胰岛素对不同孕周妊娠合并糖尿病患者的安全性研究

Effects of Insulin on Maternal and Child Outcomes and Safety in Women with Gestational Diabetes Mellitus at Different Gestational Weeks

目的探讨不同孕周使用胰岛素对妊娠合并糖尿病孕妇的母婴结局及安全性。方法选择妊娠合并糖尿病(均为GDM)且在本院分娩的孕产妇186例。以孕周<32周时开始应用胰岛素治疗的孕产妇90例为早期组,孕周≥32周时开始应用胰岛素治疗的孕产妇96例为晚期组,两组孕产妇在胰岛素治疗的基础上进行适量运动及饮食控制。对比分析两组孕产妇血糖变化及妊娠结局。结果分娩时,早期组空腹血糖(FPG)及餐后2 h血糖(2h PBG)值明显低于晚期组,差异有统计学意义(P<0.05);两组剖宫产发生率差异无统计学意义(P>0.05);早期组产后出血及感染、妊娠高血压、新生儿低血糖、高胆红素血症、新生儿窒息、巨大儿发生率均明显低于晚期组,差异有统计学意义(P<0.05);早期组新生儿1分钟Apgar评分明显高于晚期组,差异有统计学意义(P<0.05);早期组发生低血糖3例,不良反应发生率为33.33%,晚期组发生低血糖4例,不良反应发生率为41.67%,两组比较,差异无统计学意义(P>0.05)。结论 GDM患者及时发现并及早给予胰岛素治疗可以有效控制孕产妇血糖水平,也可以改善母婴不良结局,有较高的安全性。

OBJECTIVE To investigate the effects of different gestational weeks of insulin use on maternal and child outcomes and safety in women with gestational diabetes mellitus. METHODS 186 pregnant women with diabetes mellitus（ GDM） and pregnant women in Angang General hospital were selected,at the gestational weeks less than 32 weeks,90 cases of early pregnant women were treated with insulin,in gestational age over 32 weeks when starting insulin therapy in 96 cases of pregnant women who were late group,two groups of pregnant women were given proper exercise and diet control on the basis of insulin treatment.The changes of blood glucose and pregnancy outcome in two groups were compared and analyzed. RESULTS At birth,the FPG and 2h PBG values in the early group were significantly lower than those in the late group（ P〈0.05）; there was no significant difference in the incidence of caesarean section between the two groups（ P〉0. 05）; the incidence of postpartum hemorrhage and infection,pregnancy induced hypertension,neonatal hypoglycemia,hyperbilirubinemia,giant baby and neonatal asphyxia were significantly lower than those in the advanced group（ P〈0.05）; the 1 minute Apgar score in the early group was significantly higher than that in the late group（ P〈0.05）; there were 3 cases with hypoglycemia in the early stage,and the incidence of adverse reactions was 33.33%,there were 4 cases with hypoglycemia in the late stage group,and the adverse reaction rate was 41. 67%,there was no significant difference between the two groups（ P〉0. 05）.CONCLUSION The patients with GDM can discover the early treatment of insulin and control the blood sugar level effectively,maternal and child outcomes can also be improved,it has higher security.