 were selected as research object,then they were divided into standardized treatment group（ 96 patients） and non-standardized treatment group（ 28 patients）. Obstetric and neonatal complications in the two groups were analyzed retrospectively. General conditions and blood glucose control conditions at one week and three months after delivery were analyzed. The influencing factors of abnormal glucose metabolism were also analyzed. Results Cesarean section rate,the incidence rates of premature birth,polyhydramnios,neonatal asphyxia,macrosomia,neonatal respiratory distress,and neonatal hyperbilirubinemia in standardized treatment group were statistically significantly lower than those in non-standardized treatment group（ all P〈0. 05）. At one week and three months after delivery,fasting blood glucose level,glycosylated hemoglobin level,and 2-hour postprandial blood glucose level in standardized treatment group were statistically significantly lower than those in non-standardized treatment group（ all P〈0. 05）. The incidence rate of impaired glucose tolerance in standardized treatment group was statistically significantly lower than that in non-standardized treatment group（ P〈0. 05）. Standardized therapy during pregnancy,postpartum breastfeeding and dietary intervention were helpful to return to normal level of glucose metabolism; hyperlipidemia was helpful to outcomes of abnormal blood glucose metabolism. Conclusion Standardized therapy can significantly reduce maternal and neonatal complications during perinatal period,which is helpful to improvement of pregnancy outcomes,control of postpartum blood glucose,and outcomes of abnormal blood glucose metabolism.