不同孕周加用胰岛素对妊娠合并糖尿病孕产妇妊娠结局的影响分析

目的分析对于妊娠合并糖尿病孕产妇在不同孕周加用胰岛素治疗对剖宫产及早产发生率的影响。方法回顾性选取2017年6月至2018年6月同济大学附属第一妇婴保健院收治的采用胰岛素控制的妊娠合并糖尿病孕产妇179例,按照加用胰岛素时孕周的不同将孕产妇分为两组:<32周为早期组(n=96),≥32周为晚期组(n=83)。比较两组孕产妇胰岛素使用后,空腹血糖、餐后2 h血糖、血糖控制达标率与妊娠结局(包括剖宫产、早产、顺产发生率)。结果胰岛素使用后早期组孕产妇空腹与餐后2 h血糖水平(5.48±0.34)mmol/L、(7.08±0.75)mmol/L明显低于晚期组(6.72±0.47)mmol/L、(8.83±1.34)mmol/L,差异具有统计学意义(P<0.05)。早期组孕产妇血糖控制达标率(94.90%)明显高于晚期组(71.08%),差异具有统计学意义(P<0.05)。早期组孕产妇剖宫产率为13.54%,顺产率为79.17%,早产率为7.29%;晚期组孕产妇剖宫产率为32.53%,顺产率为36.14%,早产率为31.33%;两组比较差异具有统计学意义(P<0.01)。早期组孕产妇的不良妊娠结局发生率(7.29%)显著低于晚期组(15.66%),差异具有统计学意义(P<0.05)。结论对于妊娠合并糖尿病孕产妇,在早期加用胰岛素,可明显控制产妇产前空腹、餐后2 h血糖水平,提高血糖控制达标率,降低剖宫产率和早产发生率,效果理想。

Effect of insulin at different periods on pregnancy outcome in pregnant women with diabetes mellitus

Objective To analyze the effect of insulin therapy at different gestational weeks on the incidence of cesarean delivery and premature delivery in pregnant women with diabetes mellitus.Methods 179 pregnant women with gestational diabetes mellitus treated with insulin in the Obstetrics and Gynecology Department of our hospital from June 2017 to June 2018 were retrospectively selected in this study.The pregnant women were divided into two groups according to the periods of insulin application:the early group(n=96)for<32 weeks and the late group(n=83)for≥32 weeks.The fasting blood-glucose,2 h postprandial blood glucose,blood glucose control rate and pregnancy outcomes(including cesarean section,premature delivery and spontaneous delivery)after insulin use were compared between the two groups.Results The fasting and2-hour postprandial blood glucose levels in the early group(5.48±0.34)mmol/L and(7.08±0.75)mmol/L]were significantly lower than those in the late group(6.72±0.47)mmol/L and(8.83±1.34)mmol/L],and the differences were statistically significant(P<0.05).The blood glucose control rate was 94.90%in the early group and 71.08%in the late group.The blood glucose control rate in the early group was significantly higher than that in the late group(P<0.05).The rate of cesarean section,spontaneous delivery and premature delivery were13.54%,79.17%and 7.29%respectively in the early group,while 32.53%,36.14%and 31.33%in the late group;the difference between the two groups was statistically significant(P<0.01).The incidence of adverse pregnancy outcome in the early group(7.29%)was significantly lower than that in the late group(15.66%).The difference was statistically significant(P<0.05).Conclusion For pregnant women with diabetes mellitus,early insulin administration can significantly control the prenatal fasting blood glucose and 2 h postprandial blood glucose levels,improve the rate of blood glucose control,and reduce the incidence of cesarean section and premature delivery.