妊娠糖尿病早期识别的必要性

Necessity to recognize early gestational diabetes mellitus

孕期轻度的高血糖(低于非妊娠糖尿病的血糖数值)和不良的妊娠结局呈线性相关。但是由于以下几个因素,不良妊娠结局(HAPO)研究是基于孕晚期的血糖与HAPO关系的研究;非糖尿病妊娠早期血糖数据有限;血糖在整个孕期变化较大,我们不能在整个孕期应用同样诊断切点。尽管对孕早期的妊娠糖尿病诊断标准存在争议,但已有研究显示孕早期的血糖水平预示了HAPO。悉尼阿尔弗雷德王子医院糖尿病中心研究显示孕早期的高血糖即使经过血糖控制仍然没有降低HAPO的风险。或许这与胎儿血糖偷窃现象,新生儿高胰岛素血症缓解了母亲的高血糖等因素有关。目前尚没有有效的研究提示血糖干预可以减少HAPO。需要关注妊娠期的高血糖。了解孕早期高血糖和HAPO的关系。

There is a linear association between glucose in early gestational diabetes mellitus（GDM）and outcomes.But we can not use the same criteria in early pregnancy,because glucose thresholds based on relationships in later pregnancy;very little data are available on glucose in normal pregnancy;glucose varies over trimesters in normal pregnancy.Despite uncertainty over currently recommended diagnostic criteria for early GDM,several studies showed that glucose levels in early pregnancy predicted pregnancy complications.Some evidences supported for poor pregnancy outcomes even in treatment.Maybe this is associated with fetal glucose steal phenomenon,fetal hyperinsulinemia,potentially attenuate maternal glucose level.As there is limited evidence that intervention improves pregnancy outcomes,it is time to recognize early GDM.