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妊娠期糖尿病75gOGTT不同时点血糖异常与妊娠结局的相关性分析
引用本文:怀莹莹,李晨波. 妊娠期糖尿病75gOGTT不同时点血糖异常与妊娠结局的相关性分析[J]. 中国妇幼健康研究, 2017, 28(7). DOI: 10.3969/j.issn.1673-5293.2017.07.024
作者姓名:怀莹莹  李晨波
作者单位:江苏大学附属昆山市第一人民医院妇产科,江苏 昆山,215300
摘    要:目的 探讨妊娠期糖尿病孕妇不同血糖指标异常与妊娠结局的关系.方法 选择2016年1至12月于昆山市第一人民医院定期产检并分娩的937例妊娠期糖尿病孕妇,孕24~28周均直接行75g葡萄糖耐量试验(75gOGTT),单纯空腹血糖异常为A组,餐后1h或2h血糖异常而空腹血糖正常为B组,空腹及餐后1h或2h血糖异常为C组,分析三组孕妇妊娠结局及胰岛素使用率的差异.为分析不同指标血糖异常与新生儿出生体重的相关性,将单纯空腹血糖异常为空腹血糖组,单纯OGTT1h异常为OGTT1h组,单纯OGTT2h异常为OGTT2h组,分别将三组的空腹血糖、OGTT1h血糖、OGTT2h血糖与相应的新生儿出生体重进行相关性分析.结果 在937例GDM孕妇中,A组323例(34.47%)、B组436例(46.53%)、C组178例(19.00%).A、B、C三组在早产、巨大儿及产后出血的比较中具有显著差异(χ2值分别为6.72、12.00、6.29,均P<0.05);两两比较,C组的早产、产后出血率均明显高于A组和B组(χ2值分别为4.37、4.61、5.78、4.89,均P<0.05),A组和C组的巨大儿发生率均显著高于B组(χ2值分别为4.75和11.86,均P<0.05),而A组和C组的巨大儿发生率无明显差异(χ2=1.99,P>0.05),A组和B组在早产及产后出血方面的比较无明显差异(χ2值分别为0.03、0.00,均P>0.05).三组在胎膜早破、妊娠合并甲状腺机能减退、妊娠高血压疾病方面无明显差异(χ2值分别为0.94、0.39、0.56,均P>0.05).三组胰岛素使用率比较,C组明显高于GDM A组,且A组显著高于B组,差异均有统计学意义(χ2值分别为15.81、5.44,均P<0.05);在相关性比较中发现,在诊断的GDM孕妇中,OGTT中的空腹血糖与新生儿的出生体重呈正相关,差异有统计学意义(r=0.12,P<0.05);而OGTT1h及OGTT2h血糖与新生儿出生体重无明显相关(r值分别为0.08,0.01,均P>0.05).结论 GDM孕妇空腹血糖异常合并l项或两项不同时间点血糖异常,其不良妊娠结局发生率明显增加,OGTT空腹血糖值对于妊娠期糖尿病检测及新生儿体重的预测具有重要意义.临床上应根据OGTT异常情况进行分层管理.

关 键 词:妊娠期糖尿病  口服葡萄糖耐量试验  妊娠结局  新生儿出生体重

Relationship between abnormal blood glucose of 75gOGTT at different time point and pregnancy outcomes in women with gestational diabetes mellitus
HUAI Ying-ying,LI Chen-bo. Relationship between abnormal blood glucose of 75gOGTT at different time point and pregnancy outcomes in women with gestational diabetes mellitus[J]. Chinese Journal of Maternal and Child Health Research, 2017, 28(7). DOI: 10.3969/j.issn.1673-5293.2017.07.024
Authors:HUAI Ying-ying  LI Chen-bo
Abstract:Objective To investigate the relationship between abnormal blood glucose index and pregnancy outcomes in women with gestational diabetes mellitus (GDM).Methods Altogether 937 cases of GDM who underwent regular prenatal examination and delivered in the First People''s Hospital of Kunshan from January to December in 2016 were selected.Seventy-five gram oral glucose tolerance test (75gOGTT) was operated in 24-28 weeks.According to blood glucose of 75gOGTT at each time point, these women were separated into group A (only fasting glucose abnormal), group B (1h and/or 2h glucose abnormal but fasting glucose normal) and group C (fasting glucose abnormal and 1h and/or 2h glucose abnormal).Differences in pregnant outcomes and insulin usage rate among three groups were analyzed.To analyze relativity between abnormality of different blood glucose index and neonatal birth weight, pregnant women with simple fasting glucose abnormality were divided into fasting blood glucose group, women with 1h OGTT abnormality into OGTT1h group and women with OGTT 2h abnormality into OGTT2h group.Relativity of fasting blood glucose, OGTT1h blood glucose, OGTT2h blood glucose and neonatal birth weight were analyzed.Results In 937 pregnant women with GDM, 323 cases were in group A (34.47%), 436 cases in group B (46.53%) and 178 cases in group C (19.00%).There were significant differences in incidence of premature delivery, macrosomia and postpartum hemorrhage among group A, B and C (χ2 value was 6.72, 12.00 and 6.29, respectively, all P<0.05).Comparison between every two groups showed that incidences of premature delivery and postpartum hemorrhage in group C were significantly higher than those in group A and B (χ2 value was 4.37, 4.61, 5.78 and 4.89, respectively, all P<0.05), incidence of macrosomia in group A and C was much higher than that in group B (χ2 value was 4.75 and 11.86, respectively, both P<0.05), but there was no significant difference in macrosomia incidence between group A and C (χ2=1.99, P>0.05).There was no significant difference in premature delivery and postpartum hemorrhage between group A and B (χ2 value was 0.03 and 0.00, respectively, both P>0.05).Incidences of premature rupture of membranes, pregnancy complicated with hypothyroidism and pregnancy induced hypertension in three groups had no significant difference (χ2 value was 0.94, 0.39 and 0.56, respectively, all P>0.05).Comparison of insulin usage rate among three groups revealed that insulin usage rate in group C was statistically higher than that in group A, and that in group A was higher than in group B with statistically significant difference (χ2 value was 15.81 and 5.44, respectively, both P<0.05).Relativity comparison showed that in pregnant women diagnosed with GDM, OGTT fasting blood glucose was positively associated with neonatal birth weight and difference was statistically significant (r=0.12, P<0.05), but no obvious correlation was found between OGTT1h and OGTT2h blood glucose and neonatal birth weight (r value was 0.08 and 0.01, respectively, both P>0.05).Conclusion Incidence of adverse pregnant outcomes is increased significantly in GDM pregnant women with abnormal fasting blood glucose combined with blood glucose abnormality at one or two different time points.OGTT fasting blood glucose is of great significance for detection of GDM and prediction of neonatal birth weight.Clinical management should be classified based on OGTT abnormality status.
Keywords:gestational diabetes mellitus (GDM)  oral glucose tolerance test (OGTT)  pregnant outcomes  neonatal birth weight
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