超声动态血流监测重度先兆子痫前期孕妇胎儿血流动力学变化的临床意义

目的 探讨彩色多普勒超声动态检测重度先兆子痫前期孕妇胎儿脐动脉和大脑中动脉血流动力学变化的临床价值,为及时采取必要的干预措施提供依据.方法 检测30例正常孕妇(对照组)与30例重度先兆子痫前期孕妇(观察组)胎儿的脐动脉和大脑中动脉血流参数,结果进行对比分析.结果 对照组胎儿脐动脉和大脑中动脉血流阻力指数随着孕龄的增加呈降低趋势,观察组胎儿脐动脉阻力指数较对照组明显增高,而大脑中动脉血流阻力指数和胎盘小血管阻力指数明显下降,两组间比较差异均有统计学意义(均P＜ 0.05).结论 彩色多普勒超声动态血流检测晚孕期胎儿脐动脉和大脑中动脉血流参数指标可了解并评估胎儿宫内状况,为临床医师提供重要的诊断信息,降低孕产妇和新生儿的发病率及病死率.     

Doppler velocimetry of the fetal middle cerebral and renal arteries: interobserver reliability.

Using color and pulsed Doppler ultrasonography, the interobserver reliability of measurements in the fetal circulation was evaluated in 41 pregnancies of 25 to 39 weeks' gestation. Two observers recorded flow velocity waveforms from the middle cerebral and renal arteries for measurement of peak systolic, minimum diastolic, and mean velocities, pulsatility index, and resistive index. Intraclass correlation coefficient of reliability was calculated by analysis of variance. Substantial interobserver agreement was found for pulsatility index and minimum diastolic velocity in both arteries. Therefore, these measurements have the greatest clinical applicability.     

胎儿脐动脉S/D比值及超声生长参数Z-评分评估妊娠期糖尿病孕妇胎儿生长受限的价值

目的探讨胎儿脐动脉S/D比值及超声生长参数Z-评分在评估妊娠期糖尿病（GDM）孕妇胎儿生长受限（FGR）中的临床价值。 方法选取2016年6月至2021年10月在金华市妇幼保健院进行常规产检并于本院分娩的3409例单胎GDM孕妇作为研究对象。将诊断为FGR者作为观察组（35例）,其余作为对照组（3374例）。对比2组孕28周和孕32周的胎儿生长参数、脐动脉S/D比值、腹围Z-评分、头围Z-评分、头围/腹围比值Z-评分,绘制ROC曲线并分析脐动脉S/D比值及超声生长参数Z-评分评价FGR的效能。 结果观察组胎儿28周和32周双顶径、头围、腹围和股骨长均明显低于对照组,头围/腹围比值明显高于对照组,差异均有统计学意义（P均＜0.05）。观察组胎儿28周和32周的脐动脉S/D比值、头围/腹围比值Z-评分明显高于对照组,腹围Z-评分明显低于对照组,差异均有统计学意义（P均＜0.05）。28周和32周胎儿脐动脉S/D比值、腹围Z-评分和头围/腹围比值Z-评分评价FGR的ROC曲线下面积分别为0.820、0.984、0.948和0.855、0.941、0.981。 结论胎儿脐动脉S/D比值、超声生长参数Z-评分能够较为准确可靠地对胎儿宫内生长发育状况进行定量评估,为GDM孕妇FGR的临床诊断提供重要信息。     

不同孕产妇代谢特性对妊娠期糖尿病妇女的胎儿生长发育的影响

目的探究不同孕产妇代谢特性对妊娠期糖尿病妇女的胎儿生长发育的影响。方法选取广州市增城区妇幼保健院于2011年6月至2014年12月收治的128例妊娠期糖尿病患者作为研究对象,选取同期入院检查的健康怀孕妇女140例作为对照组。详细记录产妇的年龄、胎儿出生体重、妊娠期糖尿病史、糖尿病家族史、孕前体重、孕期体重、BMI、孕龄、录入时胎龄、空腹血糖、甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、低密度脂蛋白/高密度脂蛋白、胰岛素等,统计分析采用SPSS 17.0数据包,计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,相关分析采用Pearson相关分析法,P<0.05表示差异具有统计学意义。结果妊娠期糖尿病组和对照组糖尿病家族史和孕周的比较差异具有统计学意义(P<0.05);而妊娠期糖尿病组和对照组的年龄、胎儿出生体重、妊娠期糖尿病史、孕前体重、孕期体重、BMI、录入时胎龄比较,差异无统计学意义(P>0.05)。通过分析两组产妇28~32周、32~36周和>36周分娩的生化指标特征,结果表明,妊娠期糖尿病组和对照组空腹血糖、胰岛素和甘油三酯的比较差异具有统计学意义(P<0.05);而妊娠期糖尿病组和对照组产妇总胆固醇、低密度脂蛋白、高密度脂蛋白水平比较,差异无统计学意义(P>0.05)。比较28~32周、32~36周和>36周分娩,妊娠期糖尿病组总胆固醇、低密度脂蛋白、低密度脂蛋白/高密度脂蛋白、胰岛素和甘油三酯差异具有统计学意义(P<0.05)。对照组血糖、甘油三酯、总胆固醇、低密度脂蛋白差异具有统计学意义(P<0.05)。通过比较两组新生儿结局,结果表明,孕周、新生儿血糖、BMI、Apgar(1 min)、Apgar(5 min)、巨大儿及大于胎龄儿的比较,差异具有统计学意义(P<0.05)。相关分析表明,甘油三酯水平增高与胰岛素抵抗和胰岛素抵抗指数增加呈显著相关关系(P<0.001)。结论甘油三酯水平增高与胰岛素抵抗和胰岛素抵抗指数增加呈显著相关关系,甘油三酯水平可能预测妊娠期糖尿病孕产妇胰岛素水平变化情况。     

Determinants of body fat in infants of women with gestational diabetes mellitus differ with fetal sex

OBJECTIVE

Neonatal adiposity is a well-recognized complication of gestational diabetes mellitus (GDM). This study aimed to identify factors influencing adiposity in male and female infants of women treated for GDM.

RESEARCH DESIGN AND METHODS

This was a prospective study of 84 women with GDM. Daily blood glucose levels (BGLs) were retrieved from glucose meters, and overall mean fasting and mean 2-h postprandial BGLs were calculated for each woman. Infant body composition was measured at birth, and regression analysis was used to identify significant predictors of infant body fat separately in male and female infants.

RESULTS

Maternal fasting BGL was the major predictor of adiposity in male infants but had little relationship to adiposity in female infants. In male infants, percent fat was increased by 0.44% for each 0.1 mmol/L increase in mean maternal fasting BGL. Maternal BMI was the primary predictor in female infants but had little effect in males. In female infants, percent fat was increased by 0.11% for each 1 kg/m² increase in maternal prepregnancy BMI.

CONCLUSIONS

Fetal sex may influence the impact that treatment strategies for GDM have on infant adiposity.The maternal metabolic disturbance of gestational diabetes mellitus (GDM) affects fetal development and alters birth weight, BMI, and percent body fat at birth (1,2). Current treatment of GDM achieves normalization of birth weight and reduces neonatal complications (3). However, the effects of GDM on the offspring extend well beyond the fetal period and, thus, offspring of women with GDM also have an increased risk of unfavorable long-term outcomes such as obesity and diabetes, well above that explained by genetics alone (4), even after treatment.To date, studies designed to inform optimal treatment of GDM have focused on normalization of birth weight, but neonatal adiposity may be a more sensitive marker of disturbed in utero metabolism, risk of obesity, and poor long-term health than birth weight alone (1). Body fat at birth is elevated in infants born to women with GDM even when birth weight is normal (1). In a group of 6- to 12-year-old children born to women with GDM, percent body fat in childhood was significantly correlated to body fat at birth, but there was no relationship between birth weight and weight at the time of study (5). Even though treatment of mild GDM does reduce the incidence of macrosomia, it does not reduce the incidence of obesity in the offspring at 4–5 years (6).To interrupt the obesity cycle and reduce the risk of future poor adult health, it may be necessary to normalize neonatal adiposity as well as birth weight. To do this, it is essential to understand the factors that determine adiposity in infants of women with GDM.While genetic factors may be the primary determinant of lean body mass, fetal fat mass may be more strongly influenced by the in utero environment (7). A range of maternal factors have been identified as determinants of neonatal size and body fat, including maternal BMI, parity, maternal glucose concentration, and insulin sensitivity (8–10). Higher gestational weight gain is associated with increased infant birth weight in lean and moderately overweight women (11) and in women with normal glucose tolerance (9) but not in obese women (11) or women with GDM (9). However, the factors influencing fetal fat accretion remain poorly understood.Both body weight and body composition at birth are different in male and female infants (12), and sex of the infant has been reported as a significant determinant of each (9). We hypothesized that the determinants of fetal body composition may also differ with fetal sex. The aim of this study was to identify factors that influence adiposity in male and female infants born to women treated for GDM.     

妊娠期糖尿病病人铁营养状况的临床分析

[目的]研究妊娠期糖尿病（GDM）妇女的铁营养状况,旨在探讨妊娠中期铁营养与GDM的关系及各项指标对GDM发生的预测作用。[方法]在产检孕妇中,按血糖筛查和75g糖耐量试验（OGTT）筛选出ODM孕妇104例,随机选择糖耐量正常孕妇104例作为对照组,分别测定两组孕妇的血清铁蛋白（SF）等指标,以评价机体的铁营养状况,并对相应指标作对比和回归分析。[结果]GDM组孕妇SF、血红蛋白（Hb）、糖化血红蛋白（HbAlc）及红细胞压积（HCT）水平均显著高于对照组（P〈0．01）;平均红细胞体积（MCV）和平均红细胞血红蛋白量（MCH）两组比较差异无统计学意义;多因素分析表明,SF、HbAlc和HCT是GDM的独立预测因子。[结论]GDM病人铁营养状况较好,体内铁储备较高;孕期铁营养过剩与GDM的风险增加有关。     

时间-空间相关成像联合组织多普勒超声观察妊娠期糖尿病孕妇胎儿心脏结构和功能

目的 探讨时间-空间相关成像（STIC）联合组织多普勒（TDI）超声检测妊娠期糖尿病（GDM）孕妇胎儿心脏结构和功能的应用价值。方法 选取140例GDM孕妇（胰岛素治疗组40例,饮食控制组62例,血糖控制不良组38例）和211名正常妊娠孕妇（对照组）。应用STIC后处理获得M型图像（STIC-M型）,测量胎儿左、右心室壁和室间隔收缩末期和舒张末期厚度,以TDI测量胎儿心脏房室瓣环舒张早期运动速度（Ea）、舒张晚期运动速度（Aa）及收缩期运动速度（Sa）,并计算Ea/Aa值,比较4组间参数的差异。结果 4组间胎儿左、右心室壁及室间隔舒张末期和收缩末期厚度总体差异均有统计学意义（P均<0.05）,GDM各组均大于对照组（P均<0.05）,GDM各组间差异均无统计学意义（P均>0.05）。4组间二尖瓣环Ea/Aa总体差异有统计学意义（P=0.002）,GDM各组二尖瓣环Ea/Aa均小于对照组（P均<0.05）,GDM各组间差异无统计学意义（P均>0.05）。4组间三尖瓣环Ea/Aa、二尖瓣环Sa、三尖瓣环Sa总体差异均无统计学意义（P均>0.05）。结论 GDM孕妇胎儿心室壁及室间隔厚度增加,心脏舒张功能降低,血糖控制情况的差异对胎儿心肌厚度和心脏功能改变无显著影响。STIC-M型联合TDI超声技术对评估GDM孕妇胎儿心脏结构和功能具有一定应用价值。     

Increased visfatin concentrations in women with gestational diabetes mellitus

The recently discovered adipocytokine visfatin has insulin-like properties. It lowers blood glucose and improves insulin sensitivity; however, clinical data on visfatin are limited. To evaluate the role of visfatin in GDM (gestational diabetes mellitus), we determined visfatin levels in women with GDM and in healthy pregnant controls. Furthermore, visfatin concentrations were investigated longitudinally during pregnancy and after delivery in a subgroup of women with GDM. Blood for measurement of visfatin and metabolic parameters was obtained from 64 women with GDM [median week of gestation, 34 (interquartile range, 27-36) weeks] and 30 healthy pregnant controls [median week of gestation, 34 (interquartile range, 28-36) weeks]. In a subgroup of 24 women with GDM, visfatin, leptin and metabolic parameters were investigated twice during pregnancy (28-30 and 38-40 weeks of gestation) and 2 weeks after delivery. In the cross-sectional analysis, median visfatin levels were significantly elevated in women with GDM [64.0 (interquartile range, 50.9-74.8) ng/ml] compared with controls [46.0 (interquartile range, 36.9-54.6) ng/ml; P<0.0001]. In women with GDM, visfatin correlated with week of gestation at the time of blood draw (R=0.35, P=0.005). No association with fasting glucose, insulin, homoeostasis model assessment-insulin resistance or body mass index was observed. According to the longitudinal analysis, visfatin increased during pregnancy (P=0.002) and rose further after delivery (P=0.014), whereas leptin and insulin levels decreased after parturition (both P<0.001). In conclusion, visfatin is elevated in women with GDM and increases during the course of pregnancy as well as after delivery. Furthermore, visfatin shows no association with insulin and leptin in women with GDM.     

Early onset of subclinical atherosclerosis in women with gestational diabetes mellitus.

OBJECTIVE: Common carotid artery intima-media thickness (CIMT) is a non-invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM). METHODS: Thirty women with GDM and 40 unaffected women (as a control group) were included in the study. Blood samples were drawn from each woman in the morning after they had fasted for at least 8 h, and levels of fasting glucose, insulin, homocysteine, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and very low-density lipoprotein (VLDL) cholesterol were measured, along with the CIMT in the two groups. RESULTS: The mean triglyceride (P = 0.016) and VLDL cholesterol (P = 0.011) levels in the GDM group were significantly higher than those in the unaffected women. There were no significant differences between the groups with respect to plasma levels of total cholesterol, HDL cholesterol, LDL cholesterol and insulin. The mean homocysteine (P = 0.027) and fasting glucose (P = 0.019) levels in women with GDM were significantly higher than those in the control group. Patients with GDM had significantly higher CIMT than did the unaffected women (0.582 +/- 0.066 mm vs. 0.543 +/- 0.049 mm, P = 0.006). CIMT correlated positively with maternal age (r = 0.316, P = 0.008), body mass index (BMI) at the time of a 50-g oral glucose load test (r = 0.414, P = 0.001) and homocysteine levels (r = 0.332, P = 0.008), and fasting glucose (r = 0.265, P = 0.031) and 1-h glucose value (r = 0.410, P = 0.001) at the time of the oral glucose tolerance test. There was a positive correlation between the presence of GDM and CIMT (r = 0.372, P = 0.001). However, stepwise multiple regression analysis showed that GDM/no GDM (95% CI +0.012 to +0.076, P = 0.008) and BMI at the time of the 50-g test (95% CI +0.001 to +0.009, P = 0.011) were independent parameters related to CIMT. CONCLUSION: Women with GDM have increased CIMT compared with unaffected women.     

超声在妊娠期糖尿病孕妇胎儿检查中的应用

随着医疗诊断技术和人们生活水平的提高,妊娠期糖尿病(GDM)的发病率呈逐年上升趋势。通过超声对胎儿生长发育等方面的监测,可评估GDM对围生儿的影响,为GDM诊断、治疗提供一种更加直接、有效、无创的方法。     

超声检测妊娠期糖尿病孕妇胎儿肾动脉血流动力学的价值

目的 探讨超声检测胎儿肾动脉m流动力学指标在妊娠期糖尿痫（GDM）孕妇中的临床价值：、方法GDM孕妇83例,同期分娩正常孕妇80例为对照组,于妊娠晚期超声榆测胎儿肾动脉阻力指数、搏动指数及收缩期峰值流速和舒张未期流速的比值（S／D）,比较两组肾动脉血流动力学变化及妊娠结局。、结果GDM组胎儿肾动脉阻力指数、搏动指数及S／D均高于对照组（P〈0．05）,GDM组围产儿结局不良高于对照组（P〈0．05）;在GDM组中胎儿肾动脉阻力指数≥0．85,S／D≥6．5,其预测闱产儿结局不良的敏感性分别为72．2％、77．8％,特异性分刖为87．7％、84．6％,二者预测差异尤统计学意义（P〉0．05）．．结论趟声检测GDM孕妇的胎儿肾动脉血流动力学的指标,是了解围产儿预后的有效监护手段,而胎儿肾动脉阻力指数和S／D导常预测围产儿结局不良具有较高的敏感性和特异性。     

妊娠期糖尿病妇女产后2型糖尿病发生及预防的研究进展

随着糖尿病(diabetes mellitus,DM)发病率及相关病死率在全球范围内的不断上升,严重威胁人类健康,DM预防已成为世界各国共同关注的健康问题。同时,文献显示妊娠期     

Understanding exercise beliefs and behaviors in women with gestational diabetes mellitus

OBJECTIVE: The purpose of this study was to examine the exercise beliefs and behaviors of postpartum women who had gestational diabetes mellitus (GDM) during a recent pregnancy. RESEARCH DESIGN AND METHODS: Postpartum women with GDM (n = 28) completed a mail survey assessing their self-reported exercise beliefs (advantages, barriers, and important social influences) and behaviors. RESULTS: We found that 1) the strongest perceived advantage of exercise during pregnancy was controlling blood glucose and postpartum it was controlling weight, 2) the most common barrier to exercise during pregnancy was fatigue and postpartum it was a lack of time, 3) women's husband/partner most strongly influenced their exercise during pregnancy and postpartum, 4) women exercised more during the postpartum period than before or during pregnancy, and 5) the number of exercise advantages was positively associated with women's pregnancy and postpartum exercise behavior. CONCLUSIONS: To increase exercise behavior and reduce the risk of type 2 diabetes in women with GDM, researchers and health care professionals are encouraged to use women's exercise beliefs, that is, advantages, social influences, and perceived barriers to exercise, as a framework for designing effective diabetes treatment and prevention programs.     

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…     

组织多普勒技术评价妊娠期糖尿病胎儿心脏作功指数

目的探讨妊娠期糖尿病对胎儿心脏结构和功能的影响.方法妊娠期糖尿病患者血糖控制不良者18例,血糖控制良好者17例,正常对照组70例.每例妊娠过程中至少进行3～4次胎儿超声心动图检查,测量胎儿心脏室壁厚度,应用组织多普勒技术计算胎儿心脏的整体作功指数(Tei指数).结果妊娠期糖尿病血糖控制不良组胎儿心脏室壁厚度及左、右心Tei指数均高于其他两组.血糖控制良好组胎儿心脏左、右心Tei指数高于正常组,室壁厚度与正常组无差异.结论妊娠期糖尿病患者胎儿心脏的结构与功能受到不同程度的损害.     

标准化糖尿病护理路径在妊娠合并糖尿病孕妇围产期中的应用

目的:探讨标准化糖尿病护理路径在妊娠合并糖尿病孕妇围产期中的应用效果。方法:选取2011年5月~2014年5月妊娠合并糖尿病孕妇50例,将其随机等分为对照组和观察组,对照组予常规护理,观察组予标准化护理路径护理,观察护理后在围产期血糖、产程监护相关指标上变化情况。结果:观察组护理后空腹血糖、餐后2 h血糖、糖化血红蛋白、并发症发生率低于对照组(P0.05);两组患者妊娠结局比较,观察组优于对照组(P0.05)。两组新生儿并发症发生率差异无统计学意义(P0.05)。结论:标准化护理能降低妊娠合并糖尿病孕妇围产期血糖值,保证产程安全。