高龄孕妇糖耐量血糖特征及其管理对妊娠结局的影响

Effects of the OGTT characteristics and blood glucose management on pregnancy outcomes in elderly pregnant women

目的探讨不同阶段高龄孕妇OGTT血糖特征、GDM检出率及孕期BG管理对母婴结局的影响。方法选取2017年1~6月于福建省妇幼保健院分娩的908名高龄孕妇临床资料,按照年龄分为35~39岁组(n=721)和≥40岁组(n=187),比较两组75 g OGTT血糖特征。按照是否诊断GDM分为GDM组(n=253)和非GDM组(non-GDM,n=655)。GDM患者采取健康教育、饮食指导、运动、BG监测及药物治疗等综合管理模式,根据BG控制情况分为BG控制良好亚组(well-GDM,n=220)和控制欠佳亚组(bad-GDM,n=33)。分析BG管理对妊娠结局的影响。结果908名高龄孕妇GDM检出率为27.86%。≥40岁组75 g OGTT不同时间点BG值、时间-血糖曲线的AUC、AUC≥13 mmol/(L·h)比例、GDM检出率、单纯FBG异常比例高于35~39岁组(P<0.05)。bad-GDM亚组妊娠期高血压病、早产、羊水过多、巨大儿、新生儿高胆红素血症发生率均高于well-GDM亚组(P<0.05)。结论随着高龄孕妇年龄增加,GDM检出率增加,应重视高龄孕妇GDM防治。加强GDM孕期规范化管理,控制BG水平,可影响母婴妊娠结局。

Objective To explore the OGTT characteristics,the detection rate of GDM and the effect of blood glucose management during gestation on pregnancy outcomes in elderly pregnant women(≥35 years old).Methods The clinical data of 908 elderly pregnant women who delivered in Fujian Maternity and Child Health Hospital were collected in this study from January 2017 to June 2017.All the subjects were divided into 35~39 years old group(n=721)and≥40 years old group(n=187).The OGTT characteristics were compared between the two groups.According to whether GDM was diagnosed or not,they were divided into GDM group(n=253)and non-GDM group(non-GDM,n=655).Women with GDM adopted comprehensive management models such as health education,diet guidance,exercise,blood glucose monitoring and drug therapy.According to the blood glucose control,they were further divided into well-GDM(n=220)and bad-GDM(n=33).The effect of blood glucose management on pregnancy outcomes was analyzed.Results The detection rate of GDM was 27.86%in elderly pregnant women.The GDM detection rate,blood glucose of 75 g OGTT,AUC of time glucose curve,proportion of AUC≥13 mmol/(L·h)and only fasting blood glucose abnormality were higher in≥40 years old group than in 35~39 years old group.The prevalence of gestational hypertension,preterm birth,polyhydramnios,macrosomia and neonatal hyperbilirubinemia were higher in bad-GDM subgroup than in well-GDM subgroup(P<0.05).Conclusion With aging of elderly pregnant women,the detection rate of GDM is increasing.Attention should be paid to the prevention and treatment of GDM in the elderly pregnant women.We should strengthen the standardized management in GDM and control blood glucose to improve the pregnancy outcomes.