妊娠早期生活方式干预对高危孕妇妊娠期糖尿病的预防效果评价研究

目的评价自妊娠早期开始实施生活方式干预是否能降低高危孕妇妊娠期糖尿病(GDM)的发病风险。方法自2020年1月至2021年9月, 在天津市市区(河西区、南开区、河东区、河北区)和郊区(东丽区、西青区、津南区)招募有高危因素[妊娠早期体重指数(BMI)为24～35 kg/m2或有糖尿病家族史]的妊娠6～15周孕妇作为干预队列, 通过电子信息系统回顾性收集同期在天津市一个市区(南开区)和一个郊区(东丽区)接受孕产妇常规管理但未纳入干预队列的所有具有上述高危因素的孕妇信息, 作为对照队列。干预队列接受线上和线下相结合的生活方式干预(营养、运动和体重控制)。基线调查时, 收集年龄、糖尿病家族史、孕周和空腹血糖(FPG)水平等信息, 记录身高和体重并计算BMI。所有孕妇在孕24～28周接受两步法GDM筛查。两组间比较采用t检验或χ2检验。采用logistic回归模型评价生活方式干预对降低GDM发病风险的效果。结果干预队列和对照队列分别106人和2 348人纳入研究, 干预队列和对照队列的孕妇在怀孕年龄、一级亲属糖尿病家族史比例、基线调查时孕周和基线调查时FPG水平差异均有统计学意义(P<0...     

糖尿病合并妊娠和妊娠期糖尿病母儿并发症的诊断分析

目的探讨分析糖尿病合并妊娠和妊娠期糖尿病母儿并发症的诊断。方法选取2013年6月—2014年6月该院收治的GDM患者12例与同期糖尿病合并妊娠期患者12例,分别作A、B组,A组患者视病情采取饮食控制与必要胰岛素治疗,B组患者全部饮食控制与胰岛素治疗,对比两组患者的母儿并发症与妊娠结局。结果 GDM患者的妊娠结局明显好于糖尿病合并妊娠患者,母儿的并发症明显较少,组间差异有统计学意义(P0.05)。结论对糖尿病合并妊娠患者与妊娠期糖尿病患者进行有效的血糖控制,能够有效降低并发症的发生,提高妊娠结局。     

护理干预对妊娠期糖尿病并发症的影响研究

目的探讨妊娠期糖尿病的产前护理干预对产妇及胎儿并发症的影响。方法选取该院2013年1月—2014年3月收治的80例妊娠期糖尿病患者,随机分为两组,对照组行常规护理,研究组除常规护理外,给予专项护理干预。结果研究组的孕妇出现高血压、术后感染、早产儿、巨大儿的几率均低于对照组。结论产前护理干预有利于减少妊娠期糖尿病并发症的发生。     

妊娠期糖尿病围生期个体化饮食干预效果研究

目的探讨妊娠期糖尿病（GDM）孕妇围生期实施个体化饮食干预的临床效果。方法将我院确诊为GDM的孕妇76例随机分为实验组和对照组。实验组将GDM孕妇列入高危妊娠管理,实施食物交换份法饮食教育并采取一系列临床干预措施,对照组未进行系统管理。结果实验组健康知识掌握率、依从性明显高于对照组,血糖生化指标及焦虑、产后抑郁发生率显著低于对照组。结论围生期个体化饮食干预可以提高GDM孕妇健康知识水平,提高其依从性,有效控制血糖,并能降低孕妇焦虑和产后抑郁的发生。     

妊娠期糖尿病的护理

糖尿病是一种遗传因素与环境因素共同作用的全身性慢性代谢性疾病。是因胰岛素绝对或相对不足而引起糖、脂肪和蛋白质代谢紊乱。而妊娠期糖尿病是指妊娠时发生或发现的糖尿病。由于妊娠期生理、内分泌代谢变化复杂，胎儿的生长发育需要能量，而糖尿病本身为了调节血糖水平，需要控制饮食，正常孕妇能吃的水果、甜食等营养物质成为糖尿病孕妇的禁忌，或只能限量摄取。孕妇常担心自己限制饮食会影响宝宝的生长而感到焦虑。     

妊娠期糖尿病患者血清瘦素水平变化及其与母婴预后的关系

目的观察妊娠期糖尿病（GDM）患者血清瘦素水平的变化,探讨其与母婴预后的关系。方法选择30例规范治疗的GDM患者（治疗组）、12例未规范治疗的GDM患者（GDM组）及32例正常孕妇（对照组）,采用酶联免疫吸附法测定其血清瘦素,分析其与母婴预后的关系。结果治疗组治疗前血清瘦素水平为（22.6±5.8）μg/L,GDM组为（24.5±4.7）μg/L,对照组为（8.8±2.4）g/L,治疗组、GDM组与对照组比较,P均〈0.05。治疗组治疗后血清瘦素水平为（10.0±3.4）μg/L,与对照组比较,P〉0.05。治疗组发生妊娠期高血压疾病2例,巨大儿3例,胎儿窘迫3例,新生儿低血糖0例,产后2型糖尿病5例;GDM组分别为3、8、2、2、3例,对照组分别为3、4、2、0、0例,治疗组、对照组与GDM组比较,P均〈0.05。血清瘦素水平与GDM患者产后2型糖尿病和巨大儿的发生率呈正相关（r分别为0.015、0.018,P均〈0.05）。结论GDM患者血清瘦素水平升高,可增加母婴并发症的发生率。     

妊娠期糖尿病的社区个体化综合干预的效果分析

目的观察社区个体化综合干预对妊娠期糖尿病(GDM)的治疗效果。方法对临床确诊的31例GDM孕妇进行社区个体化综合干预,包括:心理护理、健康教育、饮食控制、适量运动、胰岛素治疗及产后随访等的联合干预措施,观察至产前、随访2～6个月的血糖控制情况。结果 31例GDM孕妇进行社区个体化综合干预前,29例存在不良心理(93.5%),干预后2例(6.4%);14例知晓糖尿病知识(45.2%),干预后31例均知晓(100.0%),干预前后患者不良心理发生率和GDM知识知晓率比较,差异均有统计学意义(P<0.01)。至产前27例GDM孕妇血糖水平控制良好(87.1%),其中23例只采取饮食控制、适量运动,4例增加胰岛素治疗,4例为产前血糖水平控制不良(12.9%),干预过程中均使用胰岛素治疗。31例GDM孕妇产后均得到随访,随访时间为2～6个月,其中3例血糖水平控制不良转内科治疗,均为产前血糖水平控制不良者,余28例血糖水平控制良好。结论社区个体化综合干预GDM患者,血糖控制良好率高,能够改善不良心理、提高GDM知识知晓率。     

妊娠期糖尿病对妊娠结果的影响

目的为研究妊娠期糖尿病对母亲以及新生儿的健康影响。方法选择2011年2月—2013年5月在该院妇产科产检的产妇,妊娠期糖尿病者组:初产妇120例,经产妇30例,年龄平均30岁。对照组:年龄23~35岁,平均年龄25.1岁,30岁以上90例,无急慢性疾病史,糖筛查正常,初产妇109例,经产妇12例。对150例妊娠期糖尿病孕妇和150例非妊娠期糖尿病孕妇进行对照试验,在妊娠24~28周时,经过口服50 g的葡萄糖筛检及100 g口服葡萄糖耐受试验,测出空腹、餐后1h、2 h及3 h之血糖浓度,若发现其中至少有两项数值高于标准值时(空腹,105 mg/dl;餐后1 h,190 mg/dl;餐后2 h,165 mg/dl;餐后3 h,145mg/dl),则诊断为糖尿病,并对妊娠结果进行分析,以此获取妊娠期糖尿病对孕妇妊娠结果的影响。结果妊娠期糖尿病孕妇的相关指标、并发症以及新生儿的疾病发生率等都相对应于非妊娠期糖尿病孕妇高。结论妊娠期严重影响孕妇以及新生儿的健康,孕妇应定期检查,做好预防措施,做好控制血糖和早期诊断是减少并发症的关键措施,除此之外,孕妇要合理控制自己的饮食,遵照医生的嘱咐。     

妊娠期糖尿病产前护理干预对患者并发症的影响

目的:探究产前护理干预应用于妊娠期糖尿病,对其效果以及对患者并发症的影响进行具体的分析.方法:选择妊娠期糖尿病120例,随机分为两组.分别为对照组和观察组,每组60例.对照组采用常规护理方式进行护理,观察组在此基础上应用护理干预.实验结束后将两组数据进行整合和分析.结果:观察组患者的血糖水平低于对照组,观察组的患者的并...     

妊娠期糖尿病护理干预研究进展

妊娠期糖尿病(GDM)属高危妊娠,其发病与胰岛素抵抗(IR)和胰岛β细胞分泌功能障碍有关,目前胰岛素治疗是药物控制GDM糖代谢紊乱的最佳选择。近年来,围产医学开展了多种形式的糖尿病孕妇护理干预研究,对有效控制血糖,确保妊娠期母婴并发症有积极意义。本文就护理干预研究进展作一综述。     

Neonatal hyperthyrotropinemia in gestational diabetes mellitus and perinatal complications

The aim of this study is to explore the relationship between high cord blood thyroid-stimulating hormone (TSH) level and in-utero stress to the fetus in gestational diabetes mellitus (GDM). Cord blood TSH results were analyzed in 1,578 euthyroid infants from singleton pregnancies with GDM: 103 with elevated TSH (>16 mIU/l) and 1,475 with normal TSH. Maternal characteristics, pregnancy outcome and perinatal complications were compared between the two groups. Multiple logistic regression was used to study the association between high cord blood TSH level and various perinatal complications which reflect in-utero stress in GDM after adjusting for the confounding effects of parity, instrumental delivery, cesarean section and baby gender. High cord blood TSH level was found to be associated with the 1-min Apgar score <7 (OR 3.31, 95% CI 1.78-6.16), birth trauma (OR 3.44, 95% CI 1.11-10.69), neonatal jaundice requiring treatment (OR 2.08, 95% CI 1.30-3.32), neonatal sepsis (OR 2.34, 95% CI 1.24-4.42), respiratory complications (OR 3.45, 95% CI 1.37-8.70), neurological complications (OR 8.01, 95% CI 1.91-33.60) and overall perinatal morbidity (OR 2.41, 95% CI 1.58-3.67). Cord blood TSH level seems to be a better and independent indicator of the in-utero stress to the fetus in GDM when compared to the commonly used sugar profile result and HbA1c level.     

Gestational diabetes mellitus: postpartum opportunities for the diagnosis and prevention of type 2 diabetes mellitus

Gestational diabetes mellitus (GDM) affects approximately 4% of all pregnant women in the US and represents 90% of all cases of diabetes mellitus diagnosed during pregnancy. In addition to the adverse pregnancy outcomes associated with this complication, a history of GDM predisposes women to the future development of type 2 diabetes mellitus (T2DM). Incidence rates of GDM are increasing in the US. As a consequence, a growing number of women are now at increased risk for T2DM. Opportunities to diagnose and prevent T2DM in women with a history of GDM include early diagnosis by postpartum screening and implementation of diabetes prevention measures. In this Review, we discuss current guidelines for postpartum screening, how they might be implemented, and who should take responsibility for screening individuals at risk of T2DM. In addition, we describe measures to prevent the onset of T2DM in women with a history of GDM, focusing on lifestyle modifications, such as diet and breast-feeding.     

Diabetes related autoimmunity in gestational diabetes mellitus: Is it important?

Some GDM women show autoantibody positivity during and after pregnancy and pancreatic autoantibodies can appear for the first time in some patients after delivery. Autoantibody positivity is often accompanied by a high frequency of DR3 and DR4 alleles, which are classically related to the development of type 1 diabetes and, although not all studies agree on this point, by an immunological imbalance expressed by the behaviour of the lymphocyte subpopulation, which can be seen as diabetic anomalies overlapping with the immunological changes that occur during pregnancy. It is worth emphasizing that such patients may develop classical type 1 diabetes during and/or after their pregnancy or they may evolve, often some years after their pregnancy, into cases of latent autoimmune diabetes of adulthood (LADA).Autoimmune GDM accounts for a relatively small number of cases (about 10% of all GDM) but the risk of these women developing type 1 diabetes or LADA is very high, so these patients must be identified in order to prevent the severe maternal and fetal complications of type 1 diabetes developing in pregnancy, or its acute onset afterwards.Since women with autoimmune GDM must be considered at high risk of developing type 1 diabetes in any of its clinical forms, these women should be regarded as future candidates for the immunomodulatory strategies used in type 1 diabetes.     

Diabetes mellitus in Egypt: glycaemic control and microvascular and neuropathic complications

We performed a cross-sectional, population-based survey of persons 20 years of age and older living in Cairo and surrounding rural villages. The purpose was to describe glycaemic control and the prevalence of microvascular and neuropathic complications among Egyptians with diagnosed diabetes, previously undiagnosed diabetes, impaired glucose tolerance, and normal glucose tolerance. A total of 6052 households were surveyed. The response rate was 76 % for the household survey and 72 % for the medical examination. Among people with previously diagnosed diabetes, mean haemoglobin A_1c was 9.0 %. Forty-two per cent had retinopathy, 21 % albuminuria, and 22 % neuropathy. Legal blindness was prevalent (5 %) but clinical nephropathy (7 %) and foot ulcers (1 %) were uncommon in persons with diagnosed diabetes. Among people with diagnosed diabetes, microvascular and neuropathic complications were associated with hyperglycaemia. Retinopathy was also associated with duration of diabetes; albuminuria with hypertension and hypercholesterolaemia; and neuropathy with age, female sex, and hypercholesterolaemia. Albuminuria was as common in people with previously undiagnosed diabetes (22 %) as those with diagnosed disease (21 %). Mean haemoglobin A_1c was lower (7.8 %) and retinopathy (16 %) and neuropathy (14 %) were less prevalent in people with previously undiagnosed disease. Ocular conditions, blindness, and neuropathy were prevalent in the non-diabetic population. The microvascular and neuropathic complications of diabetes are a major clinical and public health problem in Egypt. Copyright © 1998 John Wiley & Sons, Ltd.     

糖尿病的全球流行现状和未来20年发展趋势——2009年IDF第4版《糖尿病图集》最新数据

2009年10月18-22日在加拿大蒙特利尔举行的第20届国际糖尿病联盟(IDF)会议中发布了第4版<糖尿病图集>.IDF希望通过<糖尿病图集>向全球医生、科学家、卫生经济学家、政府部门提供基于循证医学的有关糖尿病流行现状及未来发展趋势的最新数据.IDF的<糖尿病图集>已被世界卫生组织(WHO)、世界银行、经济合作发展组织(OECD)及世界经济论坛采用作为数据来源.