536例采用IADPSG标准诊断妊娠期糖尿病患者的妊娠结局

Pregnancy outcomes of 536 GDM patients based on IADPSG diagnostic criteria

目的:探讨IADPSG标准诊断妊娠期糖尿病(GDM)的妊娠结局。方法:2011年12月~2012年8月采用IADPSG诊断标准诊断为GDM孕妇共410例,其中符合教科书(乐杰主编的第7版《妇产科学》)诊断标准共122例为教课书组,不符合教科书诊断标准共288例为新诊断组,选取2011年2月~2011年11月因采用教科书诊断标准漏诊GDM孕妇126例为漏诊组,比较3组孕妇妊娠结局。结果:2011年12~2012年8月按照教科书诊断标准,GDM发生率为4.78%(122/2 555),按照IADPSG诊断标准GDM的发生率为16.04%(410/2 555),两组发病率比较有统计学差异(P<0.05)。教科书组孕妇羊水过多、巨大儿发生率分别为3.28%(4/122)、22.95%(28/122),均高于新诊断组(P<0.05)。漏诊组孕妇胎膜早破、巨大儿、羊水过少、妊娠期高血压疾病、胎儿窘迫发生率分别为20.63%(26/126)、19.05%(24/126)、22.22%(28/126)、30.16%(38/126)、28.57%(36/126)均高于新诊断组(P<0.05)。教科书组和漏诊组中潜伏期延长、胎儿窘迫、羊水过少、巨大儿、头盆不称为手术指征发生率均高于新诊断组(P<0.05),手术指征中社会因素比率和剖宫产率3组比较无统计学差异(P>0.05)。结论:采用IADPSG标准,更多的GDM孕妇被诊断,通过对其膳食及生活方式的干预和对其病情轻重程度进行有效的分层管理,以期待降低剖宫产率,改善母婴预后。

Objective: To explore the pregnancy outcomes of 536 gestational diabetes mellitus( GDM) patients based on IADPSG diagnostic criteria. Methods: A total of 410 pregnant women diagnosed as GDM according to IADPSG diagnostic criteria from December2011 to August 2012 were selected and divided into textbook group and new diagnostic criteria group,122 women in textbook group accorded with the diagnostic criteria of Obstetrics and Gynecology edited by YUE Jie( the seventh edition),while 288 women in new diagnostic criteria group didn't accord with the diagnostic criteria of Obstetrics and Gynecology; 126 GDM patients of missed diagnosis based on the diagnostic criteria of Obstetrics and Gynecology from February to November in 2011 were selected as missed diagnosis group; the pregnancy outcomes in the three groups were compared. Results: The incidence rates of GDM in textbook group and new diagnostic criteria group were 4. 78%( 122/2 555) and 16.04%( 410/2 555),respectively,there was statistically significant difference between the two groups( P <0.05).The incidence rates of polyhydramnios and macrosomia in textbook group were 3. 28%( 4 /122) and 22. 95%( 28 /122),respectively,which were statistically significantly higher than those in new diagnostic criteria group( P < 0. 05). The incidence rates of premature rupture of fetal membrane,macrosomia,oligohydramnios,hypertensive disorder complicating pregnancy and fetal distress in missed diagnosis group were 20. 63%( 26 /126),19. 05%( 24 /126),22. 22%( 28 /126),30. 16%( 38 /126) and 28. 57%( 36 /126),respectively,which were statistically significantly higher than those in new diagnostic criteria group( P < 0. 05). The proportions of patients with prolonged latent phase,fetal distress,oligohydramnios,macrosomia and cephalopelvic disproportion as surgical indications in textbook group and missed diagnosis group were statistically significantly higher than those in new diagnostic criteria group( P < 0. 05); there was no statistically significant difference in the proportion of social factors among surgical indications and cesarean section rate among the three groups( P > 0. 05).Conclusion: According to IADPSG diagnostic criteria,more pregnant women with GDM were diagnosed. Dietary and lifestyle intervention,effectively hierarchical management on the degree of severity of GDM can educe cesarean section rate and improve maternal and infantile prognosis.