妊娠期50 g葡萄糖负荷试验筛查945例临床分析

目的探讨妊娠糖尿病的临床特点及其相关因素。方法采用两种妊娠糖尿病诊断标准(世界卫生组织标准和Carpenter/Coustan标准)回顾性分析近1年在我院进行产前检查并行50g葡萄糖负荷试验(GCT)的945例孕妇的临床资料。结果945例孕妇GCT异常率为35.8%(338/945),228例GCT异常者中妊娠糖尿病发生率为44.7%(102/228,世界卫生组织标准)。两种标准诊断的妊娠糖尿病孕妇与GCT正常的孕妇相比,年龄较大,孕前体重指数较高,孕初期体重增长较快,孕初期空腹血糖较高,糖尿病家族史阳性率较高。约孕30周时行75g口服葡萄糖耐量试验结果显示,妊娠糖尿病孕妇较妊娠期正常糖耐量孕妇胰岛素敏感性下降,且胰岛素分泌高峰明显延迟。logistic回归分析显示,孕妇年龄、孕前体重指数、孕初期体重增长、孕初期空腹血糖与妊娠糖尿病发生呈正相关。结论妊娠糖尿病孕妇与非妊娠糖尿病孕妇比较,年龄较大,孕前体重指数较高,孕初期体重增长较快,孕初期空腹血糖较高,糖尿病家族史阳性率较高,胰岛素抵抗更重。对于具有妊娠糖尿病危险因素者,应在孕早期进行空腹血糖的筛查,以尽早诊断和治疗。

Clinical analysis of screening for gestational diabetes mellitus in 945 pregnant women with 50 g glucose challenge test

Objective To explore the clinical characteristics of gestational diabetes mellitus (GDM) and its relevant factors.Methods Using two diagnostic criteria set by World Health Organization and Carpenter/Coustan respectively, clinical data of 945 pregnant women who underwent glucose challenge test (GCT) in the Department of Obstetrics and Gynecology of China-Japan Friendship Hospital in Beijing during the past year were retrospectively analyzed.Results Of 945 pregnant women, 338 (35.8%) had 1 h serum glucose level equal to or greater than 7.8 mmol/L(140 mg/dl).Of these 338 women with positive GCT, 228 underwent 75 g oral glucose tolerance test (OGTT) and 102 (44.7%) of 228 were diagnosed as GDM. Women with GDM diagnosed according to either criteria had older age, higher body mass index(BMI) before pregnancy, more weight gain during the first 15 weeks of gestation, higher fasting blood glucose in early pregnancy and higher proportion of those with history of diabetes in their first-degree relatives than those with negative GCT. OGTT for pregnant women at about 30 weeks of gestation showed that insulin sensitivity decreased significantly in those with GDM compared with that in those with normal glucose tolerance, and the peak of insulin secretion delayed significantly in women with GDM.Logistic regression analysis showed that older age, higher BMI before pregnancy, more weight gain in early pregnancy and higher fasting blood glucose in early pregnancy were all independently associated with increased incidence of GDM.Conclusions Older age, higher BMI before pregnancy,more weight gain in early pregnancy,higher fasting blood glucose in early pregnancy,higher proportion of those with history of diabetes in their first-degree relatives and more severe insulin resistance were found in pregnant women with GDM than in those without GDM. It is suggested that those pregnant women with risk factors of GDM should be screened by fasting blood glucose in early pregnancy in order to be diagnosed and treated earlier.