妊娠期血糖异常产后母儿随访分析

Long-term postpartum follow-up in mothers with abnormal glucose level and their children

目的 探讨妊娠期不同程度的血糖异常者产后发生糖尿病 (DM )的高危因素和预防措施 ,以及妊娠期血糖异常对其子女的远期不良影响等。方法 对 1994～ 2 0 0 0年 196例妊娠期血糖异常者进行产后随访 ,其中50 g葡萄糖筛查阳性 (50g阳性 ) 12 3例 ,葡萄糖耐量减低 (IGT) 3 7例 ,妊娠期糖尿病 (GDM ) 3 6例。此 3组人群均进行 75g葡萄糖耐量试验 (OGTT )及血脂检测。对其子女行血糖检测及生长发育水平观察 ,包括测量头围、胸围、身高及体重等。结果 196例随访者中发生IGT、空腹血糖异常 (IFG)、DM共 2 2例 (占 11 2 2 % ) ,其中 50g阳性、IGT、GDM者其产后平均 3年内血糖异常发生率依次为 2 43 %、2 1 62 %、3 0 56% ,后两者与 50 g阳性相比差异有显著性意义 (P <0 0 1) ,其相关因素与产妇高龄 (40 90 % )、肥胖体型 (2 1 2 7% )、孕期血糖控制不良(45 45% )、产后体重显著增加 (40 91% )有关。 14 5例随访子女中虽血糖检测未见异常 ,但发生肥胖者 16例 (占11 0 3 % ) ,且其母孕期血糖控制不良者 9例 (占 56 2 5% )。结论 GDM及IGT者产后DM发生率高 ,应引起重视。妊娠期及时有效地控制高血糖及产后继续饮食调理与加强运动疗法 。

ObjectiveTo investigate high risk factors and preventive measures for postpartum diabetes mellitus (DM) in those with abnormal glucose tolerance of different degrees dur ing pregnancy,as well as long-term adverse effects on their children.MethodsA total of 196 women were followed up after pregnancy,including 123 cases with p ositive 50g glucose screen ing test,37 cases with impaired glucose tolerance,and 36 cases with gestational diabetes mellitus(GDM).A 75g oral glucose tolerance test(OGTT) and measurement o f cholesterol,HDL cholesterol,triglycerides were performed in these 3 groups of women.Blood glucose and gro wth index including height,weight,head circumference and chest circumference wer e assessed in their children.ResultsAccording to ADA criteria,diabetes developed subsequently in 22 patients(11 22% ) .Incidence rate was higher in GDM(30 56%) and IGT patients(21 62%) with statis tical significance,compared to 50g glucose screening test (+) patients(2 42%).Elderly pregnancy(40 90 %),obesity(21 27%),poor blood glucose control (45 45%) and significant weight gain(40 91%) after delivery were high-risk factors for subsequent diabetes.Alth ough abno rmal blood glucose tolerance was not found in all 145 children,16(11 03%) were found to be adipose,among whom 9 were from those with poor maternal blood gluc ose control during pregnancy.ConclusionGDM and IGT patients are more likely to develop subsequent diabetes.Satisfactor y blood glucose control during pregnancy,diet control and exercise from postpar tum on are beneficial to both mothers and their children.