1993年至2019年孕前糖尿病诊治情况的回顾性分析

Retrospective analysis of prevalence and therapy of pregestational diabetes mellitus from 1993 to 2019

目的:分析不同类型孕前糖尿病的发病情况、治疗情况和母儿结局。方法:收集1993年至2019年于中山大学附属第一医院分娩的1 846名单胎孕妇资料,其中923例孕前糖尿病孕妇分为孕前诊断组(210例)和孕期诊断组(713例),另923名孕妇为对照组。比较3组的一般资料、妊娠期治疗情况、妊娠结局、母体并发症和围产儿并发症。结果:(1)1993年至2019年,孕前糖尿病总发病率从0.4%(8/2 078)升至2.1%(77/3 621),其中孕前诊断比例从0.1%(3/2 078)升至0.7%(24/3 621),孕期诊断比例从0.2%(5/2 078)升至1.5%(53/3 621)。(2)对照组、孕前诊断组和孕期诊断组肥胖症比例[1.3%(7/555)对5.7%(8/140)对3.2%(13/411), P<0.01]、早产比例[0.9%(8/923)对17.6%(37/210)对14.3%(102/713), P<0.01]、剖宫产比例[49.2%(442/898)对70.4%(131/186)对74.6%(524/702), P<0.01]、妊娠期高血压疾病发生率[2.3%(21/923)对12.4%(26/210)对13.2%(94/713), P<0.01];组间两两比较,对照组与孕前诊断组、孕期诊断组差异均有统计学意义( P<0.05或 P<0.01)。(3)孕前诊断组和孕期诊断组孕期需要胰岛素治疗的比例[71.9%(151/210)对30.0%(214/713), P<0.01]、分娩前HbA 1C[(6.03±0.73)%对(5.87±0.86)%, P<0.01];2组巨大儿、新生儿窒息、转科、低血糖和呼吸窘迫综合症发生比例差异无统计学意义,而与对照组相比差异均有统计学意义( P<0.01)。 结论:27年间,总体及各型孕前糖尿病的发病率均呈上升趋势。孕前诊断者的糖代谢紊乱较孕期诊断者更为严峻,虽两者间多数母儿并发症的发生比例无显著差异,但较血糖正常的孕妇发生风险更高。因此,应当重视孕期诊断的孕前糖尿病患者的基础体重及孕期血糖管理。

Objective To analyze the prevalence,treatment,and maternal and neonatal outcomes of different kinds of pregestational diabetes mellitus.Methods A total of 1846 medical records of singleton pregnancy in the First Affiliated Hospital,Sun Yat-sen University from 1993 to 2019 were collected.They were divided into three groups,including 210 pregestational diabetes diagnosed before pregnancy,713 pregestational diabetes diagnosed during pregnancy,and 923 controls.The general data,treatment conditions,complications,as well as maternal and neonatal outcomes among three groups were compared.Results(1)From 1993 to 2019,general incidence of pregestational diabetes has been risen from 0.4%(8/2078)to 2.1%(77/3621),diagnosed before pregnancy has risen from 0.1%(3/2078)to 0.7%(24/3621),and diagnosed during pregnancy has risen from 0.2%(5/2078)to 1.5%(53/3621).(2)Among groups of controls,pregestational diabetes diagnosed before pregnancy and during pregnancy,pregestational obesity percentages were 1.3%(7/555),5.7%(8/140),and 3.2%(13/411),preterm delievery percentages were 0.9%(8/923),17.6%(37/210),and 14.3%(102/713),cesarean percentages were 49.2%(442/898),70.4%(131/186),and 74.6%(524/702),the proportions of hypertensive disease in pregnancy were 2.3%(21/923),12.4%(26/210),and 13.2%(94/713),all with P<0.01.Pairwise comparisons between controls and pregestational diabetes diagnosed before pregnancy,controls and pregestational diabetes diagnosed during pregnancy,all the differences were statistically significant(P<0.05 or P<0.01).(3)Between groups of pregestational diabetes diagnosed before and during pregnancy,insulin therapy percentage was 71.9%(151/210)and 30.0%(214/713,P<0.01).Mean HbA1C before delievery was(6.03±0.73)%and(5.87±0.86)%(P<0.01).The differences in percentages of macrosomia,neonatal asphyxia,admission,hypoglycemia,and respiratory distress syndrome were not statistically significant,and these differences of two pregestational diabetes groups were all statistically significant when comparing with the control group(P<0.01).Conclusions General incidence and incidence of all type of pregestational diabetes have been arising in past 27 years.Patients of pregestational diabetes diagnosed before pregnancy had worse glycemia conditions than pregestational diabetes diagnosed during pregnancy,although the percentages of most maternal and neonatal complications were similar,they were higher comparing with non pregestational diabetes gravida.Accordingly,the glucose and weight management of pregestational diabetes diagnosed during pregnancy should be emphasized.