妊娠期糖尿病诊断标准的探讨

目的　探讨妊娠期糖尿病 ( GDM)的诊断标准。　方法　对 1 578例孕妇进行血糖筛查试验 ,阳性者进行葡萄糖耐量试验 ( OGTT)。按照世界卫生组织 ( WHO)、美国糖尿病资料组 ( NDDG)和国内 (董志光等 )三种诊断标准对孕妇进行诊断并分组 ,随机选择糖筛查试验阴性孕妇 1 0 0例作为对照组 ,对四组母儿妊娠结局进行比较。　结果　血糖筛查试验阳性 2 76例 ,OGTT试验达到 WHO、NDDG、国内标准者分别为 3 3、60、68例 ,检出率分别为 2 .1 % ( 3 3 / 1 578) ,3 .8% ( 60 / 1 578) ,和 4 .3 %( 68/ 1 578)。各 GDM组间比较 ,产母重度妊高征、羊水过多、羊水过少、巨大儿的发生率和剖宫产率均无显著性差异 ( P>0 .0 5) ,而与对照组相比 ,存在显著性差异 ( P<0 .0 5)。　结论　及时诊断并积极处理 GDM对获得良好的妊娠结局是极为必要的。 WHO标准过于严格 ;NDDG标准可以应用 ,但有漏诊的可能 ,国内标准有待大样本证实。

Study of Diagnostic Criteria for Gestational Diabetes Mellitus

Objective To study the diagnostic criteria for gestational diabetes mellitus. Method A total of 1 578 pregnant women were screened for a plasma glucose of 7.8 mmol/L or greater, 1 hour after a 50-g glucose administered after an overnight fast during 28 to 32 weeks' gestational age. Positive subjects received a 75 g oral glucose tolerance test (OGTT). The diagnosis of GDM were according to three diagnostic criteria: WHO, NDDG (national diabetes data group) and China. One hundred negative screenees were randomly selected as control group. The outcome of the mother and the neonate of the four groups were compared. Results Of the 1578 pregnant women,276 had a positive 50 g gluose screen and underwent a 75 g OGTT?Of these women,33 met the WHO criterion,60 met the NDDG criterion,and 68 met the Chinese criterion for the GDM diagnosis. Therefore, the incidence of GDM in this series were 2.1% (33/1578), 3.8% (60/1578) and 4.3% (68/1578) by the three diagnostic criteria, respectively. Maternal complications including severe pregnancy induced hypertension, polyhydramnios, oligohydramnios and macrosomia and the percentage of the cesarean section were compared. Significant differences were shown among the three GDM groups ( P >0.05), but there were significant differesnces compared with the control group ( P< 0.05 ). Conclusions It's very important to diagnose and treat GDM actively in time to gain a good outcome of pregnancy. The WHO criterion is over strict. The NDDG criterion sometimes might result in some GDM patients undiagnosed. The Chinese criterion demands to be proved by large samples.