广东地区15家医院孕前糖尿病的调查研究

Investigation of pregestational diabetes mellitus in 15 hospitals in Guangdong province

目的调查广东地区15家医院孕前糖尿病（PGDM）的发生率，并分析PGDM孕妇的诊断情况和妊娠结局。 方法收集2016年1至6月于广东地区15家医院进行产前检查并分娩的41 338例孕妇，其中PGDM孕妇195例（PGDM组），并纳入同期195例糖耐量正常的孕妇为对照组。统计PGDM的发生率及诊断情况；比较两组孕妇的一般临床资料、妊娠并发症及母儿结局；并将PGDM孕妇再分为使用胰岛素组（91例）和未使用胰岛素组（104例），比较两亚组孕妇的母儿结局。结果（1）PGDM的发生率：研究期间，15家医院PGDM的发生率为0.472%（195/41 338）；其中孕前诊断PGDM者59例，占30.3%（59/195）；孕期诊断PGDM者136例，占69.7%（136/195）。孕期通过空腹血糖和糖化血红蛋白筛查确诊PGDM者46例，占33.8%（46/136）。（2）一般临床资料：PGDM组孕妇的年龄、孕前体质指数（BMI）、产前BMI、孕次、糖尿病家族史者、既往巨大儿分娩史者的比例及低密度脂蛋白水平，均明显高于对照组（P均〈0.05）。PGDM组与对照组孕妇的糖化血红蛋白水平[分别为（6.3±1.3）%、（5.2±0.4）%]，空腹血糖水平[（6.3±2.3）、（4.8±1.1）mmol/L]，75 g口服糖耐量试验1 h [（12.6±2.9）、（7.1±1.3）mmol/L]、2 h[（12.0±3.0）、（6.4±1.0）mmol/L]结果分别比较，差异均有统计学意义（P均〈0.01）。（3）PGDM组与对照组孕妇的早产率（分别为11.3%、1.0%）、分娩孕周[（37.6±2.3）、（39.2±1.2）周]、剖宫产率（70.8%、29.7%）分别比较，差异均有统计学意义（P均〈0.01）。PGDM组与对照组孕妇新生儿的男/女比例（分别为98/97、111/84）、新生儿出生体质量[（3 159±700）、（3 451±423）g]、新生儿低血糖的发生率（7.7%、2.6%）分别比较，差异均有统计学意义（P均〈0.05）。（4）PGDM孕妇中，使用胰岛素组与未使用胰岛素组的分娩孕周[（36.9±2.9）、（37.9±2.5）周]，新生儿转新生儿ICU率（24.2%、9.6%）分别比较，差异均有统计学意义（P均〈0.01）。结论广东地区15家医院调查的PGDM发生率为0.472%。多数PGDM孕妇于孕期诊断，糖化血红蛋白及空腹血糖水平是良好的筛查PGDM的指标。PGDM孕妇的家族史明显，多孕者更易发病。PGDM孕妇的早产风险增加，新生儿低血糖的发生率增加，若血糖控制不满意再使用胰岛素可能增加新生儿转新生儿ICU率的概率。

ObjectiveTo investigate the morbidity, diagnostic profile and perinatal outcome of pregestational diabetes mellitus （PGDM） in 15 hospitals in Guangdong province.MethodsA total of 41 338 women delivered in the 15 hospitals during the 6 months, 195 women with PGDM （PGDM group） and 195 women with normal glucose test result （control group） were recruited from these tertiary hospitals in Guangdong province from January 2016 to June 2016. The morbidity and diagnostic profile of PGDM were analyzed. The complications during pregnancy and perinatal outcomes were compared between the two groups. In the PGDM group, pregnancy outcomes were analyzed in women who used insulin treatment （n=91） and women who did not （n=104）. Results（1） The incidence of PGDM was 0.472%（195/41 338）. Diabetes mellitus were diagnosed in 59 women （30.3%, 59/195） before pregnancy, and 136 women （69.7%,136/195） were diagnosed as PGDM after conceptions. Forty-six women （33.8%） were diagnosed by fasting glucose and glycohemoglobin （HbA1c） screening. （2） The maternal age, pre-pregnancy body mass index （BMI） , prenatal BMI, percentage of family history of diabetes, incidence of macrosomia, concentration of low density lipoprotein were significantly higher in PGDM group than those in control group （all P〈0.05）. Women in PGDM group had significantly higher HbA1c concentration （（6.3±1.3）% vs （5.2±0.4）%） , fasting glucose [（6.3±2.3） vs （4.8±1.1） mmol/L], oral glucose tolerance test （OGTT） -1 h glucose （（12.6±2.9） vs （7.1±1.3） mmol/L） and OGTT-2 h glucose [（12.0±3.0） vs （6.4±1.0） mmol/L] than those in control group （P〈0.01）. （3） The morbidity of preterm births was significantly higher （11.3% vs 1.0%, P〈0.01）, and the gestational age at delivery in PGDM group was significantly smaller [（37.6±2.3） vs （39.2±1.2） weeks, P〈0.01]. Cesarean delivery rate in the PGDM group （70.8% vs 29.7%） was significantly higher than the control group （P〈0.01）. There was significantly difference between PGDM group and control in the neonatal male/female ratio （98/97 vs 111/84, P=0.033）. The neonatal birth weight in PGDM group was significantly higher （（3 159±700） vs （3 451±423） g, P〈0.01） . And the incidence of neonatal hypoglycemia in the PGDM group was higher than the control group （7.7% vs 2.6%, P=0.036）. （4） In the PGDM group, women who were treated with insulin had a smaller gestational age at delivery [（36.9±2.9） vs （37.9±2.5） weeks, P〈0.01], and the neonates had a higher neonatal ICU （NICU） admission rate （24.2% vs 9.6%, P〈0.01）.ConclusionsThe morbidity of PGDM in the 15 hospitals in Guangdong province is 0.472%. The majority of PGDM was diagnosed during pregnancy; HbA1c and fasting glucose are reliable parameters for PGDM screening. Women with PGDM have obvious family history of diabetes and repeated pregnancy may accelerate the process of diabetes mellitus. Women with PGDM have higher risk for preterm delivery and neonatal hypoglycemia. Unsatisfied glucose control followed by insulin treatment may increase the need for NICU admission.