妊娠期糖尿病并发胎儿生长受限的临床分析

目的 改善妊娠期糖尿病（GDM）并发胎儿生长受限（FGR）的母婴预后。方法 选择1997年1月～2004年6月在我院系统产前检查并分娩、符合GDM和FGR诊断标准的孕妇23例为FOR组，同期符合GDM诊断标准而新生儿出生体重正常的孕妇30例为对照组，分析两组GDM的发病孕周、脐血流S／D比值、孕期血糖控制情况、妊娠并发症和妊娠结局。结果 FGR组：1．确诊为GDM的孕周早于对照组、胎盘病理检查异常和剖宫产率高于对照组（P〈0．05）。2．出现脐血流S/D比值升高早于对照组（P〈0．01），孕期血糖控制欠佳、出现妊娠期高血压疾病、羊水过少、胎儿窘迫和早产较对照组显著增加（P〈0．01）。3．新生儿窒息、低血糖、红细胞增多症和脱水的发生率比对照组高（P〈0．01）；高胆红素血症的发生率比对照组显著增加（P〈0．05）。结论 重视GDM的早期诊断和治疗，严格控制血糖、预防妊娠期高血压疾病等合并症的发生是改善GDM并发FGR的母婴预后的关键措施。

Clinical Analysis of Gestationai Diabetes Meilitus Fetal Growth Restriction

Objective To improve the outcome of gestational diabetes mellitus(GDM) complicated with fetal growth restriction(FGR). Methods Twenty-three cases of GDM complicated with FGR (FGR group) had received prenatal care systematically and delivered in our hospital from Jan.1997 to Dec.2003; and 30 cases of GDM with normal neonatal birth weight at the same time(Control group). To understand the pathogenesis during the gestation period, S/D ratio on umbilical artery tochogram , the blood sugar level, the pregnancy complications and the pregnancy outcomes of both the maternal and fetus were analyzed. Results The FGR group was different from the control group in three ways: 1. The delivery of GDM gestation week was earlier; the abnormal placental pathohistology and cesarean section rate was higher than that of the control group(P<0.05).2. The pathogenesis of abnormal S/D ratio on umbilical artery tochogram was earlier and the control of blood sugar level was unsatisfactory as compared with that in the control group (P<(0.01)), and the incidences of pregnancy induced-hypertension, oligohydramnios, fetal distress, premature delivery were much more than that of the control group (P<0.01). 3. The incidence of neonatal asphyxia, hypoglycemia, erythromatosis and dehydration were significantly higher than that of the control group (P<0.01). The incidence of hyperbilirubinemia was significantly higher than that of the control group (P<0.05). Conclusions The key (measurements) of improve the prognosis of GDM complicated with FGR are early detection of the presence of GDM, thus to provide adequate measures to have blood sugar satisfactory controlled during pregnancy and to prevent the development of pregnancy-induced hypertension.