肥胖与妊娠期糖尿病

妊娠期糖尿病(gestational diabetes mellitus,GDM)是妊娠期间首次发生或发现的糖代谢异常,是在妊娠期发展的一种对碳水化合物不耐受的状态。近年来肥胖及GDM的发病率逐年增高,成为必须重视的问题。肥胖是GDM发病的独立危险因素,可导致不良妊娠结局。本文从妊娠期肥胖的评价指标及妊娠期肥胖的管理等角度,阐述肥胖与GDM的关系。     

妊娠期糖尿病的诊治体会

目的:探讨妊娠期糖尿病(GDM)的临床治疗,并分析与妊娠结局的关系。方法:回顾性分析我院2006年1月至2010年12月住院分娩的GDM孕妇87例,其中43例GDM血糖未控制组(观察组1)44例GDM血糖控制组(观察组2)及50例糖筛查正常孕妇组(对照组)的妊娠结局。结果:经临床治疗后,血糖未控制组母儿并发症明显高于血糖控制组及对照组(P<0.05)。结论:重视孕妇血糖筛查,及时诊断和治疗妊娠期糖尿病,选择合适的时间和方式终止妊娠可以有效地降低母儿并发症的发生率。     

妊娠期糖尿病患者的分娩时机及方式

妊娠期糖尿病(gestational diabetes mellitus,GDM)的发病率逐年上升,已成为妊娠期最常见的合并症之一,严重影响了围产期母儿的妊娠结局.合适的分娩时机及分娩方式,能有效降低GDM围产期并发症的发生率,有利于改善孕妇和新生儿不良结局.本文主要就近年来关于GDM的分娩时机、分娩方式及其影响因素研...     

妊娠合并糖尿病的诊断

妊娠合并糖尿病包括患有糖尿病者妊娠(即糖尿病合并妊娠),以及妊娠期糖尿病(gestational diabetes mellitus,GDM).GDM是指妊娠期发生或发现的糖尿病.当然GDM患者其实包含一部分妊娠前已患有糖尿病但未曾获得诊断仅在本次妊娠期被发现,尽管大多数GDM患者产后糖代谢异常能恢复正常,但是产后5～16年时将有17%～63%罹患有糖尿病.妊娠期及时对GDM者做出诊断,加以正确管理,不仅能减少孕期母儿合并症,也能够降低远期糖尿病的发生率.GDM发病率因种族差异采用诊断标准不统一[1,2],目前世界各国报道相差悬殊,美国报道该病发病率3%～5%[3,4].近年来,随着国内学者对妊娠合并糖尿病认识的提高,重视了孕期糖尿病筛查,该病检出率逐年升高,我院近3年妊娠合并糖尿病发病率高达2.99%,其中以GDM为多见,约占95%.     

妊娠期糖尿病合并亚临床甲状腺功能减退对妊娠结局的影响

目的探讨妊娠期糖尿病（gestational diabetes mellitus,GDM）合并亚临床甲状腺功能减退（subclinical hypothyroidism,SCH）的发病情况,及合并这两种内分泌疾病对妊娠结局的影响。方法选择2012年1月-12月在北京市通州区妇幼保健院分娩的孕妇,分为四组（GDM组、SCH组、GDM＋SCH组及对照组）,对四组的妊娠结局进行比较。结果妊娠合并SCH患者中GDM发生率达45％,GDM＋SCH组的妊娠期高血压疾病、妊娠期蛋白尿、剖宫产率、早产、胎儿低体重高于其他组。结论临床工作中,应重视糖代谢异常孕妇甲状腺功能的筛查,以减少母儿并发症。     

妊娠期葡萄糖耐量试验血糖值与新生儿出生体重的关系

妊娠期糖尿病(gestational diabetes mellitus,GDM)是妊娠期特有疾病,指妊娠期发生或首次发现的不同程度的糖耐量异常,包含了一部分妊娠前已经患有糖尿病但妊娠期首次被诊断的患者.由于GDM的发病率逐年上升,且与巨大儿、剖宫产率增加、子痫前期等一系列不良妊娠结局的发生及母儿远期不良预后密切相关[1 2],故目前周内已广泛开展GDM的筛查工作.本研究对孕妇进行50 g葡萄糖负荷试验(glucose challenge test,GCT),对筛查异常的孕妇进行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT),随访其妊娠结局,探讨OGTT各时点血糖值及OGTT结果的曲线下面积(area under the curve of the results of the oral glucose tolerance test,AUC-OGTT)与新生儿出生体重之间的关系.     

妊娠期糖尿病空腹血糖筛查的意义及其对妊娠结局的影响

妊娠期糖尿病(gestational diabetes mellitus,GDM)的发生率逐年上升,不良妊娠结局与血糖水平相关,即使妊娠妇女的血糖水平在正常范围,随着血糖水平的升高,大于胎龄儿、剖宫产率、新生儿低血糖、新生儿高胰岛素血症及生后糖尿病的发生等母儿不良预后的发生率增加,尽早诊断及治疗GDM有助于改善不良妊娠结局。利用空腹血糖(fasting plasma glucose,FPG)筛查GDM越来越受关注。其具有操作简单,价格低廉,可重复率高并且容易被妊娠妇女接受等优点。近年来许多研究证实,妊娠早期FPG与葡萄糖负荷试验(glucose challenge test,GCT)及口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)的血糖水平呈正相关,且显著降低了需要行OGTT检查的人数。故FPG筛查对GDM有较高的价值。     

糖化血红蛋白检测在妊娠合并糖尿病诊疗中的价值

妊娠合并糖尿病包括孕前糖尿病(PGDM)和妊娠期糖尿病(GDM),与母儿近远期并发症有关。糖化血红蛋白(HbA1c)可反映近2~3个月血糖水平,近年来用作非妊娠期糖尿病的诊断标准之一。很多学者对不同妊娠时期HbA1c水平能否预测GDM的发生、母儿不良妊娠结局和母亲产后糖尿病发生风险以及不同种族HbA1c水平差异、HbA1c水平的影响因素等方面进行了大量研究,多数认为HbA1c作为GDM的诊断指标敏感度不高,可能增加漏诊率,但其单独或与更多指标联合是筛查和诊断GDM的有力补充,可以减少口服葡萄糖耐量试验(OGTT)的检测。孕期不同时点的HbA1c水平均可能与妊娠结局有关,而产前HbA1c水平对识别可能进展为2型糖尿病的高危GDM孕妇也有一定的价值。不过,对HbA1c的截断值、包含HbA1c的不同筛查诊断策略意见尚不统一,仍需更多的研究进一步明确。     

妊娠期甲状腺功能异常37例临床分析

<正>妊娠期甲状腺激素水平与胎儿生长发育密切相关,妊娠期甲状腺功能异常将影响妊娠结局。近年,妊娠期甲状腺功能筛查已日益受到重视,规范孕期保健,有效控制甲状腺功能异常,可改善妊娠结局。本文回顾分析了37例妊娠期合     

正常孕妇与妊娠期糖尿病孕妇膳食矿物质摄入量的病例对照研究

妊娠期糖尿病(gestational diabetes mellitus,GDM)是指在妊娠期首次发生或发现的糖代谢异常,与不良妊娠结局有关,还会影响母儿的远期健康.我国目前GDM的发病率为1.31%～3.75%[1].     

Twin pregnancy outcomes for women with gestational diabetes mellitus compared with glucose tolerant women

OBJECTIVE: To examine pregnancy outcomes for women with gestational diabetes mellitus (GDM) and a twin pregnancy compared with glucose tolerant women with a twin pregnancy. DESIGN: Comparison of selected pregnancy outcomes. SETTING: Wollongong, New South Wales, Australia. POPULATION: Women with GDM seen over a 10-year period by an endocrinologist, and women from a selected year of an obstetric database including Wollongong and Shellharbour Hospitals. METHODS: Examination of pregnancy outcome data from the two sources. MAIN OUTCOME MEASURES: Fetal birthweights and method of delivery. RESULTS: There were 28 GDM women with a twin pregnancy from 1229 consecutive referrals (2.3%) of women with GDM for medical management. For comparison there were 29 glucose tolerant women with twin pregnancies evaluable who had delivered over a 1-year period. For the women with GDM and a twin pregnancy there were no significant differences in demographics or outcomes except for a higher rate of elective Caesarean section. CONCLUSION: The higher rate of Caesarean section appeared to be related to the combination of a twin pregnancy and GDM rather than the twin pregnancy or the GDM independently.     

Pregnancy resolutions among pregnant teens: termination,parenting or adoption?

Women with gestational diabetes mellitus (GDM) and their offsprings are at increased risk of future type 2 diabetes and metabolic abnormalities. Early diagnosis and proper management of GDM, as well as, postpartum follow-up and preventive care is expected to reduce this risk. However, no large scale prospective studies have been done particularly from the developing world on this aspect. The objective of this study is to identify and follow a cohort of pregnant women with and without GDM and their offspring to identify determinants and risk factors for GDM, for various pregnancy outcomes, as well as, for the development of future diabetes and metabolic abnormalities. This is a prospective cohort study involving pregnant women attending prenatal clinics from urban, semi-urban and rural areas in the greater Chennai region in South India. Around 9850 pregnant women will be screened for GDM. Socio-economic status, demographic data, obstetric history, delivery and birth outcomes, perinatal and postnatal complications, neonatal morbidity, maternal postpartum and offsprings follow-up data will be collected. Those diagnosed with GDM will initially be advised routine care. Those unable to reach glycaemic control with diet alone will be advised to take insulin. Postpartum screening for glucose abnormalities will be performed at months 3 and 6 and then every year for 10 years. The offsprings will be followed up every year for anthropometric measurements and growth velocity, as well as, plasma glucose, insulin and lipid profile. In addition, qualitative research will be carried out to identify barriers and facilitators for early GDM screening, treatment compliance and postpartum follow-up and testing, as well as, for continued adherence to lifestyle modifications. The study will demonstrate whether measures to improve diagnosis and care of GDM mothers followed by preventive postpartum care are possible in the routine care setting. It will also map out the barriers and facilitators for such initiatives and provide new evidence on the determinants and risk factors for both GDM development and occurrence of adverse pregnancy outcomes and development of future diabetes and metabolic abnormalities in the GDM mother and her offspring.     

两种标准诊断妊娠期糖尿病妊娠结局的对比观察

目的对比教科书标准和国际妊娠与糖尿病研究组织（IADPSG）标准诊断妊娠期糖尿病的母婴结局。方法 2011年至2012年在煤炭总医院诊断并分娩的妊娠期糖尿病患者246例,按不同诊断标准分为两组,教科书组（73例）和IADPSG组（173例）,并给予相应的临床干预,对比两组患者的母婴结局。结果教科书标准诊断GDM的诊断率为9.61%,IADPSG标准为14.62%,差异有统计学意义（P〈0.05）。比较两组患者胎膜早破的发生率：教科书组为38.36%,IADPSG组为23.12%,差异有统计学意义（P〈0.05）。而比较两组患者胰岛素使用率、孕期体重增长、剖宫产率及巨大儿、妊娠期高血压、羊水过多、产后出血、胎儿宫内窘迫、新生儿高胆红素血症、新生儿低血糖发生率差异均无统计学意义（P〉0.05）。结论 IADPSG标准诊断妊娠期糖尿病,可以提高诊断率,改善不良母婴结局。     

Risk for gestational diabetes and hypertension for women with twin pregnancy compared to singleton pregnancy

OBJECTIVES. This study was undertaken to determine the incidence of pregnancy induced hypertension (PIH) and gestational diabetes (GDM) in twin pregnancies (TP) in comparison with singleton pregnancies (SP), and to test whether TP with GDM have a higher risk than TP without GDM, as is known to be the case in SP. MATERIALS AND METHODS. Eighty-nine patients with TP who sought prenatal care between 1 September 1994 and 30 October 1997, were asked to participate. One hundred and seventy-eight of the 1,416 patients were matched in a 1:2 ratio by age, body-mass-index, parity, gestational age at screening, and ethnicity with a singleton pregnancy from our database dating from the same period. The diagnosis "hypertension" or "preeclampsia" was made using clinical criteria including a repeated blood pressure above 140/90 mm Hg. Maternal and fetal outcome were compared between SP and TP, between TP with and without pathological screening, between TP with and without GDM. RESULTS. Patients with TP did not have a higher rate of GDM but of PIH (GDM 3.4% vs. 3.4%, p=0.63; PIH 2.8% vs. 9.0%, p=0.036). Expectant mothers of twins whose glucose screening test was pathological have a higher incidence of hypertension than those whose screening test was normal (17.9% vs. 4.9%, p=0.048). Twins of gestational diabetics have a higher rate of admission to the neonatal intensive care unit than twins of healthy pregnant patients (100% vs. 31%, p=0.028). CONCLUSIONS. TP are associated with a higher risk of hypertension than SP but not for GDM. Patients expecting twins who show a carbohydrate intolerance are at a higher risk for hypertension and fetal diabetes-associated complications.     

Gestational diabetes: screening,diagnosis, treatment and management

Gestational diabetes (GDM) is a common medical condition in pregnancy, and is associated with a range of short and long term maternal and infant complications including pre-eclampsia, pre-term birth, caesarean section, stillbirth, macrosomia and large-for-gestational age, neonatal hypoglycaemia, and increased risk of later type 2 diabetes in both mother and offspring. The incidence of complications can be reduced and pregnancy outcomes for these women are generally good with effective management of hyperglycaemia using regular monitoring of blood glucose, antenatal care with a multidisciplinary team, diet and lifestyle intervention, and pharmacotherapy. Risk of recurrence in future pregnancies, and of later development of type 2 diabetes is high in women with GDM. Attention should be given to screening and reducing risk in women who have experienced GDM, with encouragement of breastfeeding, diet and lifestyle intervention, weight management, and possibly metformin.     

Prevalence of gestational diabetes mellitus and pregnancy outcomes in Asian women with polycystic ovary syndrome.

The aim of this study was to determine the prevalence of gestational diabetes mellitus (GDM) and the pregnancy outcomes in Asian women with polycystic ovary syndrome (PCOS). The retrospective cohort study was performed to compare pregnancy outcomes of 47 pregnancies in 41 PCOS women with 264 pregnancies in 222 women with normal menstruation. Logistic regression was used to assess the risk of PCOS on GDM, hypertensive disorder in pregnancy (HDP) and premature delivery. The mean age of both groups was 31 years. The mean body mass index (BMI) and proportion of BMI of > 25 kg/m2 were significantly higher in the PCOS than in the control group. There was no difference in the prevalence of GDM between the PCOS women and the high-risk group of the controls. The prevalence of HDP and premature delivery was significantly greater in PCOS women (21.3 and 13.3%) than in the controls (6.4 and 5.4%), respectively. PCOS was demonstrated as a risk factor for GDM and HDP with borderline statistical significance, but not for premature birth. The Cesarean section rate was higher in the PCOS than in the control group. In conclusion, the prevalence of GDM in Asian women with PCOS is high and comparable to those of a high-risk group.     

Perinatal outcomes after adopting 1- versus 2-step approach to diagnosing gestational diabetes

Objective: The American College of Obstetricians and Gynecologists (ACOG) and the IADPSG (International Association of Diabetes and Pregnancy Study Groups) proposed distinct approaches to diagnosing gestational diabetes mellitus (GDM). We sought to analyze these paradigms: (1) ACOG 2-step approach where screening is followed by diagnostic testing, (2) IADPSG 1-step diagnostic testing.

Study design: We reviewed data from pregnant women (24–28 wks) screened for GDM over two periods: (1) November 2011–May 2012 (2) November 2012–May 2013. Period 1: 2-step approach (screening 1-h glucose challenge test (GCT) followed by a diagnostic 3-h 100-g glucose tolerance test (GTT) when abnormal (≥140?mg/dl)). Period 2: an abnormal value after a 2-h 75-g GTT result was diagnostic of GDM. We compared the incidence of GDM and perinatal outcomes using either approach.

Results: Out of 471 patients screened by ACOG 2-step approach, 72 (15.3%) had an abnormal 1-h screening and underwent the 3-h diagnostic GTT, and 26 (5.5%) developed GDM. The 1-step approach resulted in 53 (15.96%) with GDM of a total 332 evaluated. There was no statistically significant difference in perinatal outcomes between the two cohorts. Maternal weight at the start and the end of pregnancy was greater for patients diagnosed by the ACOG 2-step approach.

Conclusion: Adopting 1-step approach (ADA) to diagnose GDM resulted in a 3-fold increase in prevalence of GDM with no differences in perinatal outcomes.     

Dépistage du diabète gestationnel : le temps est-il venu de revoir les recommandations ?

Universal screening for gestational diabetes mellitus (GDM) has been a topic of ongoing controversy for many years. In 2005, the French Health Authority concluded that no recommendation could be issued because of insufficient evidence. Recently, several studies have clarified the issues. It is now clearly established that women with GDM, including mild forms, are at increased risk of perinatal complications. Randomized controlled trials demonstrate that treatment to reduce maternal glucose levels improves perinatal outcomes. Today, the rationale for screening appears unquestionable. There are simple screening tests. However, it remains difficult to define threshold values because there is a strong, continuous association of maternal glucose levels with increased risks of adverse pregnancy outcomes.     

Fasting or two-hour postprandial plasma glucose levels in early months of pregnancy as screening tools for gestational diabetes mellitus developing in later months of pregnancy

PURPOSE: The present study was done to find out whether the fasting or 2-hour postprandial plasma glucose (PPPG) levels in early months of pregnancy can be used as screening tools for gestational diabetes mellitus (GDM) developing in later months of pregnancy. BASIC PROCEDURE: Fasting and 2-hour PPPG levels were measured in the early months of pregnancy in 246 women attending the antenatal clinic of the author. All of the women underwent glucose challenge tests with 50 grams of glucose at 24-28 weeks and if the value exceeded 140 mg%, a three-hour oral glucose tolerance test (OGTT) with 100 grams of glucose was performed to diagnose GDM. MAIN FINDINGS: The present study found that the incidence of GDM was 10.5% in the third trimester. Statistical analysis did not show any correlation between fasting and the PPPG values in the early months and GDM in later months of pregnancy. CONCLUSION: Fasting or PPPG values cannot be used as efficient screening tools for GDM developing in the later months of pregnancy.