孕妇糖耐量异常与围生儿结局的关系

[目的]探讨妊娠期糖尿病(GDM)及妊娠期糖耐量异常(GIGT)对围生儿结局的影响.[方法]4 416例孕妇行50 g葡萄糖筛查(50 g GCT),孕32周重复筛查,共568例异常者行75 g葡萄糖耐量试验(OGTT),其中正常254例,确诊为妊娠期糖耐量受损(GIGT)142例、妊娠期糖尿病(GDM)172例,并与600例对照者比较妊娠结局.[结果]50 g GCT阳性率为12.86%,GIGT及GDM检出率分别是3.22%和3.89%.GIGT及GDM病人妊娠期高血压、羊水过多、巨大儿、剖宫产率、新生儿病发生率明显高于对照组(P＜0.05).[结论]对所有孕妇进行50 g GCT,以及早确诊GDM及GIGT,GDM与GIGT均能对妊娠造成不同程度的危害,应引起重视.     

1 743例孕妇葡萄糖负荷试验结果分析及临床意义

目的 研究妊娠期糖尿病(GDM)筛查的发病率.方法 1 743例妊娠24～32周孕妇的50 g葡萄糖负荷试验(GCT)≥7.8 mmol/L则说明孕妇葡萄糖负荷筛查阳性,需要进一步进行75 g葡萄糖耐量试验(OGTT).结果 GCT阳性401例(23%),其中315例进行葡萄糖耐量试验,55例诊断为GDM(17.4%).83例诊断为糖耐量低减IGT(26.3%).结论 孕期检测葡萄糖负荷试验作为妊娠糖尿病筛查就显得至关重要.     

孕妇糖耐量异常与围生儿结局的关系

[目的]探讨妊娠期糖尿病（GDM）及妊娠期糖耐量异常（GIGT）对围生儿结局的影响。[方法]4416例孕妇行50g葡萄糖筛查（50gGCT）,孕32周重复筛查,共568例异常者行75g葡萄糖耐量试验（OGTT）,其中正常254例,确诊为妊娠期糖耐量受损（GIGT）142例、妊娠期糖尿病（GDM）172例,并与600例对照者比较妊娠结局。[结果]50gGCT阳性率为12.86%,GIGT及GDM检出率分别是3.22%和3.89%。GIGT及GDM病人妊娠期高血压、羊水过多、巨大儿、剖宫产率、新生儿病发生率明显高于对照组（P〈0.05）。[结论]对所有孕妇进行50gGCT,以及早确诊GDM及GIGT,GDM与GIGT均能对妊娠造成不同程度的危害,应引起重视。     

妊娠期糖尿病高危孕妇血糖再筛查的临床研究

目的：探讨糖尿病高危孕妇妊娠晚期血糖再筛查的临床价值.方法：选取妊娠24～28周50 g葡萄糖筛查试验（glucose challenge test,GCT）阴性但有糖尿病高危因素的孕妇600例,于妊娠32～34周再行50 g GCT筛查,阳性者再作100 g口服葡萄糖耐量试验（oral glucose tolerance test,OGTT）.根据检查结果,将600例孕妇分为4组,并对这4组孕妇及围产儿结局进行比较.结果：首次GCT阴性的600例孕妇中,妊娠期糖尿病（gestational diabetes mellitus,GDM）和妊娠期糖耐量受损（gestational impaired glucose tolerance,GIGT）的患病率分别为2.3％和5.2％.GDM组的年龄、分娩前体质量指数、合并羊水过多者、巨大儿发生率与GCT（-）组差异有统计学意义.GDM组、GIGT组及GCT（＋）组孕妇的孕前体质量、妊娠高血压发生率、手术分娩率、新生儿病率的差异有统计学意义.结论：妊娠期糖代谢异常能增加孕产期并发症和围产儿的患病率.因此,对首次GCT阴性者在妊娠晚期再次血糖筛查与管理是非常必要的.     

338例妊娠期糖尿病筛查检测分析报告

[目的]分析妊娠期糖尿病发病情况与部分高危因素的关系。[方法]随机选取338例孕妇进行50g葡萄糖筛查,对异常者进行口服葡萄糖耐量试验（0GTT）。[结果]妊娠期糖尿病发生率2．4％,糖耐量受损发生率7．0％。[结论]妊娠期糖尿病无明显症状体征,应重视妊娠期糖尿病的早诊断、早治疗,进一步明确了妊娠糖尿病筛查的必要性。     

妊娠期妇女葡萄糖筛查2870例结果临床分析

目的初步了解本地区妊娠期糖尿病（GDM）的患病率,探讨不同孕期妇女的50 g葡萄糖负荷试验（GCT）对筛查GDM的临床意义,以及GDM与孕妇伴随有高危因素和孕期的关系。方法 2010年1—12月,来我院行葡萄糖筛查孕妇2 870例,按不同孕期分为孕24~28周组、孕〉28周组;按其是否伴有高危因素分为伴高危因素组、无高危因素组。进行分组对照研究。结果妊娠伴有高危因素的孕妇GCT和75 g口服葡萄糖糖耐量试验（OGTT）的异常检出率明显高于妊娠无高危因素组,两组比较差异有统计学意义（χ2=63.52、109.51,P〈0.05）;而不同孕周两组比较差异无统计学意义（χ2=1.00、0.27,P〉0.05）。结论本地区GDM有一定的患病率,伴有高危因素的孕妇GDM发生率高。对伴有高危因素的孕妇应尽早进行GCT筛查,对临床早期诊断、治疗GDM、改善妊娠结局具有重要意义。     

1050例妊娠期妇女糖耐量检测分析

目的：观察妊娠24～28周孕妇产前检测糖耐量试验结果,分析妊娠期糖尿病（GDM ）诊断依据。方法选取2014年8月至2015年9月就诊于我院的妊娠24～28周的孕妇,口服75克葡萄糖进行糖耐量试验（OGTT）,利用葡萄糖氧化酶法进行检测。结果1050例妊娠期妇女做糖耐量分析,妊娠期糖尿病诊断率为9％,空腹血糖＜4．4 mol／L的妊娠期妇女妊娠期糖尿病的诊断率为1．6％。结论应普及对所有孕妇在妊娠24～28周时进行OGTT 试验,以免漏诊GDM ,对妊娠结局造成不良影响。同时要多关注高龄孕妇的GDM 患病风险。     

1 953例孕妇妊娠期糖筛查试验结果与分析

目的分析1953例孕妇妊娠期糖筛查试验（GCT）结果,探讨其与妊娠期糖尿病（GDM）及妊娠期糖耐量受损（GIGT）的关系。方法行产前检查的1953例孕妇进行GCT,结果阳性者1周内进行空腹口服葡萄糖耐量试验（OGTT）以确诊。结果GCT阳性562例（28．8％）,均做OGTT,诊断GDM42例（2．15％）,GIGT78例（4．0％）,糖代谢正常1833例（93．9％）;年龄大于或等于35岁孕妇组GCT阳性率及诊断为GDM和GIGT的比例明显高于年龄小于35岁组。结论GDM及GIGT对母儿危害极大,应引起广泛重视,及早诊断、及早干预,减少并发症的发生尤为重要。     

健康教育对妊娠期糖尿病孕妇认知程度的影响调查

妊娠期糖尿病(GDM)是指妊娠前糖代谢正常或有潜在糖耐量减退,妊娠期才出现或发现糖尿病.糖尿病孕妇中有80％以上为GDM.GDM发生率世界各国报1％～4％,我国发生率1％～5％,近年有明显增高趋势[1].GDM属产科高危妊娠,对母儿均有较大危害,如果得不到及时诊治,会出现一系列母要并发症以至产生不良结局.许多研究表明,大多数GDM孕妇对糖尿病相关知识知晓率较低是导致其治疗依从性差的直接原因[2].本文旨在通过了解健康教育对妊娠期糖尿病孕妇认知程度的影响,从而为孕妇制定适宜的最佳健康教育的方式提供依据.     

糖尿病孕妇分娩近期的血糖随访

妊娠期糖尿病(gestational diabetes mellitus,GDM)是指孕妇在妊娠期发生或发现不同程度的糖耐量异常,其中包含部分孕前即有糖代谢异常的妇女。大多GDM孕妇分娩后糖代谢正常,但亦有分娩后糖代谢异常持续存在。分娩后胰岛素抵抗被解除,糖代谢异常得到改善,但该类患者糖尿病(DM)的发生率仍很高,所以对其血糖随访仍非常重要,本研究对31例GDM孕妇产后7d做了随访,并对产后血糖异常的发生率、高危因素以及随访管理进行分析。材料和方法一、研究对象2004年1～8月在我院分娩的31例GDM孕妇,中位年龄为28岁(22～43岁),均为单胎妊娠。孕妇高龄4例…     

Gestational diabetes mellitus in women of single gravidity in Tianjin City, China

OBJECTIVE: The aim of this study was to investigate the prevalence of gestational diabetes mellitus (GDM) and risk factors for the development of GDM in pregnant women in Tianjin, China, where the prevalence of GDM is still unknown. STUDY DESIGN AND METHODS: A total of 9,471 pregnant women living in the six urban districts of Tianjin, China, took part in the initial screening between December 1998 and December 1999. The screening test consisted of a 50-g 1-h glucose test. Women with a reading > or =7.8 mmol/l at the initial screening were invited to undergo a 75-g 2-h oral glucose tolerance test (OGTT). GDM was confirmed using the World Health Organization's diagnostic criteria. RESULTS: At the initial screening test, 888 women had a glucose reading of > or =7.8 mmol/l. A total of 701 (79%) women took a subsequent OGTT. Of these, 174 women were confirmed to have GDM (154 with impaired glucose tolerance [IGT] and 20 with diabetes). The prevalence of GDM was 2.31% (2.03% for IGT and 0.28% for diabetes), adjusting for serum glucose levels at the initial screening test. Independent predictors for GDM were maternal age, stature, prepregnancy BMI, weight gain in pregnancy before screening, diabetes in first-degree relatives, and habitual cigarette smoking during pregnancy. Women who smoked or had a short stature are more likely to develop GDM than their counterparts. CONCLUSIONS: The prevalence of GDM in pregnant women in the city of Tianjin, China, was 2.31%. Short stature and smoking in pregnancy were additional risk factors for GDM.     

妊娠早期空腹血糖测定结果回顾性分析

目的 探讨妊娠早期空腹血糖（FPG）测定水平与妊娠中期75g葡萄糖口服糖耐量试验（OGTT）结果 的关系。方法 选取2012年8月至2013年4月在孕12周时来该院建立孕册行空腹血糖检测,并于24～28周行75g葡萄糖OGTT试验的孕妇1107例,对其临床资料进行回顾性分析。以国际妊娠合并糖尿病研究组（IADPSG）2010年提出的新诊断标准按OGTT结果 将孕妇分为4组。A组为OGTT结果 正常组,B组为OGTT结果 有1项异常,C组为OGTT结果 有2项异常,D组为OGTT结果 有3项异常。比较4组孕妇空腹血糖结果 的差异。结果 A、B、C、D组的孕早期空腹血糖均值呈递增变化,A组孕早期FPG≥5．1mmol／L的孕妇有65例占5．9％（65／1107）,OGTT异常组有7例孕妇早期FPG≤4mmol／L。结论 孕早期空腹血糖升高是预警信号,提示孕中期发生妊娠糖尿病（GDM）的可能性增大。但将孕早期FPG≥5．1mmol／L作为GDM的诊断标准尚存疑问。处于任何一个空腹血糖区间,均有可能发生糖耐量异常,设立1个空腹血糖值而排除GDM的方法 不准确。     

Gestational diabetes may represent discovery of preexisting glucose intolerance

A representative sample of 817 American women aged 20-44 yr who were not pregnant and had no medical history of diabetes were given 75-g 2-h oral glucose tolerance tests (OGTTs). Although these conditions are somewhat different from those recommended for pregnant women (100 g glucose, 3-h OGTT), 3.8% of the women might have been considered to have met O'Sullivan and Mahan criteria for gestational diabetes mellitus (GDM) had they been pregnant. Prevalence was 2-3% below age 35 yr, similar to that found in studies of pregnant women, and rose to 8% at age 40-44 yr. Rates of women meeting World Health Organization criteria for gestational impaired glucose tolerance (G-IGT) rose steadily from 5% at age 20-24 yr to 11% at age 40-44 yr. Risk factors for non-insulin-dependent diabetes mellitus (NIDDM) including parental history and obesity were more prevalent among women meeting these criteria than among women in the entire group; the same risk factors are also more prevalent among pregnant women with GDM. The similarity of rates in this study to rates of GDM and G-IGT, together with their association with risk factors for NIDDM, indicate that these entities are compatible with undiagnosed glucose intolerance occurring before pregnancy and discovered during the metabolic testing that generally accompanies prenatal care rather than conditions that have an etiologic relationship to pregnancy.     

Early postpartum metabolic assessment in women with prior gestational diabetes.

OBJECTIVE: To present the results of early postpartum metabolic assessment in women with gestational diabetes mellitus (GDM), to determine predictive factors for subsequent diabetes, and to investigate the association of postpartum glucose tolerance with other components of the metabolic syndrome. RESEARCH DESIGN AND METHODS: A total of 788 women were evaluated 3-6 months after a GDM pregnancy. A 75-g oral glucose tolerance test (OGTT) was performed. Cholesterol, HDL cholesterol, triglycerides, blood pressure, BMI, and body fat distribution were assessed. Clinical and obstetric history, baseline variables at the diagnosis of GDM, metabolic control during pregnancy, and index pregnancy outcome were compared in women with diabetes and women without diabetes (American Diabetes Association [ADA] criteria) after pregnancy. Multivariate logistic regression analysis was used to ascertain independent predictors of subsequent diabetes. Correlation coefficients were assessed between postpartum glucose tolerance and lipid levels, blood pressure, BMI, and body fat distribution. RESULTS: According to ADA criteria, 588 (74.6%) women were normal, 46 (5.8%) had impaired fasting glucose, 82 (10.4%) had impaired glucose tolerance, 29 (3.7%) had both impaired fasting glucose and impaired glucose tolerance, and 43 (5.4%) had diabetes. Prepregnancy obesity, recurrence of GDM, gestational age at diagnosis of GDM, glucose values in the 100-g OGTT, number of abnormal values in the 100-g OGTT, fasting C-peptide levels in pregnancy, C-peptide/glucose score in pregnancy, insulin requirement in pregnancy, 3rd trimester HbA1c levels, and macrosomia differed significantly in women with subsequent diabetes. Independent predictors of postpartum diabetes were prepregnancy obesity, C-peptide/glucose score during pregnancy, and the number of abnormal values in the 100-g diagnostic OGTT. The area under the postpartum glucose curve was positively associated with BMI, waist circumference, waist-to-hip ratio, triglycerides, and systolic and diastolic blood pressures. CONCLUSIONS: Low C-peptide/glucose score during pregnancy together with prepregnancy obesity and severity of GDM (number of abnormal values in the 100-g diagnostic OGTT) are independent predictors of subsequent diabetes. Our data suggest that regardless of obesity and severity of GDM, a beta-cell defect increases the risk of postpartum diabetes. The association of postpartum glucose tolerance with triglyceride levels, blood pressure, obesity, and regional distribution of body fat suggests that postpartum glucose intolerance anticipates a high-risk cardiovascular profile that comprises other risk factors besides diabetes.     

糖化血红蛋白在早孕期糖尿病筛查中的意义

目的：探讨糖化血红蛋白（HbA1c）在早孕期糖尿病（GDM）筛查中的意义。方法正常组120例、糖耐量异常组59例及糖尿病组78例,在妊娠20周时分别进行空腹血糖（FPG）、75g葡萄糖耐量实验（OGTT）和HbA1c测定。结果糖尿病组FPG,OGTT,HbA1c水平均高于正常组（P〈0.01）,HbA1c在糖耐量异常组及糖尿病组中的阳性率分别为96.7%、98.7%。结论 HbA1c在GDM筛查中的诊断效率明显高于FPG和OGTT,可作为临床GDM早孕期筛查诊断的指标。     

Gestational diabetes mellitus

Gestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees that is first detected during pregnancy. GDM is detected through the screening of pregnant women for clinical risk factors and, among at-risk women, testing for abnormal glucose tolerance that is usually, but not invariably, mild and asymptomatic. GDM appears to result from the same broad spectrum of physiological and genetic abnormalities that characterize diabetes outside of pregnancy. Indeed, women with GDM are at high risk for having or developing diabetes when they are not pregnant. Thus, GDM provides a unique opportunity to study the early pathogenesis of diabetes and to develop interventions to prevent the disease.     

浙江省舟山群岛地区妊娠期糖尿病流行情况及影响因素研究

目的描述浙江省舟山地区孕妇妊娠期糖尿病（GDM）的流行情况并分析其影响因素。方法采用回顾性调查研究,对2014年1月至2018年6月舟山市妇幼保健院GDM筛查情况进行分析,并采用logistic回归模型分析GDM及其亚型的影响因素。结果采用口服葡萄糖耐量试验（OGTT）筛查的10 802名孕妇中,GDM患病率为13.78%;其中,亚型A（单纯空腹型）占21.49%,亚型B（单纯餐后型）占66.15%,亚型C（空腹与餐后型）占12.36%。 多因素logistic回归分析显示,年龄较大、孕早期体质指数（BMI）高、孕早期血糖高、孕早期心率快、孕早期白蛋白高、OGTT筛查时间为冬春季和初产妇等因素增加GDM的发生风险,而文化程度与GDM无关。 不同亚型GDM多分类logistic回归分析显示,孕早期BMI高、孕早期血糖高、OGTT筛查时间为冬春季等因素增加GDM亚型A发生的风险;年龄较大、孕早期血糖高、孕早期心率快、孕早期白蛋白高、OGTT筛查时间为冬春季和高文化程度等因素增加GDM亚型B的发生风险,而经产妇则降低GDM亚型B的发生风险。 年龄较大、孕早期BMI高、孕早期血糖高、孕早期心率快、OGTT筛查时间为冬春季等因素增加GDM亚型C的发生风险,而文化程度高和经产妇则降低GDM亚型C的发生风险。结论舟山地区GDM的发病率较高,年龄较大、孕早期BMI高、孕早期血糖高、孕早期心率快、孕早期白蛋白高、OGTT筛查时间为冬春季等因素与GDM的发病有关。 因此,应加强健康宣教,避免高龄妊娠。 同时,重视围产期保健和GDM筛查,控制孕前BMI,促进母婴健康。     

246例妊娠期糖尿病孕妇产后6周血糖监测状况分析

目的分析妊娠期糖尿病(GDM)孕妇产后6周行口服葡萄糖耐量试验(OGTT)状况及影响因素,探索提高产后血糖管理对策。方法回顾性分析对确诊的GDM孕妇产后行75g OGTT复查和访谈。结果2015~2019年共计孕妇建卡数2533例,2532例行OGTT确诊GDM 246例,其中170例孕妇产后6周行OGTT,51例拒绝检查,25例失访。170例中发现25例糖调节受损,2例糖尿病。51例GDM孕妇拒绝OGTT的因素分别是自测空腹血糖正常、坚信自己不会得糖尿病、害怕多次抽血、没时间、喝糖水不适及家人不支持或反对。结论GDM孕妇产后6周行OGTT是必要的,但依从性不高。建议扩大健康宣教对象,加强宣教力度,利用信息技术完善动态管理机制,妇保医生联合全科医生对GDM孕妇产后血糖管理。