妊娠期糖尿病终止妊娠的时机选择

Timing of termination of pregnancy in patients with gestational diabetes

目的探讨妊娠期糖尿病(GDM)终止妊娠的时机选择。方法收集2019年1月至2020年12月于慈溪市人民医院就诊的246例GDM患者的临床资料,其中A组(37~38+6周)、B组(39~40周)及C组(>40周)各82例。所有GDM患者均进行运动指导,按照标准体重计算食物总热量和不同食物的比重进行饮食调节;监测患者血糖水平,必要时皮下注射胰岛素。比较3组剖宫产情况、妊娠结局和新生儿结局情况。结果A组和B组的剖宫产率均低于C组(均P<0.05),而A组与B组之间差异无统计学意义(P>0.05)。A组和B组的妊娠期高血压和羊水过多发生率均低于C组(均P<0.05),而A组与B组之间差异均无统计学意义(均P>0.05)。3组产后出血发生率比较,差异无统计学意义(P>0.05)。A组和B组的巨大儿和新生儿低血糖发生率均低于C组(均P<0.05);B组和C组的新生儿呼吸窘迫综合征和新生儿窒息发生率均低于A组(均P<0.05)。结论GDM患者在严格控制血糖基础上,于妊娠39~40周终止妊娠可明显降低不良妊娠结局和不良新生儿结局。

Objective To explore the timing of termination of pregnancy in patients with gestational diabetes mellitus(GDM).Methods A total of 246 patients with GDM admitted in Cixi People's Hospital from January 2019 to December 2020 were enrolled in the study.Patients were randomly divided into 3 groups with 82 cases in each group:the pregnancy was terminated at 37-38 weeks(group A),39-40 weeks(group B)and>40 weeks(group C),respectively.All GDM patients were given exercise instruction,diet was adjusted and blood sugar level was controlled.The rate of cesarean section,pregnancy outcome and neonatal outcome were compared among three groups.Results The rate of cesarean section in group A and group B was lower than that in group C(P<0.05),while there was no significant difference between group A and group B(P<0.05).The incidences of gestational hypertension and polyhydramnios in group A and group B were lower than that in group C(P<0.05),while there was no significant difference between group A and group B(P<0.05).There was no significant difference in the incidence of postpartum hemorrhage among the three groups(P>0.05).The incidence of macrosomia and neonatal hypoglycemia in group A and group B was lower than that in group C(P<0.05).The incidence of neonatal respiratory distress syndrome and neonatal asphyxia in group B and group C was lower than that in group A(P<0.05),and the incidence of neonatal hypoglycemia in group B was lower than that in group C(P<0.05).Conclusion For patients with GDM,strict control of blood glucose level,termination of pregnancy at 39-40 weeks of gestation can significantly improve the pregnancy outcomes and neonatal outcomes.