妊娠期糖尿病IADPSG诊断标准的探讨

目的:探讨国际糖尿病与妊娠关系研究协会(IADPSG)推荐的妊娠期糖尿病(GDM)新标准(2011年ADA诊断标准)是否适用于我国。方法:选取2011年6月至2012年2月在暨南大学附属第一医院妇产科产检的孕妇1101例,于妊娠24～28周行葡萄糖耐量实验(OGTT)。结果:(1)纳入研究的1054例孕妇OGTT空腹、1h、2h血糖的95%医学参考值分别为5.2、10.7、9.1 mmol/L;90%医学参考值分别为5.0、9.9、8.5mmol/L。(2)2011年ADA诊断标准诊断GDM的发病率为18.7%,显著高于第7版《妇产科学》诊断标准(4.2%)、日本诊断标准(4.4%)及本研究95%参考值(10.3%)(P'均<0.005);(3)空腹血糖与餐后1h血糖、餐后2h血糖的相关性较低;依据第7版《妇产科学》及2011年ADA诊断标准诊断为GDM者分别为44例和197例,其中空腹血糖≤4.4mmol/L者分别为11例(25%)和66例(33.5%)。结论:(1)在获得我国相关临床研究数据之前,IADPSG诊断标准在我国的全面推广会显著增加GDM发病率,值得商榷;(2)不建议使用空腹血糖排除GDM,即使空腹血糖≤4.4mmol/L。     

妊娠期糖尿病诊断标准的探讨

目的　探讨妊娠期糖尿病 ( GDM)的诊断标准。　方法　对 1 578例孕妇进行血糖筛查试验 ,阳性者进行葡萄糖耐量试验 ( OGTT)。按照世界卫生组织 ( WHO)、美国糖尿病资料组 ( NDDG)和国内 (董志光等 )三种诊断标准对孕妇进行诊断并分组 ,随机选择糖筛查试验阴性孕妇 1 0 0例作为对照组 ,对四组母儿妊娠结局进行比较。　结果　血糖筛查试验阳性 2 76例 ,OGTT试验达到 WHO、NDDG、国内标准者分别为 3 3、60、68例 ,检出率分别为 2 .1 % ( 3 3 / 1 578) ,3 .8% ( 60 / 1 578) ,和 4 .3 %( 68/ 1 578)。各 GDM组间比较 ,产母重度妊高征、羊水过多、羊水过少、巨大儿的发生率和剖宫产率均无显著性差异 ( P>0 .0 5) ,而与对照组相比 ,存在显著性差异 ( P<0 .0 5)。　结论　及时诊断并积极处理 GDM对获得良好的妊娠结局是极为必要的。 WHO标准过于严格 ;NDDG标准可以应用 ,但有漏诊的可能 ,国内标准有待大样本证实。     

妊娠期糖尿病新旧两种诊断标准对妊娠结局的影响

目的:探讨妊娠期糖尿病(GDM)两种诊断标准对妊娠结局的影响。方法:回顾分析2011年9~11月及2012年9~11月在济南市妇幼保健院分娩的878例和1080例孕妇的临床资料,两时段分别采用GDM旧诊断标准和新诊断标准。采用旧标准诊断的54例GDM孕妇作为旧标准GDM组,其余824例为旧标准正常组;采用新标准诊断的GDM孕妇168例为新标准GDM组,其余912例为新标准正常组。GDM组孕妇给予个体化营养管理,正常组孕妇纳入常规产前保健管理。比较两组GDM患者的母婴结局。结果:新标准组和旧标准组的GDM发生率分别为15.56%和6.15%,差异显著(P0.005)。旧标准GDM孕妇的体重指数(BMI)高于新标准GDM组(P0.05);而剖宫产、早产、产后出血、羊水过多、巨大儿及妊娠期高血压疾病发生率无显著差异(P0.05)。旧标准正常组的妊娠期高血压疾病发生率显著高于新标准正常组(P0.005);而剖宫产、早产、产后出血、羊水过多及巨大儿发生率无显著差异(P0.05)。结论:新诊断标准可检出更多存在血糖问题的孕妇,合理管理GDM患者可能有助于降低妊娠期高血压疾病的发生率。     

妊娠期糖尿病诊断标准的新探讨

目的探讨适合国内孕妇的妊娠期糖尿病(GDM)诊断标准。方法选取2000年6月至2002年7月在本院行产前检查并分娩,无显性糖尿病及其他内分泌疾病的340例孕妇为研究对象,其中190例为非高危孕妇组,其余150例为高危孕妇组。每位孕妇在孕24～28周时行100g葡萄糖3小时OGTT。以正常孕妇组100g葡萄糖3小时OGTT静脉血糖值的第97.5百分位值为本研究确定的诊断标准。结果本研究确定的诊断标准即空腹5.2mmol/L;服糖后1小时10.3mmol/L;服糖后2小时8.9mmol/L;服糖后3小时7.7mmol/L为阳性。以此4项中2项以上阳性为GDM,1项阳性为糖耐量异常(IGT),4项均阴性为正常。本研究新诊断标准与Carpenter/Coustan标准诊断GDM的一致性更高,Kappa值为0.83(P<0.001)。结论当采用葡萄糖氧化酶法测定血浆葡萄糖值时,100g糖耐量试验的Carpenter/Coustan标准也是适合中国人的GDM诊断标准。     

妊娠期糖尿病的筛查与诊断

妊娠合并糖尿病是妊娠期最常见的内科合并症之一,它包括孕前患有糖尿病者妊娠,以及妊娠期糖尿病（gestational diabetes mellitus,GDM）.GDM是指妊娠期发生或首次发现的不同程度的糖耐量异常,约占妊娠合并糖尿病的80%～90%.20世纪50年代初国外一些学者（如Burt等）研究发现妊娠期胰岛素的敏感性、降解等发生一定变化,提出妊娠期糖尿病诊断标准应与非孕期不同.1964年,O＇Sullivan和Mahanz对该病进行描述,并提出孕期口服葡萄糖耐量试验（oral glucose tolerance test, OGTT）结果与孕妇将来是否发生2型糖尿病密切相关.1979年世界卫生组织将该病列为糖尿病的一个独立类型.     

妊娠期糖尿病新诊断标准应用后面临的问题

一、妊娠期糖尿病诊断标准的变更长期以来,妊娠期糖尿病（gestational diabetes mellitus,GDM）的国内、外诊断标准未达成一致。2007年我国制定的妊娠合并糖尿病临床诊断与治疗推荐指南（草案）[1],推荐采用75g口服葡萄糖耐量试验.     

减少糖耐量试验检测次数在妊娠期糖尿病诊断中的临床意义

目的:探讨减少口服糖耐量试验(OGTT)血糖检测次数在妊娠期糖尿病(GDM)诊断的可行性.方法:对2005年1月1日至2007年12月31日在我院产前检查,门诊确诊为GDM的235例孕妇的OGTT4次检测结果的资料进行回顾性分析.取235例患者的空腹、服糖后1小时、2小时、3小时检测血糖值为四点法组,再次选取其中服糖后1小时、2小时、3小时检测血糖值为三点法组:再次选取其中服糖后1小时、2小时血糖值为两点法组.3种方法均采用血糖值有两次异常即诊断为GDM.并比较3种方法的诊断率.结果:四点法组与三点法组诊断率比较差异无统计学意义(P=0.061),四点法组与两点法组诊断率比较差异有高度统计学意义(P=0.000).结论:三点法标准抽血次数少、诊断率高、漏诊率低,孕妇依从性好.     

妊娠期糖尿病孕妇行葡萄糖耐量试验后的血压变化

高血压和糖尿病往往并存 ,并与高胰岛素血症和胰岛素抵抗有关[1,2 ] 。有报道显示 ,妊娠期糖尿病患者 ,妊娠高血压综合征 (妊高征 )、先兆子痫的发生率高于正常孕妇 ,提示妊高征和先兆子痫的发生与葡萄糖耐量受损的程度有关[3 ] 。目前 ,尚不清楚血压正常的妊娠期糖尿病孕妇的血压改变 ,是否与行葡萄糖耐量试验 (ｏｒａｌｇｌｕｃｏｓｅｔｏｌｅｒａｎｃｅｔｅｓｔ,ＯＧＴＴ)的结果有关。本研究旨在探讨血压正常的妊娠期糖尿病孕妇 ,其ＯＧＴＴ值与平均动脉压之间的关系。一、资料和方法1.对象选择 :选择 1999年 1月至 1999年 12月 ,在香港…     

全国部分城市妊娠期糖尿病发病情况的调查及适宜诊断标准的探讨

目的 了解我国妊娠期糖代谢异常的发病现状,探讨适合我国卫生经济条件的妊娠期糖代谢异常的诊断标准.方法 前瞻性研究2006年4月1日-9月30日在全国18个城市25家医院行产前检查并进行首次50 g口服葡萄糖负荷试验(GCT)的16 286例孕妇的临床资料,并对GCT检查结果异常(服糖后1 h血糖≥7.8 mmol/L)者行75 g口服葡萄糖耐量试验(OGTT),对结果进行统计学分析.比较采用美国糖尿病学会(ADA)标准和美国国家糖尿病数据组(NDDG)标准诊断妊娠期糖代谢异常的发生率,以及妊娠期糖尿病(GDM)、妊娠期糖耐量受损(GIGT)及糖代谢正常孕妇OGTr各时间点(空腹、1 h、2 h、3 h)血糖的平均值.结果 按NDDG标准诊断,GDM及GIGT的发生率分别为2.763%(450/16 286)和3.862%(629/16 286);按ADA标准诊断则分别为5.078%(827/16 286)和5.268%(858/16 286);符合ADA标准中2项及以上异常者为841例,符合NDDG标准中1项及以上异常者为1034例,同时符合以上两个条件者为792例,分别占两者的94.2%(792/841)和76.6%(792/1034).采用ADA标准诊断的糖代谢正常者OGTF各时间点(空腹、1 h、2 h、3 h)血糖值的95%可信区间上限依次为5.3、10.4、8.7、7.7 mmol/L,与NDDG标准(分别为5.4、10.8、9.1、7.8 mmol/L)基本一致.结论 目前,妊娠期糖代谢异常发生率呈现增加趋势.ADA标准适合我国GDM的诊断,据我国目前的卫生经济情况,对NDDG标准中l项及以上异常者或对ADA标准中2项及以上异常者进行干预都是合理的.     

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.     

Postnatal testing for diabetes in Australian women following gestational diabetes mellitus

Background:  Postnatal blood glucose testing is recommended for reclassification of glucose tolerance following a pregnancy affected by gestational diabetes mellitus (GDM); however, there are limited data on the postnatal follow-up sought by Australian women.
Aims:  To describe postnatal diabetes testing patterns in Australian women following a pregnancy affected by GDM and identify factors associated with return for follow-up testing in accordance with the Australasian Diabetes in Pregnancy Society (ADIPS) guidelines.
Methods:  A cross-sectional self-administered survey of 1372 women diagnosed with GDM between 2003 and 2005, sampled from the National Diabetes Services Scheme database.
Results:  Postnatal diabetes testing was reported by 73.2% of survey respondents with 27.4% returning for an oral glucose test tolerance at six to eight weeks post-GDM pregnancy. Using logistic regression analysis, factors associated with appropriate postnatal testing were receiving individualised risk reduction advice (odds ratio (OR) 1.41 (1.08,1.84)) or written information (OR 1.35 (1.03,1.76)) and in two-way interactions, being under the care of an endocrinologist and not tertiary educated (OR 2.09 (1.49,2.93)) as well as seeing an obstetrician and diabetes educator during pregnancy (OR 1.72 (1.19,2.48)). Every five years increase in age reduced the likelihood of a woman returning for testing by 17%.
Conclusions:  Specialist diabetes care in non-tertiary educated women, or a team approach to management with diabetes education and obstetric care may act to reinforce the need for postnatal diabetes testing in accordance with the ADIPS guidelines. Individualised follow up from a health professional and provision of written information following a GDM pregnancy may also encourage return for postnatal testing in this high-risk group.     

Screening for gestational diabetes mellitus in southern Asian women

AIM: To compare fasting plasma glucose (FPG) against 2-h postprandial plasma glucose (PPPG), following a carbohydrate meal, for screening of gestational diabetes mellitus (GDM) in southern Asian women with one or more risk factors. METHODS: A comparative study was conducted at a university obstetric unit in Sri Lanka. Two hundred and seventy one women undergoing oral glucose tolerance test (OGTT) according to the WHO criteria of 1999 had a 2-h PPPG performed within the following week. Sensitivity, specificity, predictive values and correlation coefficients for predicting a diagnosis of GDM and areas under receiver-operator curves (ROC) were calculated for FPG and PPPG. The ability to predict GDM and to reduce the need for OGTT were the main outcome measures. RESULTS: The mean period of gestation was 26.43 weeks (SD = 5.4) Seventy-five (27.7%) women were diagnosed with GDM. The optimal threshold for FPG was 4.4 mmol/L and for PPPG 4.7 mmol/L. At these, sensitivity was 92.0% and 90.7%, specificity 48.7% and 25.4% and the areas under the ROC 0.82 and 0.73 for FPG and PPPG, respectively. Nine (12%) women could be diagnosed as having GDM on the basis of the FPG being above the threshold. CONCLUSIONS: FPG is superior to 2-h PPPG for screening high-risk women for GDM. Nine women were diagnosed as having GDM on the basis of having an FPG above 7 mmol/L. FPG could reduce the number of OGTT needed by 40.9%, compared to 20.6% by PPPG. FPG is a less cumbersome and cost-effective screening test.     

Gamma-glutamyltransferase level in pregnancy is an independent risk factor for gestational diabetes mellitus

Aim:  To evaluate the relationship between gamma-glutamyltransferase (GGT) level in pregnant women at oral glucose tolerance test (OGTT) and the diagnosis of gestational diabetes (GDM).
Methods:  Blood was taken for analyzing GGT level from women at high risk of GDM at the time of their scheduled OGTT. GDM was diagnosed according to World Health Organization 1999 criteria.
Results:  GGT level correlated positively with the 2-hour glucose level (Spearman's rho = 0.112: P  < 0.05). GGT values that were stratified into quartiles demonstrated a significant trend with diagnosis of GDM (χ² for trend; P  = 0.03). Multivariable logistic regression analysis taking into account maternal age, gestational age at OGTT, body mass index and a positive 50-g glucose challenge test (GCT) indicated that high GGT was an independent risk factor for GDM (adjusted odds ratio [AOR] 2.1 95% CI 1.2–3.8: P  = 0.01). In the subset of women identified by a positive GCT, on multivariable logistic regression analysis, only high GGT was an independent risk factor for GDM (AOR 2.3 95% CI 1.3–4.2: P  = 0.007).
Conclusion:  Raised GGT level is an independent risk factor for GDM in high risk pregnant women undergoing OGTT.     

妊娠期糖尿病不同诊断标准与妊娠结局

目的　通过对 85 0例糖筛查异常孕妇口服 75 g葡萄糖耐量试验 (OGTT)结果和妊娠结局的分析 ,了解妊娠期糖代谢异常不同诊断标准与妊娠结局的关系。　方法　对 2 0 0 1年 1月 1日至 2 0 0 3年12月 3 1日在我院分娩、5 0 g糖筛查异常、OGTT结果不符合我院使用的Fernando标准、未诊断妊娠期糖尿病 (GDM )和糖耐量受损 (GIGT)的 85 0例孕妇进行回顾性研究。将 85 0例孕妇分成两组 :符合董志光等人妊娠期糖尿病 (GDM )和糖耐量受损标准组 (第一组 )及不符合组 (第二组 )。　结果　妊娠期糖代谢异常发生率为 2 3 .76% (2 0 2例 ) ,以董志光诊断标准 ,其中GDM 3 7例 ,占 4.3 5 % ,IGT 165例 ,占 19.41%。新生儿平均出生体重为 (3 461.4± 475 .9)g ,高于不符合组 [(3 40 7.8± 43 8.4) g ,P <0 .0 1]。巨大儿发生率虽高一些 ,但无统计学差异。剖宫产率两组间也无差异。妊娠期合并症如妊娠高血压综合征、胎膜早破和早产的发生率 ,以及新生儿低血糖、黄疸和低出生体重儿的发生率两组间均无差异。　结论　按Fernando标准 ,糖筛查异常人群中将有 2 3 .76%的糖代谢异常者被漏诊 ,但发生妊娠高血压综合征、胎膜早破、早产、剖宫产、新生儿低血糖、黄疸和低出生体重儿的危险性并无明显增加。如按董志光等人的标准 ,将     

瘦素与妊娠期糖尿病胰岛素抵抗的关系

目的　探讨瘦素与妊娠期糖尿病 (GDM)胰岛素抵抗 (IR)关系及在GDM发病机制中的作用。方法　应用放射免疫法测量 32例GDM妇女、 30例正常糖耐量妊娠妇女 (NGT)的空腹瘦素、C肽水平及空腹胰岛素和 75g葡萄糖耐量试验 (OGTT)后 2h的胰岛素水平。应用稳态模型胰岛素抵抗指数 (HOMA -IR)及胰岛分泌功能指数 (HBCI) ,比较两组HOMA -IR及HBCI的差异 ,分析两组空腹瘦素与IR之间的关系。结果　①GDM组HOMA -IR (2 3± 0 3)高于NGT组 (1 4± 0 4 ) ,差异有显著性 (P <0 0 1) ;两组间HBCI比较差异无显著性 (P >0 0 5 )。②GDM组血清瘦素水平 (2 4 7± 2 2 )ng ml高于NGT组 (2 0 3± 1 5 )ng ml,两组之间比较差异有显著性 (P <0 0 5 )。相关分析表明 ,在GDM组瘦素与HOMA -IR呈正相关 (rLeptin =0 5 4 8,P <0 0 0 1) ,在NGT组二者之间无相关性 (rNGT =0 2 2 1P >0 0 5 )。结论　妊娠期IR程度增加 ,可能是GDM主要的发病机制之一。瘦素与GDM胰岛素抵抗有关 ,可能参与GDM的发病     

Gestational diabetes: comparision of the carpenter and the coustan thresholds with the new thresholds of Turkish women and implications of variations in diagnostic criteria

Objective: To find optimal 100-g 3-h oral glucose tolerance test (OGTT) threshold levels for diagnosis of gestational diabetes (GDM) in Turkish pregnant women. Methods: This study was conducted with 808 women screened for GDM between 24–28 weeks of gestation using the 1-h 50-g glucose challenge test (GCT) with a subsequent 3-h 100-g OGTT for confirmation if screen was positive. The glucose values obtained were analysed by both the Carpenter and Coustan (C&C criteria) and National Diabetes Data Group (NDDG) criteria for the diagnosis of GDM and IGT. Optimal OGTT cutoff values for Turkish population were calculated by ROC curve analysis. Results: The new diagnostic criteria, based on the result of the 100-g OGTT obtained from the healthy pregnant women, were 82.5, 171.5, 151.5, and 111.5?mg/dl at 0, 1, 2, and 3?h. The prevalence of GDM was 15.7% by the new criteria, 8.1% by C&C criteria, and 5.6% by the NDDG criteria. According to new criteria, 7.7% of infants of diabetic mothers had macrosomia. This ratio was 2.6% for non diabetic women. Conclusions: Ethnic differences, enviromental factors and nutritional habits may effect development of GDM. Application of some pre-determined nomograms to all races and ethnic groups can lead errors.     

Twin pregnancy outcomes for women with gestational diabetes mellitus compared with glucose tolerant women

OBJECTIVE: To examine pregnancy outcomes for women with gestational diabetes mellitus (GDM) and a twin pregnancy compared with glucose tolerant women with a twin pregnancy. DESIGN: Comparison of selected pregnancy outcomes. SETTING: Wollongong, New South Wales, Australia. POPULATION: Women with GDM seen over a 10-year period by an endocrinologist, and women from a selected year of an obstetric database including Wollongong and Shellharbour Hospitals. METHODS: Examination of pregnancy outcome data from the two sources. MAIN OUTCOME MEASURES: Fetal birthweights and method of delivery. RESULTS: There were 28 GDM women with a twin pregnancy from 1229 consecutive referrals (2.3%) of women with GDM for medical management. For comparison there were 29 glucose tolerant women with twin pregnancies evaluable who had delivered over a 1-year period. For the women with GDM and a twin pregnancy there were no significant differences in demographics or outcomes except for a higher rate of elective Caesarean section. CONCLUSION: The higher rate of Caesarean section appeared to be related to the combination of a twin pregnancy and GDM rather than the twin pregnancy or the GDM independently.