妊娠期糖尿病妇女与分娩巨大儿的多因素临床研究

目的:为了研究妊娠期糖尿病妇女与分娩巨大儿的多因素临床相关性。方法:回顾性分析2004～2007年在我院分娩的孕周≥37周的妊娠期糖尿病妇女123例,按孕前体重指数(BMI)分为BMI≤23.9组(正常组)、BMI≥24组(肥胖组),妊娠期糖尿病分为单纯饮食治疗组(GDM1组)、饮食+胰岛素治疗组(GDM2组);分析正常BMI组与肥胖组、GDM1组与GDM2组分娩巨大儿的临床风险性。结果:巨大儿总的发生率为27.5%;妊娠28周前发现并治疗的GDM,其巨大儿的发生率为19.0%,妊娠28周后发现并治疗的患者,其巨大儿的发生率为30.2%,增加11.2%,但无统计学意义。GDM1组巨大儿的发生率为28.8%,GDM2组巨大儿的发生率17.4%,下降11.4%,亦无统计学差异。GDM孕前体重指数与巨大儿发病呈正相关,差异有显著性。P<0.05。结论:GDM孕前体重指数过高是分娩巨大儿的重要因素。孕期重视对孕前BMI的评估,及早发现GDM并强化胰岛素治疗,使孕期体重适当增长,可有效减少巨大儿的发生及改善母婴预后。

Multi-factor study on gestational diabetes mellitus and macrosomia

Objective:To explore the correlation among multi-factors of gestational diabetes mellitus (GDM) and macrosomia.Methods:The data of 123 women with GDM (gestational weeks≥37 weeks) were analysed from 2004 to 2007,then they were divided into control group (BMI≤23.9) and obesity group (BMI≥24) according to pregestational body mass index (BMI),GDM1 group (diet therapy) and GDM2 group (diet and insulin therapy);the clinical risk of macrosomia in the four groups was analysed.Results:The total incidence of macrosomia was 27.5%.Therapy beginning before and after 28 gestational weeks,the incidences of macrosomia were 19.0% and 30.2%,respectively,but there was no difference.There was no difference in the incidence of macrosomia between GDM1 group (28.8%) and GDM2 group (17.4%).There was positive correlation between pregestational BMI and the incidence of macrosomia (P<0.05).Conclusion:The high pregestational BMI of women with GDM is a risk factor of macrosomia.Attentions paid to the evaluation of pregestational BMI,early detection of GDM,enhancing insulin therapy and an appropriate body weight increasing during pregnancy will effectively reduce the incidence of macrosomia and improve the prognosis of the mothers and their infants.