妊娠期糖尿病75g OGTT不同时点血糖异常孕妇的临床特点与妊娠结局分析

目的:分析妊娠期糖尿病(GDM)75g葡萄糖耐量试验(75g OGTT)不同时点血糖异常孕妇的临床特点与妊娠结局。方法:选取2013年1月至2015年3月在华北理工大学附属医院行产前检查并住院分娩的妊娠期糖尿病孕妇150例,孕24~28周均直接行75g OGTT,检测结果中仅其中1项时点血糖异常为GDMⅠ组、2项时点血糖异常为GDMⅡ组、3项时点血糖均异常为GDMⅢ组。结果:(1)GDMⅢ组的孕前体重指数(BMI)高于GDMⅡ组和GDMⅠ组,两两比较差异均有统计学意义(P0.05);(2)GDMⅢ组的胰岛素使用率高于GDMⅡ组和GDMⅠ组(P0.05),GDMⅡ组与GDMⅠ组比较,差异无统计学意义(P0.05)。GDMⅢ组使用胰岛素的风险是GDMⅠ组的23.05倍(OR=23.05,95%CI 2.61~203.18);(3)GDMⅢ组的OGTT结果 3项时点血糖水平、FINS和胰岛素抵抗指数均高于GDMⅡ组和GDMⅠ组,两两比较差异均有统计学意义(P0.05);(4)GDMⅢ组的巨大儿发生率高于GDMⅡ组和GDMⅠ组(P0.05),GDMⅡ组与GDMⅠ组比较,差异无统计学意义(P0.05)。GDMⅢ组发生巨大儿的风险是GDMⅠ组的5.029倍(OR=5.029,95%CI 1.789~14.132)。结论:OGTT结果 3项时点均异常的GDM孕妇的孕前体重指数、胰岛素使用率、胰岛素抵抗水平均明显升高,也是发生巨大儿的高危人群。此类高危GDM孕妇临床应高度重视并积极干预。

Clinical characteristics and pregnancy outcomes of gestational diabetes mellitus women of abnormal blood glucose of 75g OGTT

Objective:To investigate the clinical characteristics and pregnancy out-comes of gestational diabetes mellitus(GDM) women of abnormal blood glucose of 75g OGTT. Methods:A total of 150 cases,who were diagnosed as gestational diabetes mellitus and received prenatal examination and delivered in North China University of Science and Technology Affilia-ted Hospital from Jan. 2013 to Mar. 2015,were divided into 3 groups on the basis of each time point blood glucose results in 75g OGTT. GDMⅠ:one abnormal blood glucose of OGTT result, GDMⅡ:two abnormal blood glucose and GDMⅢ:three abnormal blood glucose. Results:(1) The pre-pregnancy body mass index ( BMI ) in GDMⅢ were significantly higher than that in GDMⅡ and GDMⅠ ( P<0 . 05 ) . ( 2 ) The usage rate of insulin in GDMⅢ were higher than those in GDMⅡ and GDMⅠ ( P<0 . 05 ) . ( 3 ) The OGTT results and FINS and HOMA-IR in GDMⅢ were higher than those in GDMⅡand GDMⅠ(P<0. 05). (4)The rates of fetal mac-rosomia in GDMⅢwas higher than GDMⅡand GDMⅠ( P<0 . 05 ) . Conclusion:The pregnant women that three abnormal blood glucose in OGTT had obvious clinical characteristics including high pre-pregnancy body mass index, the high usage rate of insulin, increased insulin resist-ance,high incidence of macrosomia. High attention and positive intervention should be given to those patients with high blood glucose levels in OGTT.