妊娠合并糖尿病胎儿生长监测与产前评估

1胎儿异常生长的生物学机制和特征胎儿生长发育的潜力受几个因素的影响:遗传、环境、营养和内分泌因素以及适当的胎盘功能。任何干扰这种生长潜力的情形,如妊娠合并糖尿病包括妊娠前糖尿病(pre-gestational diabetes mellitus,PGDM)合并妊娠和妊娠期糖尿病(gestational diabetes mellitus,GDM)以及与血管病变相关的疾病均可引起胎儿生长异常。胎儿生长异常包括两个极端:生长过度(大于孕龄儿或巨大儿)与胎儿生长受限(fetalgrowth restriction,FGR)。1.1大于孕龄(large for gestational age,LGA)儿LGA指胎儿的体重大于相应孕龄的第90百…     

末梢血糖检测在妊娠期糖尿病筛查方式中可行性的探讨

妊娠合并糖尿病是妊娠期最常见的内科合并症之一，其发生率逐年升高。它包括妊娠前患有糖尿病者（称之为糖尿病合并妊娠）和妊娠期糖尿病（gestational diabetes mellitus，GDM），后者占妊娠合并糖尿病的80％～90％，目前我国GDM发病率为1．31％～3．75％。其对母婴有诸多不利影响，如易造成羊水过多、妊娠期高血压疾病、胎膜早破、巨大儿、死胎、胎儿畸形等，约50％～60％的孕妇妊娠结束后随年龄的增长可发生2型糖尿病，因此提高对GDM的认识，早期诊断、早期治疗十分重要。[第一段]     

妊娠期糖尿病合并高血压疾病孕妇采用优质护理模式的效果分析

目的 观察优质护理对妊娠期糖尿病合并妊娠期高血压疾病孕妇的影响。方法 选取76例妊娠期糖尿病合并妊娠期高血压疾病孕妇,根据随机双盲法分组,各38例。对照组采用常规护理,观察组采用优质护理。比较两组护理效果。结果 护理前,两组收缩压、舒张压水平比较,差异无统计学意义（P>0.05）;护理后,两组收缩压、舒张压水平均低于护理前,且观察组明显低于对照组,差异具有统计学意义（P<0.05）。观察组不良妊娠结局发生率7.89%低于对照组的31.58%(P<0.05)。护理前,两组空腹血糖、餐后2 h血糖及糖化血红蛋白水平比较,差异无统计学意义（P>0.05）;护理后,观察组空腹血糖、餐后2 h血糖及糖化血红蛋白水平均低于对照组（P<0.05）。结论 妊娠期糖尿病合并高血压孕妇开展优质护理的优势显著,可明显改善血压、血糖指标,减少不良事件发生,具有临床推广价值。     

妊娠期甲状腺疾病对胎儿宫内生长发育的影响

目的 探讨妊娠期甲状腺疾病对胎儿宫内生长发育的影响.方法 采用前瞻性研究方法,随机纳入2020年1月至2020年12月在深圳市南山区妇幼保健院产科分娩的孕妇550例,并在孕妇早、中、晚期检测甲状腺素水平以及甲状腺过氧化物酶抗体,记录孕妇发生甲状腺功能减低(简称:甲低)、甲状腺功能亢进(简称:甲亢)的发生率,并进行分组,...     

妊娠期糖尿病合并子痫前期对母儿的影响

目的 研究妊娠期糖尿病（gestational diabetes mellitus,GDM）合并子痫前期对新生儿出生体重及母儿并发症的影响.方法 回顾分析中国医科大学附属盛京医院及解放军202医院2002-01-2004-12收治的GDM病例共127例,其中合并子痫前期者35例（Ⅱ组,余为Ⅰ组）,以同期子痫前期35例（Ⅲ组）及正常妊娠35例（Ⅳ组）为对照,比较四组间新生儿出生体重之间的差异,以及Ⅰ、Ⅱ组母儿并发症.结果 （1）GDM孕妇子痫前期的发生率（27.6%,35/127） 明显高于同期子痫前期的发生率（6.97%,353/5066）,差异有统计学意义（P＜0.01）.（2）Ⅰ组与Ⅱ组新生儿出生体重差异无统计学意义（P＞0.05）,Ⅱ组明显高于Ⅲ组及Ⅳ组（P均＜0.01）.（3）所有GDM病例中小于胎龄儿2例,均合并重度子痫前期.（4）Ⅰ组与Ⅱ组孕妇羊水过多、酮症酸中毒等的发生率及新生儿红细胞增多症等的发生率差异无统计学意义（P均》0.05）;Ⅱ组孕妇手术产的发生率高于Ⅰ组（P＜0.05）,新生儿窒息及转科的发生率也明显高于Ⅰ组（P＜0.05）.结论 GDM易合并子痫前期,且GDM合并子痫前期者中,孕妇早产、胎膜早破等围生期并发症增多,新生儿大于胎龄儿及低血糖等并发症亦增多.     

妊娠合并糖尿病对胎儿及新生儿的影响

妊娠合并糖尿病与围产儿预后有密切关系，尽管经孕期血糖控制围产儿死亡明显降低，但胎儿畸形及新生儿合并症仍较高。积极开展糖尿病孕前咨询，血糖控制以维持孕前及早孕期血糖在正常范围可明显减少胎儿畸形发生；新生儿合并症发生主要在于胎儿高胰岛素血症存在，将孕期血糖控制在正常范围可明显减少巨大胎儿及胎儿窘迫等发生。常规的产前监测方法并不能准确反映胎儿宫内酸中毒的情况，故因急性胎儿糖代谢紊乱所致的胎儿酸中毒、胎儿     

妊娠期高血压疾病治疗现状与进展

妊娠期高血压疾病是产科常见的并发症，直接危及孕产妇及围生儿的生命安全。现就妊娠期高血压疾病治疗现状与进展简介如下。     

妊娠期糖尿病与妊娠期高血压疾病相关性的研究进展

妊娠期糖尿病与妊娠期高血压疾病是妊娠期特有且常见的疾病,对母婴都能产生不良影响。研究表明,妊娠期糖尿病患者并发妊娠期高血压疾病的危险性明显升高,这可能与胰岛素抵抗、高血糖、肥胖等因素密切相关。及早进行妊娠期糖尿病、妊娠期糖耐量异常的诊断,严密监测妊娠期血糖、血压,控制饮食,适量运动,可降低妊娠期糖尿病患者妊娠期高血压疾病的发生率。     

妊娠期低水平铅暴露对胎儿的影响

妊娠期低水平铅暴露对胎儿的影响沈晓明颜崇淮敖黎明李纫秋周建德黄红金星明唐君明吴圣楣郭迪由于现代工业、交通的迅猛发展，工业化和城市化带来的环境问题逐渐突出，成为胎儿健康发育的新隐患［１］。有研究证明，妊娠妇女（由于职业等原因）暴露于高水平铅污染环境能引...     

超声预测妊娠期糖尿病胎儿体质量与胎儿出生后实际体质量的相关性及其价值

目的:探讨超声预测妊娠期糖尿病(GDM)孕妇胎儿体质量的与胎儿出生后实际体质量的相关性,评估超声预测GDM孕妇胎儿体质量的价值。方法:随机收集2017年6月至2018年6月在中国医科大学附属盛京医院产科入院分娩的GDM孕妇200例(GDM组)及妊娠期无合并症孕妇200例(正常组),分娩前1周内行超声检查,通过测量胎儿双顶径、头围、腹围、股骨长,运用Hadlock公式计算胎儿体质量。分析超声预测GDM组及正常组胎儿体质量与其出生后实际体质量的相关性。GDM组孕妇根据胎儿出生后实际体质量大小分为4组,分析各组超声预测体质量与实际体质量的相关性。结果:正常组胎儿体质量超声预测值与实际体质量相关系数(r)为0.936,拟合优度(r~2)为0.877;GDM组孕妇胎儿体质量超声预测值与实际体质量r=0.762,r~2=0.581;超声预测正常组胎儿体质量r~2高于GDM组孕妇。胎儿体质量超声预测值与出生后胎儿实际体质量3000 g组、3000～3500 g组、3500～4000 g、4000 g组的r、P分别为r=0.565、P0.05,r=0.184、P0.05,r=0.337、P0.05,r=0.333、P0.05。结论:超声评估GDM孕妇胎儿体质量的准确性较正常孕妇胎儿体质量低。超声评估不同范围GDM孕妇胎儿体质量与实际体质量相关性不一,3000 g组相关性最强,3000～3500 g组无相关性。     

妊娠合并糖尿病的病因学研究

妊娠合并糖尿病中的一类,即孕前糖尿病患者妊娠,这包括1型和2型糖尿病患者的妊娠.其发病机制已由相关的学科阐述,这里不再赘述.本文撰写的重点是另两类,即妊娠期糖尿病(GDM)和其过渡型,妊娠期糖耐量减退(GIGT)的病因学研究.     

Doppler velocimetry measurement in pregnancy complicated with diabetes mellitus]

To evaluate the effects of diabetes mellitus (DM) on fetoplacental circulation, Doppler velocimetry was carried out in diabetic pregnant women (n = 21) and normal pregnant controls (n = 20) every 2 weeks from the 20th week of gestation till term. Blood flow wave form of umbilical artery (Um) and uterine artery (Ut) were measured and the systolic/diastolic ratio (S/D) of Um and Ut calculated. The results showed that the Um and Ut S/D ratio of diabetic mothers with AGA babies (n = 15) and normal controls were not different. The S/D ratio of diabetic women with LGA newborns (n = 6) elevated after the 30th week of gestation, and the time of elevation was in accordance with the accelerating growth stage of LGA fetus. It is suggested that the elevation of S/D ratio may be related to the increasing requirement of blood supply for LGA babies in DM mother.     

Fetal surveillance in the pregnancy complicated by diabetes mellitus

During the last decade, outpatient protocols have been developed for antepartum fetal assessment in pregnancies complicated by diabetes mellitus. This approach has been associated with a markedly reduced cost of health care and emotional stress for patients and their families attributable to lengthy hospitalization. These programs have used primarily biophysical testing, with twice weekly NSTs followed by a CST or biophysical profile when necessary. Most recently, Doppler studies have been investigated as a method for identifying fetal compromise. Maternal assessment of fetal activity can be used as a screening test in most surveillance programs. Essential to the success of these protocols has been our ability to monitor maternal glycemia and to maintain glucose levels in the physiologic range through aggressive therapy with insulin and diet. Reassuring tests of fetal condition are present in most diabetic women and therefore permit fetal maturation to take place before delivery.     

饮食控制和运动对妊娠合并糖尿病的治疗作用

近几年在各国大城市妊娠期糖尿病（GDM）或糖耐量异常的发生率已经达到3％-5％，已经成为威胁孕期健康的重要疾病。许多患者既担心血糖升高不敢吃食物，又担心孕期营养不够而摄食过多，致使很多患者的生活质量下降，给个人和家庭带来巨大的精神压力和经济损失。营养支持治疗（medical nutrition treatment，MNT）是GDM最基础的治疗手段。合理的膳食安排能提供妊娠所需的能量和营养素且不易导致餐后高血糖。     

Risk of diabetes mellitus after pregnancy complicated by gestational diabetes mellitus (GDM)

OBJECTIVES: The aim of the study was an assessment of glucose tolerance disorders' (GTD) prevalence after pregnancy complicated by GDM. DESIGN: Retro- and prospective clinical study. MATERIAL AND METHODS: The group of 461 women having GDM in their index pregnancies was invited to postpartum glucose metabolism assessment. Of them 192 subjects responded positively. In 47 of them the postpartum diagnosis of diabetes had already been established. The remaining 145 subjects underwent detailed testing that embraced fasting plasma glucose and whole blood HbA1c level measurement. Oral 75-g glucose tolerance test (OGTT) was also performed. RESULTS: OGTT revealed GTD in 55 subjects. Diabetes was found in 8 cases, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) in 23 and 24 cases respectively. Postpartum GTD appeared in 63.3% of insulin treated subjects (GDM2) compared with 30.1% of women treated with diet only (GDM1). A group with pathological OGTT had mean HbA1c concentration significantly higher compared to the one with normal test results (6.0+/-1.7% vs. 5.1+/-0.3%; p<0.001), although HbA1c>6.0% was observed only in 23.6% women with GTD. Moreover, in 25% of subject with newly diagnosed diabetes HbA1c level did not exceeded 6.0%. CONCLUSIONS: 1. More than 50% of subjects with GDM developed diabetes or other GTD during the first 6 years postpartum. 2. Risk of postpartum GTD is significantly higher in women treated with insulin during pregnancy. 3. HbA1c measurement is less sensitive than OGTT for detection of GTD after pregnancy complicated by GDM.     

Gestational diabetes mellitus diagnosed during early pregnancy

OBJECTIVE: This study was undertaken to compare pregnancy complications, obstetric outcomes, and perinatal outcomes between women with early-onset and late-onset gestational diabetes mellitus. STUDY DESIGN: Fifty-gram oral glucose challenge screening was conducted among 3986 pregnant women at the time of their first antenatal visit. Women without abnormal results underwent another test at 24 to 28 weeks' gestation. Patients with gestational diabetes mellitus in early pregnancy were compared with those who had a normal glucose tolerance at the time of this first test but in whom diabetes subsequently developed. RESULTS: Women with early-onset gestational diabetes mellitus (n = 65) were likely to be hypertensive (18.46% vs 5.88%; P =.006) and had higher glycemic values and need for insulin therapy (33.85% vs 7.06%, P =.0000) than those in whom diabetes developed later (n = 170). All the cases of neonatal hypoglycemia (n = 4) and all perinatal deaths (n = 3) were within this group (P =.005 and P =.01, respectively). CONCLUSIONS: Women with an early diagnosis of gestational diabetes represent a high-risk subgroup.     

Plasma fibronectin in pregnancy complicated by diabetes mellitus and preeclampsia

OBJECTIVES: The aim of this study was to evaluate concentration of plasma fibronectin (FN) in course of pregnancy complicated by preeclampsia accompanied by diabetes mellitus and to assess whether the concentration of FN depends on the state of carbohydrate metabolism. MATERIAL AND METHODS: The study was carried out in 2 groups: group K--consisting of 35 healthy pregnant women without complications, and group G --consisting of 12 pregnant women, 4 with gestational diabetes mellitus and 8 with pregestational diabetes mellitus, who developed preeclampsia, in course of research, after 37th week of pregnancy. Concentration of FN and Fm--in order to the state of carbohydrate metabolism--was marked in the following: before 33rd week of pregnancy, between 33rd and 37th week of pregnancy and after 37th week of pregnancy. RESULTS: No correlation between concentration of FN and duration of pregnancy in group K was found. Average concentration of FN in the subsequent periods of the pregnancy in group K were similar and have not shown vital, statistical differences. In group G crucial statistical increase in FN concentration along with increase of pregnancy duration was found (r = 0.3860, p < 0.07). No correlation between concentration of FN nor Fm was found in both groups. CONCLUSIONS: The results obtained demonstrate that vascular endothelial damage, as expressed by increase in plasma fibronectin levels, is a condition specific for preeclampsia, preceding its clinical manifestation. Maternal blood concentrations of FN do not depend on the state of carbohydrate metabolism estimated by concentration of Fm.     

Ultrastructural examination of the placenta in pregnancy complicated by diabetes mellitus

BACKGROUND: Causes of fetal hypoxia in diabetic pregnancy are still unknown. Investigation of placental vascular network seems of great importance in this research area. Abnormalities in the structure of capillaries in the vasculo-epithelial membranes and role of perivascular space may be an essential factor in explanation for fetal hypoxia in diabetic pregnant women. The aim of the study was to evaluate the relationship between the vascular surface of the terminal villi to its total surface, evaluation of the endothelial structure, perivascular space and basal membrane of the trophoblast as well as analysis of the studied parameters in relation to the classes of diabetes and metabolic control. MATERIAL AND METHODS: The study was performed on 32 placentas from women with PGDM and GDM. There were 8 pregnant women in class G1 and G2, 15 in class B, C, D, 9 in class R/F and 8 in control group. The mean diurnal glycemia in the analysed groups ranged between 90 + 22 mg/dl and 100 + 55 mg/dl (in control group 80 + 12 mg/dl). HbA1c concentrations were between 6.7 + 0.9% and 7.6 + 1.0% (in control group 6.0 + 0.5%). Placentas were examined using light microscopy and electron microscopy Opton-Zeiss EM-900. RESULTS: Decrease in the vascular surface of terminal villi was found in PGDM with fetal hypotrophy. In this cases we observed separation of basal membranes in basal capillaries and distention and proliferation of endothelial cells, disarrangements of perivascular space,. In placentas of women with hyperglycemia and fetal macrosomia there was a significant thickening of basal membranes of the trophoblast, and structural abnormalities in perivascular space with proliferation of collagen in terminal villi. Intensity of these changes was related to the degree of hyperglycemia and affected fetal and neonatal wellbeing. Examination of the placentas in women with PGDM with normal sugar levels before and during pregnancy revealed no or very limited pathological changes on light and electron microscopy. No significant relationships were shown between vascular surface in terminal villi and selected biochemical parameters and neonatal condition in diabetic pregnant women with fetal eutrophy CONCLUSIONS: Pathologic changes in the placentas of diabetic women (significant thickening of basal membranes of trophoblast separation of basal membranes in basal capillaries, distention and proliferation of endothelial cells, disarrangements of perivascular space and decrease of vascular surface of terminal villi are significant factors contributing to fetal anoxia in pregnancy complicated by diabetes mellitus.