糖尿病孕妇血糖水平与围产结局的临床研究

目的研究孕妇妊娠期血糖控制水平与围产结局,降低糖尿病孕产妇及其围产儿死亡率。方法将62例妊娠期糖尿病（GDM）产妇分为2组：a组为经产前血糖筛查发现并确诊,血糖控制达理想程度者45例,b组为产前确诊但孕期血糖控制不理想者9例,未经诊断的8例,共17例。收集并比较分析2组孕产妇及围产儿并发症情况。结果孕妇血糖控制不良其妊高征、羊水过多、羊水过少、胎儿生长受限、剖宫产、巨大胎儿、新生儿窒息和呼吸窘迫综合征、低血糖的发生率明显升高。结论控制母体血糖水平,降低围产期并发症,及时诊断治疗,确保孕产妇及其围产儿的安全与健康。     

高血糖后代父系和母系糖脂代谢障碍的差异研究

目的：探讨糖尿病合并妊娠和妊娠期糖尿病（GDM）的SD大鼠后代中父系和母系糖脂代谢障碍的差异。方法分别把SD大鼠用STZ小剂量腹腔注射和STZ加高糖高脂饮食诱导成GDM和糖尿病合并妊娠模型,得到F1代大鼠后,分别与正常异性8周大鼠杂交产生F2代,分为对照组、GDM母系组、GDM父系组、糖尿病合并妊娠母系组与糖尿病合并妊娠父系组。测定F2代SD大鼠体质量、血糖、胰岛素、三酰甘油及瘦素水平。结果＜1周时,GDM父系组和GDM母系组体质量差异有统计学意义（P＜0．05）;8周时,糖尿病合并妊娠父系组和糖尿病合并妊娠母系组体质量差异有统计学意义（P＜0.05）;＜1周时的糖尿病合并妊娠组和8周时GDM组,父系组和母系组体质量差异均无统计学意义（P＞0．05）。8周时,糖尿病合并妊娠父系组和糖尿病合并妊娠母系组的胰岛素水平、三酰甘油水平差异有统计学意义（P＜0．05）,空腹血糖水平、瘦素水平差异均无统计学意义（P＞0．05）。GDM父系组与GDM母系组的空腹血糖水平、胰岛素水平和三酰甘油水平差异有统计学意义（P＜0．05）,瘦素水平差异无统计学意义（P＞0.05）。结论糖尿病大鼠的糖脂代谢障碍存在父系和母系差异,糖尿病合并妊娠性成熟期和GDM组出生时体质量差异父系组显著高于母系组。糖尿病合并妊娠母系组和GDM母系组TG水平的代谢障碍可能更明显。子代代谢障碍可能与宫内高血糖环境有关。     

Management of diabetes mellitus in pregnancy

Diabetes is a common problem in pregnancy and the incidence depends on the racial predisposition and geographical distribution where the reports originate. Despite improvement in perinatal care, many serious clinical problems are still associated with diabetes during pregnancy. The overall strategy of management includes early identification of diabetes during pregnancy, combined management to achieve optimal glucose control with dietary manipulation and insulin, maternal and fetal monitoring during the antenatal period and determination of the delivery time. Intensive intrapartum monitoring and neonatal care at delivery and thereafter are also essential. The outlook for the newborn of the diabetic mother has changed dramatically in recent years and both perinatal mortality and morbidity rate have declined as a result of pre-pregnancy preparation and meticulous control of maternal blood glucose throughout pregnancy. Successful pregnancy outcome depends on the cooperation of the patient, the obstetrician, the physician, the neonatologist and the health educator.     

妊娠期糖尿病孕妇血糖控制对妊娠结局的影响

目的:探讨妊娠期糖尿病孕妇血糖的控制对母体、围生儿并发症和妊娠结局的影响。方法:对定期产前检查的80例妊娠期糖尿病孕妇入院资料进行分析,医护人员将孕妇分为两组,每组有40例孕妇。对照组孕妇在妊娠期血糖控制不满意,试验组孕妇在妊娠期对血糖控制满意,比较两组的妊娠期高血压疾病、羊水过多、剖宫产、巨大儿、早产等情况。结果:试验组孕妇中1例孕妇发生妊娠期高血压疾病,2例孕妇发生感染,1例孕妇产后出血,2例孕妇羊水过多,其剖宫产率为20%,均低于对照组孕妇(剖宫产率为37.5%);试验组孕妇中有2例孕妇早产儿,1例患儿胎儿窘迫,2例患儿新生儿低血糖,低于对照组孕妇。结论:临床上,医护人员要重视血糖筛查,及时诊断妊娠期糖尿病,有效控制血糖,能够有效的改善产妇妊娠结局,减轻孕妇及其新生儿围生期并发症的发生率。     

妊娠糖尿病规范化治疗与妊娠结局的临床分析

目的观察妊娠糖尿病患者经规范化治疗后母婴患病率及不同血糖水平对妊娠结局的影响。方法对86例妊娠糖尿病患者采用规范化治疗后,分析其妊娠结局。结果妊娠糖尿病规范化治疗后与正常孕妇母婴患病率无显著性差异：空腹血糖在4．0～4．8mmol／L,餐后2h血糖在4．8-7．0mmol／L,糖化血红蛋白在5％～6．2％范围内妊娠糖尿病患者母婴患病率最低。结论妊娠糖尿病经规范化治疗能减少母婴并发症,妊娠结局与血糖及糖化血红蛋白水平密切相关。     

妊娠期糖尿病的代谢改变

妊娠期糖尿病是指妊娠期首次发生或首次识别的程度不同的葡萄糖不耐受,是一种多基因遗传的内分泌代谢疾病。WHO将妊娠期糖尿病列为与1、2型糖尿病并列的一个独立类型。为改善母、婴结局,应尽量将孕妇血糖控制在正常范围,血糖水平已经成为孕期饮食治疗与监护的关键评价标准。事实上,妊娠期糖尿病患者除糖代谢异常外,还存在脂类代谢、蛋白质代谢和微量元素代谢的异常。为了胎儿正常生长发育及母婴的远期健康,维持孕妇体内正常的糖、脂、蛋白质、微量元素代谢是不可忽视的。     

糖尿病合并妊娠的治疗对妊娠结局的影响

目的：通过对219例妊娠合并糖尿病产妇临床资料回顾性分析,评估妊娠合并糖尿病的治疗与妊娠结局的关系。方法：将219例妊娠合并糖尿病的产妇根据血糖控制水平分为两组,A组为血糖控制达理想水平者146例,B组为血糖控制不理想者61例及未治疗者12例,收集并比较两组孕妇及围产儿并发症情况。结果：A组孕期血糖控制达理想水平的产妇妊高征、早产、剖宫产、新生儿低血糖、新生儿窒息、死胎的发生率均显著低于孕期血糖控制不理想及未治疗者的发生率（P〈0.05）。结论：妊娠合并糖尿病的产妇良好控制血糖可降低产妇和围产儿并发症的发生率。     

妊娠期糖尿病及糖尿病合并妊娠对母婴预后的影响

目的：研究妊娠期糖尿病及糖尿病合并妊娠患者，血糖对妊娠结局的影响及糖尿病类型与母婴并发症的关系。方法：回顾分析1999—2004年60例妊娠期糖尿病，20例1型糖尿病，20例2型糖尿病患者及30例正常产妇的临床资料，观察其妊娠结局。结果：糖尿病孕妇及胎婴儿并发症发生率明显高于正常孕妇，且随血糖升高而增加。同类型的糖尿病孕妇及胎婴儿并发症的发生几率不全一致。结论：加强糖尿病孕妇血糖控制是减少母婴并发症的有效手段，不同类型的糖尿病，应给予不同的治疗建议以改善母儿预后。     

Maternal blood glucose control and outcome of diabetic pregnancy

The results of management of 128 consecutive pregnancies occuring in diabetic patients who received insulin from before conception and throughout pregnancy are described. Mean maternal blood glucose levels were at least 1 mmol/litre greater than levels reported in normal pregnancy. Thirty-nine percent of the neonates had significant morbidity; respiratory distress syndrome (7·7%), hypocalcaemia (4·6%) and polycythaemia (10%) could be related to higher maternal blood glucose levels. Neonatal hypoglycaemia (9·2%), hyperbilirubinaemia (13·8%) and birth weight corrected for gestational age were not directly related to maternal blood glucose. This degree of maternal blood glucose control has reduced the large for dates infants (greater than 90th centile for gestational age) to 7%. Further reduction in the morbidity of infants of diabetic mothers requires studies of physiological maternal blood glucose levels which may not be possible with conventional insulin treatment as well as further efforts to reduce prematurity.     

52例妊娠糖尿病临床指标对围生期母婴影响的研究分析

目的探讨妊娠糖尿病相关临床指标与母婴围生结局的关系。方法对比分析我院附属医院52例妊娠糖尿病产妇与相匹配的52例健康产妇母婴围临床资料。结果妊娠糖尿病组较正常组空腹血糖、收缩压和舒张压增高,新生儿体重和孕妇腹围增大,孕周缩短;血糖值与产妇孕次产次和胎儿身长呈线性相关关系:妊娠高血压综合征、巨大儿、胎儿窘迫和死产的发生率显著增高。结论血糖、血压、产妇产次孕次和腹围等指标与母婴结局密切有关,为综合分析妊娠糖尿病病情提供临床依据。     

妊娠期糖尿病患者血糖水平与新生儿出生体重关系分析

目的:进一步探讨妊娠期糖尿病患者血糖水平与新生儿出生体重之间的相关性。方法:选取本院2009年1月-2012年4月收治的124例孕妇为研究对象,针对孕妇的临床资料进行了回顾性分析和研究。结果:(1)在空腹血糖水平和新生儿出生体重两方面,妊娠糖尿病组均高于健康对照组,差异具有统计学意义(P0.05);(2)在巨大儿发生率方面,妊娠糖尿病组高于健康对照组,差异具有统计学意义(P0.05);(3)妊娠糖尿病组和健康对照组新生儿出生体重与孕妇血糖水平呈现出正相关的关系。结论:妊娠期糖尿病患者血糖水平与新生儿出生体重之间呈现出正相关的关系,因此针对孕妇血糖水平进行监测,对于预防巨大儿的发生具有重要的意义。     

妊娠期糖尿病的早期诊断及治疗对母婴预后的影响分析

目的:研究早期诊断及治疗妊娠期糖尿病对于母婴预后的影响。方法:将在本院进行孕期检查并检出妊娠期糖尿病患者63例作为研究组;将未于孕期进行血糖检查但在本院分娩前或因病就诊时检出妊娠期糖尿病的54例患者作为对照组;两组患者均于本院分娩,对比两组患者及围生儿并发症的发生情况。结果:对照组孕产妇妊娠期高血压疾病、羊水过多、早产并发症发生率均显著高于研究组,P<0.01,具有统计学显著差异性;对照组孕产妇胎儿窘迫及产后出血并发症发生率高于研究组,但不具有统计学意义,P>0.05。结论:尽早发现尽早治疗妊娠期糖尿病可有效预防母婴各类并发症的发生,提高母婴预后生存质量。     

妊娠期糖尿病的饮食护理

糖尿病孕妇的病情严重且复杂，由于孕期易发生流产、早产、畸胎及酮症酸中毒等，孕产妇及围产儿病死率增高。在针对糖尿病的治疗中，合理的饮食对于控制血糖特别重要。尤其是在妊娠各期，饮食护理能很好的控制血糖，减少妊娠中的危险。     

Diabetes and pregnancy

Diabetes in pregnant women is associated with an increased risk for maternal and neonatal morbidities and remains a significant medical challenge. Fortunately, the prognosis has changed dramatically, related to an increased clinical awareness of the potential risks for the mother and the infant, better health care and intensive treatment strategies to maintain the closest to normal metabolic milieu. Diabetes and pregnancy may be divided into pregestational diabetes (women previously diagnosed with type 1 or type 2 diabetes) and gestational diabetes defined as any glucose intolerance detected during pregnancy that has evolved from a diagnosis associated with the metabolic risk of type 2 diabetes to a clinical condition associated with higher risks for maternal and perinatal morbidity. Early diagnosis of gestational diabetes is an important step to improve outcomes and systematic or selective screening with the OGTT should be established. Associated with the global epidemic in diabetes, pregnancy associated with diabetes is saturating high-risk obstetric clinics and neonatal intensive care units, becoming a heavy burden to the health care systems around the world.     

妊娠期糖尿病与母儿预后临床分析

目的:探讨妊娠期糖尿病(GDM)对母体并发症、围生儿结局的影响及科学控制血糖与母婴预后的关系。方法:通过对58例妊娠期糖尿病(GDM)患者的临床资料分析,根据血糖控制理想与否分为两组:血糖控制理想组A组(40例)血糖控制不理想组B组(18例),观察GDM孕产妇并发症及围生儿并发症的情况。结果:血糖控制理想组的GDM孕产妇妊高征、胎膜早破、胎儿窘迫、早产、新生儿低血糖、巨大儿的发生率显着低于血糖控制不理想组,两组比较差异有显著意义。结论:重视孕期糖筛查可以尽早诊断妊娠期糖尿病,积极科学合理控制血糖水平,可以降低GDM孕产妇和围生儿并发症的发生率。     

58例妊娠合并糖尿病的临床观察

目的 探讨妊娠合并糖尿病对母儿所造成的影响以及治疗对妊娠结局的影响。方法 选择1994～2003年间妊娠合并糖尿病孕妇58例与同期65例正常孕妇进行比较;并根据血糖控制情况将55例妊娠合并糖尿病孕妇分为血糖控制满意组（A组）,共40例;血糖控制不良组（B组）．共15例,进行比较。结果 与正常孕妇组比较,妊娠合并糖尿病孕妇并发症（妊娠高血压疾病、羊水过多、胎膜早破、早产及剖宫产）显著升高（P〈0．05）,围产儿并发症（死胎、新生儿窒息、巨大儿及RDS和畸形）的发病率亦显著升高（P〈0．05）。B组妊娠高血压疾病、早产发生率和新生儿窒息率、死胎发生率均显著高于A组。结论 妊娠合并糖尿病对母儿造成严重危害,加强对其管理和合理治疗可明显减少孕产妇并发症及死亡率,改善母儿结局。     

Hemoglobin A1c in normal and diabetic pregnancy.

The usefulness of determining hemoglobin A1c (HbA1c) levels during pregnancy was evaluated. In contrast to previous reports, the HbA1c values did not predict abnormal maternal glucose tolerance or infant birth weight. They did, however, correlate with long-term control of the diabetes of pregnant insulin-dependent patients. The slight decrease in HbA1c values observed as pregnancy advanced was secondary to improved control of diabetes.     

妊娠期糖尿病患者血糖、血脂水平与新生儿体质量的关系

目的：对妊娠期糖尿病（GDM）孕妇孕期血糖、血脂水平进行分析,探讨GDM孕妇血糖、血脂水平对新生儿出生体质量的影响。方法：空腹12h后,清晨采GDM孕妇肘静脉血测量血糖、血脂,另选择同期正常足月产妇95例作为对照组,对比观察两组血糖、血脂水平和孕期体质量增长值。结果：GDM组空腹血糖、血清总胆固醇（TC）、甘油三脂（TG）、孕期体质量增长值显著高于对照组（P〈0.05）,GDM组巨大儿比例高于对照组（P〈0.05）,而低密度脂蛋白（LDL）、高密度脂蛋白（HDL）水平差异无统计学意义（P〉0.05）。结论：GDM组孕妇血糖、血脂水平与孕期体质量增长值、新生儿体质量呈正相关性,应对GDM孕妇进行饮食指导和血糖、血脂监测,有效控制血糖、血脂水平,降低巨大儿发生率。     

Diabetes in pregnancy: health risks and management

Diabetes in pregnancy is increasing and therefore it is important to raise awareness of the associated health risks to the mother, the growing fetus, and the future child. Perinatal mortality and morbidity is increased in diabetic pregnancies through increased stillbirths and congenital malformation rates. These are mainly the result of early fetal exposure to maternal hyperglycaemia. In the mother, pregnancy may lead to worsening or development of diabetic complications such as retinopathy, nephropathy, and hypoglycaemia. This review defines pregestational and gestational diabetes and the associated health risks to the growing fetus and mother. Management is discussed, focusing on clinical evidence based guidelines published by the American Diabetic Association and the UK National Institute for Health and Clinical Excellence on the management of pregnant women with pre-existing diabetes.     

人类胎盘的葡萄糖转运机制及GDM对胎盘葡萄糖转运的影响

胎盘是将母体葡萄糖转运至子体的重要器官,正常的胎盘结构和功能为胎儿从母体有效摄取葡萄糖提供保障。胎盘上葡萄糖转运主要依赖于胎盘上的葡萄糖转运体（glucose transporters,GLUTs）。此外,胎盘自身对葡萄糖代谢也会影响经胎盘的葡萄糖转运。妊娠期糖尿病（gestational diabetes mellitus,GDM）是一种常见的妊娠期并发症。GDM患者胎盘上葡萄糖转体运功能的异常,可能是造成其子代产生不良结局的原因之一。就正常胎盘上的葡萄糖转运进行论述,并且探讨GDM患者胎盘上葡萄糖转运的改变及可能的分子机制。