妊娠合并糖尿病母婴预后分析

目的总结分析妊娠合并糖尿病对孕产妇及围产儿结局的影响.方法回顾性分析我院10年来产科住院分娩的19例妊娠合并糖尿病人及34例健康孕妇的母婴预后情况.结果糖尿病组病理妊娠、羊水过多、胎婴儿并发症、早产、围产儿死亡、畸形发生率分别为78.9%、15.8%、100%、57.9%、15.8%,高于对照组50%、0%、41.2%、0%、0%.结论糖尿病严重影响母婴健康.对于孕妇,主要是造成羊水过多;对于胎婴儿,主要是引起早产、围产儿死亡及畸形.以上各项均与母体孕期血糖控制情况相关,尤其是围产儿死亡,未治疗者围产儿死亡率很高.     

妊娠糖尿病对母婴影响的分析

目的探讨妊娠糖尿病（GDM）对母婴影响。方法观察妊娠糖尿病患者36例及健康孕妇36例,分析其妊娠结局。结果GDM组妊娠期高血压疾病、早产、巨大儿及剖宫产发生率分别为41.7%、27.7%、25%及58.3%,明显高于对照组16.7%、8.3%、5.5%及27.7%,差异有显著性（P〈0.05）。结论GDM是危害孕产妇和围产儿的妊娠并发症,早期诊断GDM及控制血糖是减少母婴并发症的关键。     

妊娠合并糖尿病的优生探讨

妊娠合并糖尿病是妊娠期孕妇最常见的并发症之一,发病率为5%-20%[1].妊娠合并糖尿病按确诊时间可分为两类,一是在妊娠前已经确诊有糖尿病(包括糖尿病Ⅰ型和Ⅱ型),即孕前糖尿病(diabetes mellitus,DM),一是在妊娠期首次确诊为糖尿病,即妊娠期糖尿病(gestational diabetes mellitus,GDM).所谓妊娠期糖尿病是指在妊娠期间发生或首次识别的严重程度不同的糖类不耐受,且不排除糖类不耐受在妊娠前己经存在的可能性[2].     

正常妊娠、妊娠糖尿病和妊娠糖尿病合并高血压综合征及其有关因素的探讨

目的探讨正常妊娠.妊娠糖尿病.妊娠糖尿病合并妊娠高血压综合征孕妇有关脂类,肾功、糖、胱抑素C方面变化特点。方法将146例孕妇孕周都为35~40周分为3组。Ⅰ组,正常妊娠组45例;Ⅱ组,妊娠糖尿病组51例;Ⅲ组,妊娠糖尿病合并高血压综合征50例。结果(1)Ⅱ组、Ⅲ组较Ⅰ组血糖有显著差异(P0.01);(2)Ⅱ组、Ⅲ组脂类分析较Ⅰ组有显著差异(P0.01);(3)Ⅲ组较Ⅰ组、Ⅱ组肾功、胱抑素C比较有显著差异(P0.01)。结论妊娠期糖尿病的孕妇较正常的孕妇更容易诱发妊娠高血压综合征。     

妊娠糖尿病对母婴肠道菌群影响的研究进展

妊娠糖尿病(gestational diabetes mellitus,GDM)是一种高危妊娠并发症,近年来发病率逐渐升高,对孕妇和新生儿的健康产生了重要影响.肠道菌群是居住在人体肠道黏膜表面的微生物群,其丰度及多样性变化与人体健康状态联系紧密,互相影响.大量研究表明,GDM可影响母婴肠道菌群,紊乱的肠道菌群通过调节炎...     

妊娠合并糖尿病肝病患者孕期的护理

目的：试论妊娠合并糖尿病肝病患者孕期的护理。方法选取我院2011年6月~2012年8月所接收治疗的100例妊娠合并糖尿病肝病患者。随机分为观察组和对照组,对照组采用常规护理方法,观察组加用临床护理干预措施,对比两组患者的临床疗效。结果观察组患者的临床疗效显著高于对照组患者,<0.05差异具有统计学意义。结论对妊娠合并糖尿病肝病患者使用临床护理干预措施,可以有效的控制患者的临床症状,减少并发症,具有临床价值意义,可以大力推广。     

妊娠合并糖尿病孕产妇死亡病因分析

目的探讨加强妊娠合并糖尿病围产期保健。方法回顾分析2004年-2005年2年我省10例妊娠合并糖尿病孕产妇死亡病例,根据孕产妇死亡报告卡,了解如文化程度、孕产次、产前检查、分娩地点、抢救情况及死亡原因。结果死亡原因肾衰,多器官功能衰竭占70%,酮症酸中毒,高渗性昏迷及心衰、高血压脑病各占10%,孕产妇文化程度普遍较低,小学或文盲占60%,初中30%,高中仅占10%,70%未按受产前检查,接受3次或以上仅占10%,专家对死亡病例评审结果：医疗保健部门知识技能问题占30%,个人知识及家庭态度占50%。结论提高孕产妇文化素质,加强糖尿病基本知识教育,自觉进行产前检查,开展妊娠糖尿病筛查,正规使用胰岛素控制血糖,提高医疗保健部门知识技能,及时处理急性并发症,是围产期保健的关键。     

妊娠合并糖尿病34例临床分析

目的 探讨妊娠合并糖尿病对孕产妇并发症、分娩方式与围产结局、围产儿并发症的影响.方法 回顾性分析2001年1月1日至2006年9月30日34例在本院分娩的妊娠合并糖尿病（A组）与随机选择同期未发生糖尿病高危因素的正常孕产妇34例（B组）,就孕产妇并发症、分娩方式、围产结局、围产儿情况作比较分析.结果 患糖尿病组孕产妇体重指数＞30者及早产、妊娠期高血压疾病明显高于对照组,其他与对照组比较差异均无统计学意义.巨大儿、早产儿明显高于对照组,剖宫产率与对照组比较差异显著.结论 妊娠合并糖尿病对孕产妇并发症、分娩方式与围产结局有明显影响,需加强孕期管理和产时临床处理,减少母婴并发症.     

妊娠合并糖尿病对分娩结局的影响观察

目的 探讨妊娠合并糖尿病对分娩结局的影响。方法 选取我院收治的108例糖尿病产妇,随机分为A组和B组,各54例。A组采取常规检测、用药、运动以及健康宣教等措施,B组在对照组基础上增加饮食干预的治疗措施。选取同期54例健康产妇作为对照组。观察三组产妇的分娩结局,包括早产、胎膜早破、羊水过多和产后出血,以及新生儿状况,包括巨大儿、新生儿窒息、新生儿低血糖和低体质量儿。结果 与对照组相比,A、B两组产妇的分娩结局和新生儿状况相比,差异均具有统计学意义（P＜0.05）。B组产妇早产、胎膜早破、羊水过多和产后出血发生率优于A组,B组巨大儿、新生儿窒息、新生儿低血糖和低体质量儿发生率优于A组,差异均具有统计学意义（P＜0.05）。结论 妊娠期糖尿病患者临床需要给予充分的重视,确保早期发现和科学的治疗,治疗期间确保有效的饮食干预措施,可显著改善分娩结局,提高早产妇和新生儿的健康程度。     

远程胎心监护在高危妊娠的临床应用

目的探讨远程胎儿监护在高危妊娠的临床应用价值。方法 2012年1月至2013年12月我院产科门诊诊断为高危妊娠的孕妇61例作为研究组,孕35w以上采用远程胎儿监护终端部分进行无负荷试验(NST),选择同期高危妊娠孕妇63例在家中以胎动计数结合门诊常规NST检查作为对照组,分析两组胎心监测结果和围生儿结局。结果研究组61例孕妇中NST异常25例,检出率(41%)较对照组异常8例,检出率(13%)明显增高,研究组发生围生儿不良预后1例,发生率(1.6%),低于对照组发生围生儿不良预后5例,发生率(8%),有显著差异。结论应用远程胎儿监护对高危妊娠的监测,可改善围生儿不良预后的发生率,是高危妊娠孕妇自我监护有效、可行的途径。     

妊娠期糖尿病孕妇心率变异性变化

目的:探讨妊娠期糖尿病孕妇心率变异性变化.方法:选取阳春市妇幼保健院2018年1月至2020年4月收治的50例妊娠期糖尿病患者作为观察组,选取同期健康孕检孕妇50例作为对照组,年龄20～36岁,孕周24～40周.所有孕妇给予动态心电图监测,比较两组孕妇平均心率(AHR)、正常窦性RR间期的总体标准差(SDNN)、每5 ...     

抵抗素蛋白在妊娠糖尿病孕妇与正常孕妇胎盘的表达

目的了解抵抗素蛋白在妊娠糖尿病孕妇与正常孕妇胎盘的表达情况,探讨抵抗素与妊娠生理性胰岛素抵抗(insu lin resistance,IR)及妊娠糖尿病(gestational d iabetes m ellitus,GDM)的关系。方法W estern b lot法检测妊娠糖尿病孕妇与正常孕妇胎盘抵抗素蛋白表达情况;葡萄糖氧化酶法测定血糖,测量收缩压(SBP)及舒张压(DBP)。结果W estern b lot结果以OD值表示,GDM孕妇胎盘抵抗素蛋白的表达(79305±7645.12)显著高于正常孕妇胎盘的表达(50718±3818.20)(P<0.01)。结论妊娠糖尿病孕妇胎盘抵抗素蛋白的表达显著高于正常孕妇胎盘的抵抗素蛋白的表达;表明胎盘可分泌抵抗素;抵抗素是引起妊娠生理性胰岛素抵抗和妊娠糖尿病的一个细胞因子。     

妊娠糖尿病孕妇血浆抵抗素水平及其与胰岛素和血糖关系的研究

目的探讨妊娠期糖尿病(GDM)孕妇血浆抵抗素水平及其与胰岛素和血糖的关系。方法采用竞争性酶联免疫吸附法(ELI SA)检测25例GDM组孕妇和30例正常孕妇空腹血浆抵抗素水平;采用葡萄糖氧化酶法测定两组孕妇空腹血糖水平;采用电化学发光法测定两组孕妇的空腹血浆胰岛素水平。结果(1)GDM组孕妇空腹血浆抵抗素水平为(15.32±4.26)μg/L,正常妊娠组孕妇为(11.08±1.52)μg/L两组比较,差异有极显著性(P<0.01);(2)GDM组孕妇空腹血浆胰岛素,血糖水平分别为(13.18±3.25)m IU/L,(9.13±1.34)mmol/L正常妊娠组孕妇分别为(9.10±3.41)m IU/L,(4.72±1.05)mmol/L。两组比较差异有极显著性(P<0.01);(3)GDM组孕妇血浆抵抗素水平与胰岛素、血糖水平呈明显的正相关关系,相关系数(r)分别为0.812,0.573;正常妊娠组孕妇则无相关性。结论GDM孕妇血浆抵抗素水平升高,其抵抗素水平的高低与空腹血浆胰岛素及血糖水平相关。     

瘦素、脂联素与妊娠期糖尿病胰岛素抵抗关系的研究

目的探讨瘦素、脂联素与妊娠期糖尿病胰岛素抵抗的关系。方法采用稳态模型评估法评估正常糖耐量孕妇（NGT）糖耐量减低孕妇（GIGT）和妊娠期糖尿病孕妇（GDM）的胰岛素抵抗指数,采用放射免疫分析方法检测其血浆瘦素、脂联素、血糖及胰岛素水平。结果 GDM组和GIGT组HOMA-IR显著高于NGT组,GDM组HOMA-IR显著高于GIGT组。血清瘦素水平由NGT组到GIGT组和GDM组呈显著增高,瘦素与空腹胰岛素、孕晚期体重指数、HOMA-IR呈显著正相关;血清脂联素由NGT组到GIGT组和GDM组呈显著下降,脂联素与空腹胰岛素、孕晚期体重指数、HOMA-IR呈显著负相关。结论瘦素、脂联素水平与GDM患者IR程度密切相关,其水平可作为预测妊娠期糖尿病胰岛素敏感性的指标,将来可能是治疗妊娠期糖尿病的新靶点。     

妊娠期糖尿病胰岛素的应用

目的 研究妊娠期糖尿病（GDM）患者胰岛素应用特点.方法 分析2004年元月至2006年11月21例妊娠期糖尿病胰岛素治疗情况.结果 34周GDM患者胰岛素用量明显多于24周胰岛素用量.应用诺和灵R占66.67%,诺和灵R联合诺和灵N占33.33%（其中R-R-R-N占28.57%,N＋R-R-R-N占4.76%）.结论 妊娠期糖尿病胰岛素用量随孕周增加而变化,大部分GDM患者可采用短效胰岛素控制血糖,部分患者联用中效,不宜用长效胰岛素,分娩当天及产后减少或停用胰岛素.     

妊娠前体质指数和胎次对妊娠糖尿病发病的影响

目的：探讨妊娠前体质指数(body mass index,BMI)、胎次与妊娠糖尿病(gestational diabetes mellitus,GDM)发病的关系,并探讨其对妊娠糖尿病(GDM)发病的影响。方法：本研究选择我院2014年2月至2014年12月接受孕产期检查、临床资料完整的且患有妊娠糖尿病的孕妇262名,对其采取葡萄糖耐量实验(OGTT实验),按照WTO标准,对262例足月妊娠初产妇女在孕24~28周常规进行75 g口服糖耐量试验,并完整记录年龄、孕周、文化程度、妊娠前体质指数及胎次等临床资料。根据妊娠前体质指数(BMI)将孕妇分为BMI分为4组,BMI<18.5 kg/m2者为偏瘦组,BMI 18.5~23.0 kg/m2者为正常体质量组,BMI 23.1~25.0 kg/m2者为超重组,BMI>25.0 kg/m2为肥胖组,采用SPSS l8.0统计软件对资料进行描述性分析、两样本t检验、非条件Logistic回归分析两组孕妇妊娠前体质指数(BMI)、胎次与妊娠糖尿病的关系。结果：4组OGTT结果显示妊娠前超重或肥胖的孕妇发生妊娠糖尿病的风险高于正常和偏瘦体质量组;非条件logistic回归分析结果表明,影响GDM的因素依次为：胎次、体质指数、年龄、文化程度,各影响因素回归系数分别为：2.372、     

Factors associated with diabetes mellitus prediction among pregnant Arab subjects with gestational diabetes

There is scarcity of available information on the possible significant risk factors related to diabetes mellitus (DM) prediction among expectant Saudi mothers with gestational diabetes mellitus (GDM). The present study is the first to identify such risk factors in the Arab cohort. A total of 300 pregnant subjects (mean age 33.45 ± 6.5 years) were randomly selected from all the deliveries registered at the Obstetrics Department of King Fahad Medical City, Riyadh Saudi Arabia from April 2011 to March 2013. Demographic and baseline glycemic information were collected. A total of 7 highly significant and independent risk factors were identified: age, obesity, and family history of DM, GDM < 20 weeks, macrosomia, insulin therapy and recurrent GDM. Among these factors, subjects who had insulin therapy use are 5 times more likely to develop DMT2 (p-value 3.94 × 10^-14) followed by recurrent GDM [odds-ratio 4.69 (Confidence Interval 2.34-4.84); P = 1.24 × 10^-13). The identification of the risk factors mentioned with their respective predictive powers in the detection of DMT2 needs to be taken seriously in the post-partum assessment of Saudi pregnant patients at highest risk.     

A comparison of glyburide and insulin in women with gestational diabetes mellitus

BACKGROUND: Women with gestational diabetes mellitus are rarely treated with a sulfonylurea drug, because of concern about teratogenicity and neonatal hypoglycemia. There is little information about the efficacy of these drugs in this group of women. METHODS: We studied 404 women with singleton pregnancies and gestational diabetes that required treatment. The women were randomly assigned between 11 and 33 weeks of gestation to receive glyburide or insulin according to an intensified treatment protocol. The primary end point was achievement of the desired level of glycemic control. Secondary end points included maternal and neonatal complications. RESULTS: The mean (+/-SD) pretreatment blood glucose concentration as measured at home for one week was 114+/-19 mg per deciliter (6.4+/-1.1 mmol per liter) in the glyburide group and 116+/-22 mg per deciliter (6.5+/-1.2 mmol per liter) in the insulin group (P=0.33). The mean concentrations during treatment were 105+/-16 mg per deciliter (5.9+/-0.9 mmol per liter) in the glyburide group and 105+/-18 mg per deciliter (5.9+/-1.0 mmol per liter) in the insulin group (P=0.99). Eight women in the glyburide group (4 percent) required insulin therapy. There were no significant differences between the glyburide and insulin groups in the percentage of infants who were large for gestational age (12 percent and 13 percent, respectively); who had macrosomia, defined as a birth weight of 4000 g or more (7 percent and 4 percent); who had lung complications (8 percent and 6 percent); who had hypoglycemia (9 percent and 6 percent); who were admitted to a neonatal intensive care unit (6 percent and 7 percent); or who had fetal anomalies (2 percent and 2 percent). The cord-serum insulin concentrations were similar in the two groups, and glyburide was not detected in the cord serum of any infant in the glyburide group. CONCLUSIONS: In women with gestational diabetes, glyburide is a clinically effective alternative to insulin therapy.     

Missed opportunities for diabetes prevention: post-pregnancy follow-up of women with gestational diabetes mellitus in England

Background

Women with gestational diabetes mellitus (GDM) should be followed-up to exclude ongoing diabetes and for prevention of type 2 diabetes. The National Institute for Health and Clinical Excellence (NICE) diabetes in pregnancy guideline recommends checking fasting plasma glucose (FPG) at 6 weeks postpartum (short term), and annually thereafter (long term).

Aim

To examine the reported practice regarding GDM follow-up.

Design and setting

Nationwide postal survey in England 2008-2009.

Method

Questionnaires were distributed to a consultant diabetologist and obstetrician in all maternity units, and to a random sample of general practices (approximately 1 in 5).

Results

Response rates were: 60% (915/1532) GPs, 93% (342/368) specialists; 80% of GPs and 98% of specialists reported women with GDM had short-term follow-up. More GPs (55%) than specialists (13%) used a FPG test to exclude ongoing diabetes; 26% of GPs versus 89% of specialists thought the hospital was responsible for ordering the test. Twenty per cent of GPs had difficulty in discovering women had been diagnosed with GDM in secondary care. Seventy-three per cent of specialists recommended long-term follow-up; only 39% of GPs recalled women with GDM for this. A minority of GPs and specialists had joint follow-up protocols

Conclusion

Follow-up of GDM in England diverged from national guidance. Despite consensus that short-term follow-up occurred, primary and secondary care doctors disagreed about the tests and responsibility for follow-up. There was lack of long-term follow-up. Agreement about the NICE guideline, its promotion and effective implementation by primary and secondary care, and the systematic recall of women with GDM for long-term follow-up is required.