孕前糖尿病和妊娠期糖尿病患者的母婴结局分析

Analysis on maternal-infant outcomes of pregestational diabetes mellitus and gestational diabetes mellitus

目的观察孕前糖尿病和妊娠期糖尿病患者的母婴结局。方法选取2013年1月-2015年5月在该院营养门诊就诊并住院分娩的妊娠合并糖尿病患者879例进行回顾性分析,分为孕前糖尿病(PGDM,68例)和妊娠期糖尿病(GDM,811例)两组,对比分析母婴结局情况。结果本研究中妊娠期高血压疾病的总发病率为5.2%,PGDM患者妊娠期高血压疾病的发病率(16.2%)显著高于GDM患者(4.3%)(P<0.05)。通过营养治疗,妊娠合并糖尿病巨大儿的发病率为6.5%,新生儿黄疸的发病率为5.0%。巨大儿的发病率、新生儿黄疸的发病率PGDM患者与GDM患者比较差异无统计学意义(P>0.05)。PGDM患者新生儿低血糖发病率略高于GDM患者,但差异无统计学意义(P>0.05)。PGDM患者新生儿肺炎和早产儿的发病率(19.1%、16.2%)显著高于GDM患者(9.5%、4.8%)(P<0.05)。结论 PGDM患者的母婴并发症比GDM严重,应在孕期指导糖尿病患者饮食和运动相结合,并配合使用胰岛素,保持血糖平稳,降低母婴并发症的发病率。

Objective To observe maternal-infant outcomes of pregestational diabetes mellitus （PGDM） and gestational diabetes mel- litus （GDM） . Methods A total of 879 pregnant women with GDM from January 2013 to May 2015 in the hospital were analyzed retrospec- tively. Among these cases, there were 68 women with PGDM and 811 women with GDM. The maternal-infant outcomes were compared be- tween the two groups. Results The total incidence rate of hypertensive disorder complicating pregnancy （HDCP） was 5.2%. The incidence rate of HDCP in PGDM group was 16. 2%, which was statistically significantly higher than that in GDM group （4. 3% ） （P〈0. 05 ） . Alter nutritional therapy, the incidence rate of macrosomia was 6. 5% , and the incidence rate of neonatal jaundice was 5.0%. There was no statis- tically significant difference in the incidence rates of macrosomia and neonatal jaundice between the two groups （ P〉0. 05 ） . The incidence rate of neonatal hypoglycemia in PGDM group was slightly higher than that in GDM group without statistically significant difference （ P〉 0. 05 ） . The incidence rates of neonatal pneumonia and premature birth in PGDM group were 19.1% and 16. 2%, respectively, which were respectively statistically significantly higher than those in GDM group （9.5% and 4. 8%, respectively） （P〈0. 05 ） . Conclusion The ma- ternal and infantile complications of PGDM patients are more severer than those of GDM patients. In order to reduce the incidence rates of maternal and infantile complications, the clinicians should supervise and urge GDM patients to combine diet with exercise and insulin to maintain glucostasis.