单纯糖筛查异常临床干预对妊娠结局的影响

妊娠期糖尿病（gestational diabktes mellius，GDM）和妊娠期糖耐量单项异常（gestational impares glucose tolerance，GIGT）对胎儿、新生儿的影响已引起产科医师的广泛重视。但50g葡萄糖筛查（glucose challenge test，GCT）异常、葡萄糖耐量试验（oral glucose tolerance text，OGTT）正常的孕妇（单纯GCT异常），其妊娠结局可以与GDM和GIGT有相似之处，对胎儿及新生儿的影响尚未引起足够的重视。为减少巨大儿及母儿并发症的发生，本文通过对单纯GCT异常孕妇进行妊娠期营养和糖尿病一级预防相关知识的普及，达到了降低剖宫产率和巨大儿发生的目的，报道如下。     

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。     

妊娠期糖耐量异常影响妊娠结局分析

妊娠期糖耐量异常(GIGT)是指在妊娠期行糖耐量试验(Oral glucose tolerancete,OGTT)结果4项中有任何1项超过或达到诊断标准的为糖耐量异常。不同地区发病率差异较大,估计中国发病率在5%左右[1]。近年来,随着妊娠期糖尿病     

妊娠期糖筛查时机的探讨

目的评价在不同孕周进行50 g葡萄糖负荷试验（glucose challenge test, GCT）对妊娠期糖尿病（gestational diabetes mellitus, GDM）和妊娠期糖耐量受损（gestational impaired glucose tolerance test, GIGT）的筛查效果. 方法对不同孕周的2000例孕妇进行50 g GCT,异常者再做正规糖耐量试验,确诊GDM或GIGT,并比较不同孕周妊娠期糖尿病或妊娠期糖耐量受损的诊断效果. 结果不同孕周进行50 g糖筛不影响GDM和GIGT最后诊断率,本研究GDM的发生率为4.75%（95/2000）,GIGT为5.51%（103/2000）.空腹进行50 g GCT阳性率和假阳性率均高于餐后1 h的50 g GCT,两组比较差异有统计学意义（P〈0.01）.在较早孕周初次进行GCT筛查,有助于早期发现GIGT和GDM.在GCT筛查推荐时期（孕24～28周）再进行一次50 g GCT,有助于提高GDM和GIGT的诊断率.对于GIGT血糖控制不满意者,必要时重做葡萄糖耐量试验以确诊是否发展为GDM.早期行50 g GCT组的剖宫产率和巨大儿发生率均低于孕24～28周筛查组. 结论对于GDM和GIGT的孕妇及时诊断与及时治疗,可以降低巨大儿和剖宫产率.     

果糖胺在妊娠期糖耐量异常筛查及治疗中的作用(节选)

妊娠期糖尿病严重威胁孕期母儿健康。目前，临床常采用50g糖筛查试验（glucose-challenge test，GCT）与口服糖耐量试验（oral glucose tolerance test，OGTT）联合进行诊断，但诊断时已达晚孕期。如果能在孕早期作出诊断并进行干预，将有助于改善母儿预后。果糖胺（fructosamine）的形成量与血糖浓度有关，半衰期为19d，可以反映患者近2～3周内的血糖水平。既往检测果糖胺的方法十分复杂，现采用检测出的果糖胺数值代表其浓度，并对孕期应用果糖胺检测、诊断或预测糖耐量异常的价值进行探讨。     

糖筛查试验异常对孕妇预后的影响

目的探讨糖筛查试验异常对孕妇预后的影响.方法将103例糖筛查试验异常者分为治疗组及未治疗组,治疗组进行饮食控制.结果治疗组巨大儿、早产儿、新生儿窒息率明显低于未治疗组,未治疗组孕妇妊高征、剖宫产率均高于治疗组.结论糖筛查试验异常孕妇妊娠期并发症、手术产率、围产儿病率均高于正常孕妇.     

妊娠期糖耐量降低与妊娠结局关系的前瞻性研究

随机对２８９例孕妇作５０ｇ葡萄糖应激试验（５０ｇＧＣＴ），阳性者进一步作７５ｇ葡萄糖耐量试验（７５ｇＧＴＴ），并随访妊娠结局。结果：５０ｇＧＣＴ阳性率为１６．９６％，妊娠期糖耐量降低（ＧＩＧＴ）患病率为５．１９％，妊娠期糖尿病（ＧＤＭ）患病率为１．７３％；ＧＩＧＴ及ＧＤＭ孕妇中，好高征、胎膜早破、巨大儿、手术产、新生儿患病等的发生率明显增加；５０ｇＧＣＴ时孕妇血糖水平与新中儿出生体重呈正相关。提示：妊娠期可发生不同程度的糖耐量降低，并由此导致孕产妇及胎婴儿病率增加；ＧＤＭ的诊断标准应以孕产妇和胎婴儿异常为依据。     

妊娠糖代谢异常孕妇葡萄糖耐量试验结果评价

目的　分析妊娠期糖代谢异常孕妇口服葡萄糖耐量试验 (oralglucosetolerancetest ,OGTT)的特点 ,探讨OGTT 3h血糖检测 ,在妊娠糖尿病 (gestationaldiabetesmellitus ,GDM)和妊娠糖耐量受损 (gestationalimpairedglucosetest ,GIGT)诊断中的价值。　 方法　回顾性收集、分析我院1989年 1月至 2 0 0 2年 12月 6 4 7例GDM和 2 0 0 0年 1月至 2 0 0 2年 12月 2 33例GIGT孕妇的OGTT血糖特点 ,以及各点血糖在糖代谢异常孕妇中的诊断价值。　结果　 (1) 6 4 7例GDM孕妇中 ,112例因空腹血糖明显异常被确诊为GDM ;5 35例进行了OGTT ,4 9.2 % (2 6 3/5 35 )的孕妇空腹血糖异常 ;90 .1% (482 /5 35 )的孕妇 1h血糖异常 ;6 4 .7% (35 9/ 5 35 )的孕妇 2h血糖异常 ;仅 2 1.3% (114 / 5 35 )的孕妇 3h血糖达到异常 ,其中 ,4 9.1% (5 6 / 114 )伴有OGTT其它三项血糖异常 ,34.2 % (39/114 )伴有OGTT另外两项异常 ,19例伴有另外一项异常 ,即省略OGTT 3h血糖检测 ,2 .9% (19/6 4 7)的GDM被漏诊为GIGT。 (2 ) 2 33例GIGT中 ,只有 1.72 % (4/2 33)依靠OGTT 3h血糖异常得出诊断。(3)GDM孕妇空腹血糖达异常 (≥ 5 .8mmol/L)时 ,5 9.7%需要胰岛素治疗 ,高于空腹血糖 <5 .8mmol/L需要胰岛素治疗者 (41.6 % ) ,P <0 .0 1;5 0g葡萄     

妊娠期糖耐量异常影响妊娠结局分析

妊娠期糖耐量异常(GIGT)是指在妊娠期行糖耐量试验(Oral glucse tolerancete, OGTT)结果4项中有任何1项超过或达到诊断标准的为糖耐量异常.不同地区发病率差异较大,估计中国发病率在5%左右[1].     

糖耐量正常孕妇发生巨大儿原因分析

目的　探讨糖耐量试验正常孕妇的孕期血糖水平与巨大儿发生的关系。　方法　选择孕晚期葡萄糖耐量试验正常的孕妇２００ 例,按新生儿体重分为正常组及巨大儿组,每组各１００ 例。采用样条函数对孕妇糖耐量检验结果的各时点值进行拟合,计算出曲线下的面积,同时对两组孕妇各项数据进行比较。　结果　两组孕妇身高、体重及宫高、腹围的增长均有明显统计学差异,而孕妇糖代谢过程未显示有统计学差异。　结论　对于糖耐量正常的孕妇,巨大儿的发生与糖代谢无相关关系,而与孕妇的身高、体重及宫高、腹围的增长幅度有关。故对上述孕妇需加强监测,给予合理营养指导,是减少巨大儿发生的关键。     

The Association Between Maternal Obesity,Glucose Intolerance and Hypertensive Disorders of Pregnancy in Nondiabetic Pregnant Women

Objective. The aim of this study is to evaluate whether pregnancy-induced hypertension (PIH) among nondiabetic patients is associated with glucose intolerance. Materials and Methods. A retrospective case-control study was designed including a study group who had pregnancy-induced hypertension or preeclampsia. Patients with normal pregnancy were used as a control group matched to cases by parity. Diabetic patients, nonsingleton pregnancies, and women without prenatal care were excluded. Data concerning fasting glucose levels, glucose challenge test (GCT), and oral glucose tolerance test (OGTT) were collected from patients' files. Results. There were 131 patients in each study group. The study group had significantly higher mean maternal age, mean GCT levels, and mean pregestational body mass index (BMI) (28.0 ± 5.8 vs. 26.5 ± 5.3, p = 0.02; 5.8 ± 1.4 vs. 5.1 ± 1.1 p = 0.0018; 26 ± 5.1 vs. 23 ± 4.0 p < 0.001, respectively) than the control group. Mean gestational age and birthweight were also significantly lower in the study group (38.5 ± 2.1 vs. 39.4 ± 1.7 p < 0.001; 2929 g ± 614.7 vs. 3225 ± 461.1 p < 0.001, respectively). Stratified analysis according to parity demonstrated that pregestational BMI, weight gain during pregnancy, and cesarean section (CS) were significantly higher in women with pregnancy-induced hypertension than in controls in all parity groups. Maternal age and mean GCT levels of women with pregnancy-induced hypertension were higher in all parity groups but statistically significant only among multiparous patients. Multiple logistic regression demonstrated that BMI, weight gain, and maternal age were independently associated with pregnancy-induced hypertension, while GCT level was not. Conclusions. Elevated pregestational BMI is an independent risk factor for development of pregnancy-induced hypertension (PIH). Its association with elevated GCT levels implies that even without overt diabetes, glucose intolerance may play a role in the pathogenesis of preeclampsia in obese patients.     

Association of Antithrombin Activity with Plasma Aldosterone Concentration and Plasma Renin Activity in Pregnant Women

Objective. To test the hypothesis that the blood antithrombin (AT) activity is correlated with the plasma aldosterone concentration (PAC), the plasma renin activity (PRA), and/or the PAC-to-PRA ratio during the late stage of pregnancy. Methods. The AT activity, PAC, and PRA were determined within 7 days prior to delivery in 47 women, consisting of 30 normotensive and 6 hypertensive women with singleton pregnancies and 11 normotensive women with twin pregnancies. Results. The median values of the 47 women were 86% of the normal activity level for the AT activity, 442 pg/mL for the PAC, 3.7 ng/mL/h for the PRA, and 108 pg/mL per ng/mL/h for the PAC-to-PRA ratio. Women with an AT activity ≤86% had a significantly lower PRA and a higher PAC-to-PRA ratio than women with an AT activity >86% (3.5 ± 3.0 vs. 6.6 ± 4.7 ng/mL/h for PRA, p = 0.008; 156 ± 109 vs. 97 ± 46 pg/mL per ng/h for PAC-to-PRA ratio, p = 0.021). The AT activity was significantly correlated positively with the PRA and negatively with the PAC-to-PRA ratio. Conclusions. The existence of a common pathophysiological background between a reduced AT activity and a reduced PRA during the late stage of pregnancy was suggested.     

Maternal Adjustment and Maternal Attitudes in Adolescent and Adult Pregnant Women

Study ObjectiveThis study analyzes differences between adolescent and adult pregnant women and the contribution of maternal age to maternal adjustment and maternal attitudes during pregnancy.Design, Setting, and ParticipantsA sample of 398 Portuguese pregnant women (111 younger than 19 years) was recruited in a Portuguese Maternity Hospital and completed the Maternal Adjustment and Maternal Attitudes Questionnaire between the 24^th and 36^th weeks of gestation.Main Outcome MeasuresMaternal Adjustment and Maternal Attitudes Questionnaire¹ResultsAdolescent pregnant women show lower maternal adjustment (poorer body image and worse marital relationship) and poorer maternal attitudes (more negative attitudes to sex) than adult pregnant women. When controlling for socio-demographics, age at pregnancy predicts poorer body image and more negative attitudes to sex, but not a worse marital relationship, more somatic symptoms or negative attitudes to pregnancy and the baby. A worse marital relationship was better predicted by living without the partner, and more somatic symptoms and negative attitudes to pregnancy and the baby was predicted by higher education.ConclusionAdolescent pregnant women show lower maternal adjustment and poorer maternal attitudes than adult pregnant women according to socio-demographics and unfavorable developmental circumstances.     

Correlation between Human Placental Lactogen Levels and Glucose Metabolism in Pregnant Women with Intrauterine Growth Retardation

Twenty pregnant women with fetal growth retardation and 20 pregnant women with appropriate for gestational age fetuses (controls) were recruited after the 28th week of gestation. Samples were collected for estimation of serum insulin and human placental lactogen (HPL) levels in the fasting state and a glucose tolerance test was carried out on all the subjects. The results showed the glucose and HPL levels to be significantly lower in the fetal growth retardation group compared to controls. There were no differences in the fasting serum insulin levels in the 2 groups. Fetal growth retardation appears to be linked with the absence of development of the physiological 'diabetogenic' state in the second half of pregnancy. This maternal hypoglycaemic state is associated with low HPL levels and not with raised maternal insulin levels as measured in the fasting state.     

Long-Term Prognosis of Women with Abnormal Glucose Tolerance in Pregnancy

Summary: A 6-year-follow-up of 193 Chinese women with abnormal glucose tolerance (75 g OGTT, WHO criteria) during pregnancy was compared with a control group of 58 women with normal glucose tolerance during pregnancy in the same period. In the study group, 18 (9.3%) had diabetes and 38 (19.7%) had impaired glucose tolerance i.e. 56 (29.0%) had abnormal glucose tolerance compared with 3 (5.2%), 5 (8.6%) and 8 (13.8%) respectively in the control group. The incidence of abnormal glucose tolerance was significantly higher in the study group. In the study group, the serum glucose (fasting 6 mmol/L or above, 2 hours 11.0 mmol/L or above) during pregnancy and at 6 weeks postpartum were predictive of the development of diabetes. Age, obesity, history of diabetes in first degree relatives, previous baby over 4 kg, body mass index at follow-up, recurrent abnormal glucose tolerance during pregnancy and use of oral contraceptives within 6 months of follow-up were not.     

Relationship of Fetal Macrosomia to a 75g Glucose Challenge Test in Nondiabetic Pregnant Women

Summary: We determined in nondiabetic women, the relationship of plasma glucose values obtained 2 hours after a 75 g oral glucose challenge test (GCT) at 16–20 weeks' gestation, with the incidence of macrosomia in term deliveries (37–41 weeks' gestation). From 1988–1990, in a systematic screening programme data collected prospectively from 1,331 women were analysed retrospectively. Women with gestational diabetes or impaired glucose tolerance (n = 53) were excluded. The rest (n = 1,278) had no evidence of glucose intolerance including 1,215 women with normal plasma glucose by GCT (< 7.8 mmol/L 2 hours after 75 g oral glucose load) and 63 women with abnormal GCT but no abnormal value at a glucose tolerance test. The GCT values were divided into 5 groups: Group A (< 4.5 mmol/L), B (4.5-5.5 mmol/L), C (5.6-6.6 mmol/L), D (6.7-7.7 mmol/L) and E (> 7.8 mmol/L). The variables studied were age, parity, gestational age at delivery and incidence of macrosomia.
Using <4 kg birth-weight as the definition of macrosomia, the incidence increased from 1.2% to 9.5% with increasing plasma glucose values in the GCT from Group A (< 4.5 mmol/L) to E(> 7.8 mmol/L). Similar trends of increasing incidences from 7.2% to 15.8% and 2.9% to 9.5% were noted when 90th and 95th birth-weight percentiles, respectively were used as definitions of macrosomia. The test of linear trend in this association was significant (p < 0.01). These results were not influenced by parity or gestational age at delivery.
These data provide new information to help explain the biology of macrosomia and also highlight the need for stricter criteria for diagnosis and treatment of glucose intolerance.     

肥胖孕妇外周血及脐血肥胖抑制素与母儿体质指标的相关性

目的:探讨肥胖孕妇外周血与脐血肥胖抑制素(Obestatin)浓度与母儿体质指标的关系。方法:选取中国人民武装警察部队后勤学院附属医院2013年8月—2014年9月分娩的肥胖孕妇30例作为肥胖组,取同期正常体质量孕妇35例作为对照组,于孕晚期抽取外周血,于分娩时抽取脐静脉血,采用酶联免疫吸附(ELISA)法测定Obestatin浓度。同时记录母亲体质量,记录新生儿出生体质量,LANGE皮脂厚度测量仪测定新生儿肩胛下、大腿、髂上、肱三头肌及腹壁皮褶厚度。结果:对照组外周血Obestatin水平比肥胖组高,差异有统计学意义(t=16.707,P=0.000);肥胖组孕妇外周血Obestatin浓度与BMI呈负相关(r=-0.898,P=0.000)。肥胖组新生儿脐血Obestatin浓度与体质量、腹壁皮褶厚度呈负相关(r=-0.789,P=0.000;r=-0.840,P=0.018)。结论:肥胖孕妇外周血Obestatin浓度与母体产前BMI有关;脐血Obestatin浓度与新生儿体质指标有关。     

子痫前期患者与正常孕妇血清脂质组学成分对比分析

目的：对子痫前期（pre-eclampsia,PE）患者和正常孕妇血清中脂质成分进行对比分析。方法：纳入西安医学院第一附属医院产科2019年1月1日—7月1日收治的PE患者16例为PE组,选取同期自然分娩正常孕妇16例为正常对照组（NC组）,收集2组患者血清。采用超高效液相色谱串联质谱（ultra-performance liquid chromatography tandem mass spectrometry,UPLC-MS/MS）法对各组患者血清中的甘油磷脂、鞘脂、甘油酯、甾醇类及脂肪酸五大类脂质成分进行分析。结果：2组孕妇年龄和采血时体质量指数（BMI）差异无统计学意义（P>0.05）。PE组患者妊娠时间低于NC组（P<0.05）。对2组患者血清中5大类脂质共计25种脂质成分进行分析,相比于NC组,PE组的甘油磷脂、鞘脂、甘油酯和甾醇类表达差异无统计学意义（P>0.05）。PE组患者血清中游离脂肪酸（free fatty acid,FFA）含量高于NC组,差异有统计学意义（P<0.05）。进一步对13种不同类型FFA进行分析,发现PE组孕妇血清中FFA2...