妊娠期糖尿病患者的饮食管理

妊娠期糖尿病患者的饮食管理妊娠期糖尿病（ｇｅｓｔａｔｉｏｎａｌｄｉａｂｅｔｅｓ）的定义为，在妊娠期发生或首次发现不同程度的葡萄糖不耐受征象。孕妇人群中经筛查发现，患者占２％～１３％，往往发生在３０岁以上较为肥胖的孕妇。严格控制血葡萄糖（血糖）至近正常...     

妊娠期糖尿病与围生儿预后29例分析

妊娠期糖尿病 (ＧＤＭ )是指在妊娠期才出现或发现的糖尿病。其发生率因种族不同以及诊断标准的不统一各国报道不同。美国报道为 1%～ 3 % ,我国为 1%～ 2 % [1] 。1979年ＷＨＯ将ＧＤＭ列为糖尿病的一种独立类型[2 ] 。其对妊娠、胎儿和新生儿的负面影响与显性糖尿病是一样的。因此 ,许多学者对其发生的有关因素以及对围生儿的影响进行了研究。本文对ＧＤＭ与围生儿预后 2 9例进行回顾性分析 ,报告如下。1　资料与方法1 1　一般资料　收集 1996年 1月至 1998年 12月 ,3年间经我院确诊并住我院分娩的 2 9例妊娠期糖尿病病例 ,孕前均无糖尿病…     

妊娠糖尿病34例临床分析

妊娠糖尿病 (ＧＤＭ )包括糖尿病合并妊娠和妊娠期糖尿病。前者是指先有糖尿病后妊娠 ,后者是指在妊娠期才发生或发现的糖尿病。两者均有害于母婴的健康 ,尤其对胎儿及新生儿都可造成严重的危害。因此 ,提高对妊娠糖尿病的认识 ,早期诊断和治疗 ,适时终止妊娠 ,对降低围生儿死亡是十分重要的。本文就我院 1996年 1月至 1999年5月间诊治的妊娠糖尿病 34例进行总结分析。1　资料与方法1 1　资料来源收集我院 1996年 1月至 1999年 5月期间 ,诊断为妊娠糖尿病 34例。 4例系糖尿病合并妊娠 ,30例为妊娠期糖尿病。其中初产妇 2 8例 ,经产妇 6例。…     

妊娠期糖尿病空腹血糖值与诊断关系的探讨(附60例临床分析)

糖尿病作为当今世界的流行病其患病率正逐年上升 ,我国 2 5岁以上人群中 2型糖尿病 1980年不到 0 9% ,而1995年则是 2 5 % ,是 1980年的 3倍。按此上升速度到2 0 10年可达 6 %～ 8% [1] 。我院妊娠期糖尿病 (ＧＤＭ )占产妇的住院人数比例亦每年递增 ,1994年占 0 2 3 % ,1998年占 0 87% ,1998年约是 1994年的 4倍。因此 ,有必要对妊娠期糖尿病诊断中一些问题作一总结分析。1　资料及方法1.1　一般资料　以 1994年 1月 1日至 1998年 3月 2 5日在我院分娩的和资料较为完整的ＧＤＭ 6 0例作为分析对象。这些病例不论有无糖尿病症状 ,均在 (…     

妊娠合并糖尿病妊娠期糖代谢变化

葡萄糖不仅是胎儿能量物质 ,而且是胎儿脂肪、糖原合成的原料 ,每公斤体重胎儿每分钟消耗 6ｍｇ葡萄糖 ,足月胎儿每日需摄取 2 6～ 30 ｇ葡萄糖。为满足胎儿在胚胎期、器官分化发育期和成熟期发育的能量需要 ,母体内糖代谢及其它各系统代谢皆发生相适应的变化。为了提高对糖代谢异常的认识 ,有助于充分了解妊娠与糖尿病的相互影响 ,以便及时诊断和有效处理。因此 ,掌握妊娠期糖代谢的变化是十分必要的。1　妊娠期母体激素的改变妊娠期母体激素代谢显著增加[1,2 ] 。孕期垂体的体积比非孕期增加 1倍 ,垂体前叶嗜酸细胞增生 ,自孕 7周开始分泌…     

妊娠期糖尿病性巨大儿的研究

妊娠期糖尿病性巨大儿的研究赵右更妊娠期糖尿病性巨大儿（ＧＤＭＭＳ）,是妊娠期糖尿病（ＧＤＭ）孕妇最多见的围产儿并发症。随着ＧＤＭ发生率的逐年增高,ＧＤＭＭＳ及其围产期与远期并发症的发生率也相应增加。２０年来,ＧＤＭ的处理已获明显改善,但ＧＤＭＭ...     

妊娠期糖尿病患者远期发生糖尿病的预测因素

妊娠期糖尿病患者远期发生糖尿病的预测因素熊晓燕边旭明妊娠期糖尿病（ｇｅｓｔａｔｉｏｎａｌｄｉａｂｅｔｅｓｍｅｌｉｔｕｓ,ＧＤＭ）系指在孕期首次发生或首次诊断的碳水化合物代谢异常［１］,多可在产后恢复,通常被认为是产科高危因素,发生率为３％～８％［２］...     

忽略性妊娠期糖尿病孕妇围产儿死亡7例分析

忽略性妊娠期糖尿病孕妇围产儿死亡７例分析解放军第４６３医院妇产科（１１００４２）刘亚滨沈阳市第五人民医院妇产科（１１００２１）兰涛妊娠期糖尿病（ＧＤＭ）是指仅限于妊娠期发生或发现的糖尿病，临床极易漏诊，成为忽略性妊娠期糖尿病，其围产儿病死率较高，文献...     

妊娠期糖尿病患者远期发生糖尿病的相关因素

妊娠期糖尿病（ｇｅｓｔａｔｉｏｎａｌｄｉａｂｅｔｅｓｍｅｌｉｔｕｓＧＤＭ）系指在妊娠期首次发现或发生的糖代谢异常［１］。其发生率为１％～５％［２］。ＧＤＭ可增加围产期死亡率和新生儿多种并发症。２５％的ＧＤＭ患者在远期发生显性糖尿病［３］，产后２０年内...     

正常妊娠妇女和妊娠期糖尿病患者血脂代谢的临床观察

妊娠后,为了满足胎儿不断生长发育的需要,孕妇体内多种脂类物质增加[14]。为进一步探讨妊娠期血脂变化的正常范围及其上下限、妊娠期糖尿病(ＧＤＭ)和妊娠期糖耐量减低(ＧＩＧＴ)者的血脂代谢特点及彼此间的关系,我们观察并分析正常中、晚期妊娠妇女、ＧＩＧＴ和ＧＤＭ者的血脂代谢特点,并以非孕妇女为对照,现将结果报告如下。一、资料和方法1.资料来源:自1996年1月至1999年1月,选择本院健康非孕妇女30例(对照组);正常孕妇193例(正常妊娠组):其中中期妊娠(14～27周)89例、晚期妊娠(28～39周)104例;ＧＩＧＴ和ＧＤＭ组各17与33例。均为初产妇…     

50例妊娠合并糖尿病孕妇的妊娠期管理分析

目的 :探讨妊娠合并糖尿病孕妇的妊娠期管理方法。方法 :将 5 0例妊娠合并糖尿病孕妇与 4 8例正常孕妇比较。结果 :5 0例妊娠期糖尿病孕妇中有 38例 ( 76 % )经饮食疗法后血糖控制效果良好 ,另 12例需饮食疗法加胰岛素治疗方能将血糖控制在正常范围内。经临床治疗后 ,5 0例妊娠合并糖尿病的孕妇 ,除早产发病率高于非糖尿病组孕妇外(P <0 0 5 ) ,妊高征、感染、产后出血、羊水过多、羊水过少、胎儿窘迫、巨大儿、胎儿生长受限 (FGR)、新生儿窒息、新生儿高胆红素血症等发病率与非糖尿病组孕妇无区别。结论 :加强妊娠合并糖尿病孕妇的妊娠期管理 ,用饮食疗法或胰岛素治疗控制血糖 ,适时终止妊娠 ,可有效降低母婴并发症的发生     

妊娠糖尿病胰岛素治疗与围生儿预后

目的 探讨在妊娠糖尿病（GDM）治疗中胰岛素、饮食以及开始治疗时间早晚对围生儿预后的影响。方法 选择诊断为妊娠糖尿病者109例，其中采用饮食加胰岛素治疗22例，单纯饮食控制组低于应用胰岛素组，差异显著（P＜0.05）。围生儿结局显示：巨大儿发生率、红细胞增多症发生率三组为34周后饮食控制组＞34周前饮食控制组＞胰岛素治疗组。结论 GDM要早诊断、早治疗，尤其是应用胰岛素正规治疗对降低围生儿病率、巨大发生率以及控制孕妇血糖水平有重要意义。     

妊娠期糖尿病孕妇甲状腺功能减退的临床分析

目的:探讨妊娠期糖尿病(GDM)患者甲状腺功能减退(甲减)的情况,以及GDM并发甲减对妊娠结局的影响。方法:(1)根据75g糖耐量试验结果,将2011年9月至2013年3月在产科门诊常规产检的妊娠中期妇女分为GDM组(244例)及对照组(674例)。比较两组患者的甲状腺功能;(2)将2011年9月至2013年3月收入院的妊娠晚期GDM患者分为单纯GDM组(Ⅰ组,370例)、GDM并发甲减组(Ⅱ组,79例),回顾分析两组患者的妊娠结局。结果:(1)与对照组相比,妊娠中期GDM组患者的低甲状腺素血症发生率较高(P0.05),血清游离甲状腺素(FT4)显著降低(P0.01)。两组妇女的促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、抗甲状腺过氧化物酶抗体(TPOAb)无显著差异,但TPOAb阳性的妊娠妇女TSH平均值高于正常值上限,且显著高于TPOAb阴性妇女(P0.05);(2)GDM并发甲减组的子痫前期、巨大儿、剖宫产发生率均显著高于单纯GDM组(P0.05)。结论:GDM妊娠妇女更易引发甲减,且GDM并发甲减将进一步加重不良妊娠结局。     

饮食控制对妊娠糖尿病的治疗作用

目的 研究饮食控制对妊娠糖尿病（ＧＤＭ）的治疗作用。方法 分析１７８例妊娠合并糖尿病患者病例,收集经营养门诊及病房会诊指导后的ＧＤＭ患者的血糖值（包括空腹血糖和早餐后２小时血糖）和未经营养指导ＧＤＭ患者的血糖值。结果 营养指导后的ＧＤＭ患者的血糖水平明显低于非指导组,且营养指导后血糖水平低于指导前。结论 饮食控制对妊娠糖尿病具有治疗作用。     

Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization

OBJECTIVE: This study was undertaken to compare the use of glyburide with insulin for the treatment of gestational diabetes mellitus (GDM) unresponsive to diet therapy. STUDY DESIGN: A retrospective study was performed among women with singleton pregnancies who had GDM diagnosed, with fasting plasma glucose 140 mg/dL or less on glucose tolerance testing, between 12 and 34 weeks who failed diet therapy from 1999 to 2002. We identified 584 women and compared those treated with insulin between 1999 and 2000 with women treated with glyburide between 2001 and 2002. Maternal and neonatal outcomes and complications were assessed. Statistical methods included univariate analyses and multivariable logistic regression. RESULTS: In 1999 through 2000, 268 women had GDM diagnosed and were treated with insulin; in 2001 through 2002, 316 women had GDM diagnosed of which 236 (75%) received glyburide. The 2 groups were similar with regard to age, nulliparity, and historical GDM risk factors; however, women in the insulin group had a higher mean body mass index (31.9 vs 30.6 kg/m 2 , P=.04), a greater proportion identified themselves as white (43%, 28%, P<.001) and fewer as Asian (24%, 37%, P=.001), and they had a significantly higher mean fasting on glucose tolerance test (105.4 vs 102.4 mg/dL , P=.005) compared with the glyburide group. There were no significant differences in birth weight (3599+/-650 g vs 3661+/-629 g, P=.3), macrosomia (24%, 25%, P=.7), or cesarean delivery (35%, 39 %, P=.4). Women in the glyburide group had a higher incidence of preeclampsia (12%, 6%, P=.02), and neonates in the glyburide group were more likely to receive phototherapy (9%, 5%, P<.05), and less likely to be admitted to the neonatal intensive care unit (NICU) (15%, 24%, P=.008) though they had a longer NICU length of stay (4.3+/-9.6 vs 8.0+/-10.1, P=.002). Posttreatment glycemic control data were available for 122 women treated with insulin and 137 women treated with glyburide. More women in the glyburide group achieved mean fasting and postprandial goals (86%, 63%, P<.001). These findings remained significant in logistic regression analysis. CONCLUSION: In a large managed care organization, glyburide was at least as effective as insulin in achieving glycemic control and similar birth weights in women with GDM who failed diet therapy. The increased risk of preeclampsia and phototherapy in the glyburide group warrant further study.     

Glycated hemoglobin in pregnancies at increased risk for gestational diabetes mellitus

Objective

The glycated hemoglobin (HbA_1c) value is increasingly used for the detection of (pre)diabetes, but HbA_1c decreases during pregnancy. We sought to identify clinical and metabolic correlates of HbA_1c in pregnancies at increased risk for gestational diabetes mellitus (GDM).

Study design

We prospectively studied 335 gravidas who received a 3-h 100 g oral glucose tolerance test (OGTT) at 24–32 weeks, in most cases after an abnormal glucose challenge test. Several indices of insulin sensitivity and secretion were computed from fasting measurements and the OGTT.

Results

HbA_1c concentrations gradually increased in diet-treated and insulin-treated GDM gravidas compared with non-GDM gravidas. HbA_1c was higher if the insulin peak was delayed until 180 min compared with 60 or 120 min. Stepwise regression identified the homeostasis modeling assessment of insulin resistance (HOMA-IR) as the first-rank correlate. Other correlates were ethnicity, a low insulin-to-glucose response at 60 min, and gestational age. The HbA_1c value corresponding to a fasting glucose of 5.1 mmol/l (diagnostic of GDM) was 2 mmol/mol (∼0.2%) higher if sampling occurred at 29–32 vs. 24–28 weeks or if ancestry was non-European vs. European.

Conclusion

HbA_1c is strongly associated with insulin resistance; in addition, HbA_1c captures the first-phase insulin response. However, HbA_1c varies with gestational age and ethnicity.     

The significance of blood and salivary oxidative stress markers and chemerin in gestational diabetes mellitus

ObjectiveGestational diabetes mellitus (GDM) is a medical complication of pregnancy. The aim of this study was to evaluate the correlations between the salivary and blood levels of oxidative stress markers and an adipokine chemerin, which play a role in the pathogenesis of GDM.Materials and methodsStudy groups (Control (n = 29), GDM (n = 22)) had been assessed clinically healthy oral hygiene, according to the age range between 25 and 40 years, BMI<30 kg/m2, who were non-smokers and who were not having systemic diseases. GDM was diagnosed using a 100 g OGTT. Saliva samples were collected without stimulation between 08.30 and 10.00 a.m.. Chemerin and TrxR levels were measured by ELISA. Malondialdehyde, sulfhydryl and NO levels were determined by spectrophotometric analysis. Statistical analysis were performed by Shapiro Wilk, Mann Whitney U, Student's t test.ResultsBlood pressure, BMI, and plasma chemerin, salivary chemerin, fasting glucose, LDL, triglyceride, CRP levels in GDM were not different when compared to Control. There were significant differences between Plasma TrxR and HDL levels. Also, significant differences between salivary TrxR and Malondialdehyde levels were observed in GDM.ConclusionIt was concluded that the optimal cut-off points for oxidative stress parameters and chemerin level can be used to distinguish between healthy pregnant and GDM.     

Total plasma homocysteine correlates in women with gestational diabetes

AIM: We aim to assess serum total homocysteine (tHcy) associations with metabolic syndrome components and B-vitamins in women with gestational diabetes mellitus (GDM). METHODS: We studied 61 consecutive pregnant women, 44 with GDM and 17 with normal glucose tolerance (CG). Serum homocysteine levels were analyzed by ELISA, using Bio-Rad reagents. Serum folates and vitamin B(12) concentrations were determined by chemiluminescent immunoassay, free fatty acids (FFA) and lipids enzymatically. RESULTS: Serum homocysteine levels were similar in both the GDM and the CG groups (8 +/- 2.0 vs 7.4 +/- 1.1 mumol/l, respectively). Women with GDM in comparison to CG women were characterized by higher values of homeostasis model of insulin resistance (HOMA-IR) (2.8 +/- 1.7 vs 1.6 +/- 0.9, P < 0.01), serum triglycerides (2.7 +/- 0.9 vs 1.9 +/- 0.5 mmol/l, P < 0.01) and FFA (0.6 +/- 0.2 vs 0.46 +/- 0.2 mmol/l, P < 0.05). In GDM women serum tHcy correlated with vitamin B(12) (r = -0.47, P < 0.01) and folates (r = -0.51, P < 0.001); in CG women with HOMA-IR, a marker of insulin resistance (r = -0.49, P < 0.05). In multiple regression analysis with serum tHcy as a dependent variable, folate and vitamin B(12) entered the analysis in GDM women (beta = -0.42 and -0.34, respectively, P < 0.05), whereas in CG cystatin C and HOMA-IR entered the analysis (P < 0.05). CONCLUSIONS: In women with GDM, serum homocysteine is significantly associated with vitamin B(12) and folate levels, while in healthy pregnant women with HOMA-IR and with kidney function. The results suggest the importance of the B-group vitamins in regulation of serum tHcy levels in women with insulin resistance/gestational diabetes, what might be relevant in protection against pregnancy complications associated with elevated tHcy in GDM women.     

Treatment of gestational diabetes mellitus: glyburide compared to subcutaneous insulin therapy and associated perinatal outcomes

Objective.?To examine perinatal outcomes in women with gestational diabetes mellitus treated with glyburide compared to insulin injections.

Study design.?This is a retrospective cohort study of women diagnosed with gestational diabetes mellitus (GDM) who required pharmaceutical therapy and were enrolled in the Sweet Success California Diabetes and Pregnancy Program between 2001 and 2004, a California state-wide program. Women managed with glyburide were compared to women treated with insulin injections. Perinatal outcomes were compared using chi-square test and multivariable logistic regression models; statistical significance was indicated by p?<?0.05 and 95% confidence intervals (CI).

Results.?Among the 10,682 women with GDM who required medical therapy and met study criteria, 2073 (19.4%) received glyburide and 8609 (80.6%) received subcutaneous insulin injections. Compared to insulin therapy and controlling for confounders, oral hypoglycemic treatment was associated with increased risk of birthweight >4000 g (aOR?=?1.29; 95% CI [1.03–1.64]), and admission to the intensive care nursery (aOR?=?1.46 [1.07–2.00]).

Conclusion.?Neonates born to women with gestational diabetes managed on glyburide, and were more likely to be macrosomic and to be admitted to the intensive care unit compared to those treated with insulin injections. These findings should be examined in a large, prospective trial.     

Screening for gestational diabetes mellitus in adolescent pregnancies

Objective: Our purpose was to determine the incidence of gestational diabetes mellitus in an adolescent population and to determine the cost of screening. Study Design: A retrospective review of 509 adolescent pregnancies was performed. The incidence of gestational diabetes mellitus was determined and the cost of screening analyzed. Results: Five hundred nine adolescent pregnancies were screened for gestational diabetes mellitus with a 1-hour, 50 gm oral glucose challenge test. Twenty-three of the screens (4.5%) had positive results at a plasma glucose level of ≥140 mg/dl. Three-hour 100 gm oral glucose tolerance tests were performed on screen-positive women, six of whom were diagnosed with gestational diabetes mellitus, for an incidence of 1.18%. The cost per case diagnosed was $2733. Conclusions: The incidence of gestational diabetes mellitus in an adolescent population is low. The cost of universal screening may be prohibitive in this population. Large prospective studies are needed to better analyze outcome data and efficacy of screening in adolescent pregnancies. (Am J Obstet Gynecol 1998;178:1251-6.)