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。     

妊娠期糖尿病孕妇甲状腺功能及妊娠结局的研究

目的:探讨妊娠期糖尿病(GDM)孕妇的甲状腺功能及妊娠结局情况。方法:检测569例GDM孕妇及1221例正常孕妇的血清促甲状腺素(TSH)、游离甲状腺素(FT4)和甲状腺过氧化物酶抗体(TPOAb)水平。根据结果将两组孕妇进一步分为甲减组、甲亢组、正常组,比较各组的流产、早产及新生儿窒息发生率。结果:GDM组:甲减91例(1例临床甲减、90例亚临床甲减),甲亢64例(14例临床甲亢、50例亚临床甲亢),正常414例;对照组:亚临床甲减113例,甲亢36例(3例临床甲亢、33例亚甲亢),正常1072例。GDM组的TPOAb总体阳性率显著高于对照组(12.8%vs 8.6%,P0.01)。GDM-甲减组的TPOAb总体阳性率显著高于GDM-正常组(P0.01),GDM其余各组间及对照各组间均无显著差异(P0.05)。GDM合并甲状腺功能异常孕妇的流产、早产率高于甲功正常的GDM孕妇及甲功异常和正常的非GDM孕妇;其分娩的新生儿窒息率亦高于甲功正常的GDM孕妇和甲功正常的非GDM孕妇。其中GDM合并亚临床甲减孕妇的流产、早产率高于单纯GDM孕妇及单纯亚临床甲减孕妇(P0.01),GDM合并甲亢孕妇的新生儿窒息率显著高于甲功正常的GDM孕妇(P0.05)。结论:GDM孕妇出现甲状腺功能异常的风险较高,GDM孕妇同时合并甲状腺功能异常,对母儿风险大。临床应重视孕妇特别是GDM孕妇的甲状腺疾病。     

亚临床甲状腺功能减退与妊娠期糖尿病的相关性分析

目的:探讨亚临床甲状腺功能减退(SCH)对GDM病情的影响程度。方法:选取2013年4月~2014年8月于我院就诊的GDM合并SCH孕妇共244例(研究组),根据孕妇及非孕人群血清TSH的正常值上限,将其中110例TSH4.0m U/L者归为研究组A,134例TSH 2.5~4.0m U/L者归为研究组B。另取同期就诊的甲状腺功能正常的GDM孕妇120例作为对照组。分析3组患者的临床资料。结果:3组孕妇的空腹血糖、糖化血红蛋白、糖化血清蛋白等比较,差异均无统计学意义(P0.05)。但研究组孕妇的胰岛素使用率均高于对照组,胰岛素敏感指数(ISI)和胰岛分泌功能指数(IFI)则低于对照组(P0.05)。结论:合并SCH的GDM孕产妇,其胰岛功能受损情况更为严重,使用胰岛素的概率升高。     

亚临床甲状腺功能减退与妊娠期糖尿病的关系

由于妊娠这一特殊时期的代谢变化,亚临床甲状腺功能减退合并妊娠期糖尿病较为常见.其两者之间的相互关系也受到了临床工作者的重视.本文总结了近年相关文献,阐述了两者间的相互作用,并从中得出结论:妊娠期内分泌功能紊乱的诊治应视为一个整体,不容忽视.     

妊娠合并甲状腺功能减退26例临床分析

目的探讨妊娠合并甲状腺功能减退（甲减）患者的围生期特征及母婴结局。方法对26例妊娠合并甲减患者的临床资料进行回顾性分析,并选择正常孕妇30例作为对照组,比较两组患者的妊娠结局。结果妊娠合并甲减的发病率为1.21‰（26/21 527）。26例患者中,妊娠前诊断22例,妊娠中诊断4例;并发子痫前期3例,其中轻度子痫前期2例,重度子痫前期1例;贫血5例,其中轻度贫血3例,中度贫血2例;流产1例,妊娠32周胎盘早剥致死胎1例,早产3例;新生儿阴茎缺如1例。无新生儿先天性甲减。26例患者中,21例规范治疗,5例未规范治疗;妊娠期平均左旋甲状腺素用量（43.1±40.6）ug/d;规范治疗组并发症发生率（52.3%,11/21）与未规范治疗组（4/5）比较,差异有统计学意义（P〈0.05）;甲减组总并发症发生率（57.6%,15/26）与对照组（13.3%,4/30）比较,差异有统计学意义（P〈0.05）。结论妊娠合并甲减发病率低,妊娠期动态监测甲状腺功能并规范治疗可改善母婴结局。     

亚临床甲状腺功能减退干预后对妊娠期糖耐量的影响

目的:探讨妊娠期亚临床甲状腺功能减退(SCH)与血糖的关系,为SCH的治疗方式及目标提供临床依据.方法:选择2009年4月至2012年12月在深圳市人民医院诊断为SCH的孕妇191例,选取同期正常孕妇199例为对照组,比较两组孕妇的空腹血糖及OGTT结果.SCH孕妇给予左旋甲状腺激素(L-T4)治疗,治疗目标TSH上限分别定为2.5mIU/L与3.0mIU/L,按治疗效果分为治疗达标组、治疗未达标组及未正规治疗组.比较两个治疗标准的OGTT结果.结果:TSH与空腹血糖无关(r=-0.03,P=0.34),SCH组与对照组患者的OGTT 1h血糖值有显著差异(P=0.04).治疗目标TSH上限定为2.5mIU/L时,治疗达标组OGTT 1、2h血糖值高于其余两组(P=0.00);TSH上限定为3.0mIU/L时,3组间OGTT无显著差异(P＞0.05),但治疗达标组OGTT 1、2h血糖值低于其余两组.结论:SCH可能是影响妊娠中期血糖的一个因素.甲状腺激素的正规补充治疗是减少SCH孕妇血糖异常的一个可能因素,且其治疗目标应定为3.0mIU/L.     

早孕期妊娠合并亚临床甲状腺功能减退对妊娠期糖尿病的预测北大核心CSCD

目的回顾性分析妊娠期亚临床甲状腺功能减退（subclinical hypothyroidism,SCH）对妊娠期糖尿病（gestational diabetes mellitus,GDM）的影响及预测。方法选取2015年1月至2016年1月于北京积水潭医院产检资料完整的1 872例单胎妊娠妇女为研究对象,采集包括孕前BMI、早孕期（妊娠12周前）促甲状腺激素（thyroid Stimulating Hormone,TSH）及甲状腺过氧化物酶抗体（Thyroid peroxidase antibody,TPOAb）结果,妊娠24-28周75 g糖耐量结果等,结果异常者定期复查。结果 GDM发生率为12.1%（227/1 872）。分别以TSH 2.5及4.0 m IU/L为切割值判定SCH,SCH发生率分别为35.58%（666/1 872）及9.72%（182/1 872）,TPOAb在SCH中的阳性率分别为15.0%（100/666）和29.1%（53/182）,合并GDM的发生率分别为14.56%（97/666）及28%（51/182）,差异有统计学意义（P〈0.05）。根据孕前BMI及早孕期TSH进行分组,各组间GDM发生率不同（P〈0.05）。本研究采用二分类Logistic回顾评估年龄,孕期BMI和早孕期TSH值对发生妊娠期糖尿病的影响,模型的正确分类百分比为87.8%,敏感度1.3%,特异度99.8%,阳性预测值75%,阴性预测值88.0%。针对TSH≥2.5 m IU/L的患者,模型中加入TPOAb变量,模型的正确分类百分比为88.7%,敏感度40.6%,特异度96.8%,阳性预测值68.42%,阴性预测值90.64%。结论结合年龄、孕前BMI及早孕期TSH水平,对GDM的预测有一定指导意义;针对高危人群筛查TPOAb可进一步增加预测的准确性,利于早期干预或可降低GDM发生,减少妊娠不良结局。     

妊娠期亚临床甲状腺功能减退的相关指南对比分析

亚临床甲状腺功能减退是一种常见的甲状腺内分泌疾病。很多研究显示妊娠期亚临床甲状腺功能减退可能对妊娠造成不良影响,甚至可能影响胎儿脑发育,但是对其危害以及诊断、如何进行筛查和治疗等多方面,国内外至今仍未达成一致意见。因此,本文拟通过对比分析近十年国内外公开发表的妊娠期亚临床甲状腺功能减退相关指南,为该领域的科研和临床工作者提供参考。     

左旋甲状腺素对亚临床甲状腺功能减退孕妇妊娠期糖尿病发生率的影响

目的：研究左旋甲状腺素（LT4）治疗对亚临床甲状腺功能减退（SCH）孕妇中妊娠期糖尿病（GDM）发生率的影响。方法：选取经甲状腺功能筛查诊断为SCH的妊娠妇女1 084例（SCH组）,正常妊娠妇女8 848例（对照组）。SCH组按患者是否愿意接受药物治疗分为SCH治疗组、SCH未治疗组,治疗组采用LT4治疗,未治疗组不用药。比较各组促甲状腺素（TSH）、游离甲状腺素（FT4）、甲状腺过氧化物酶抗体（TPOAb）情况,并根据口服糖耐量试验（OGTT）结果,比较各组GDM发生率。结果：SCH组TSH水平高于对照组,FT4低于对照组（均P=0.000）,治疗组与未治疗组的TSH水平高于对照组,FT4水平低于对照组（均P=0.000）。SCH治疗组的TSH水平与SCH未治疗组差异无统计学意义（P＞0.05）。SCH组TPOAb阳性率高于对照组（P=0.000）,SCH治疗组与未治疗组的TPOAb阳性率均高于对照组（P=0.000）,而SCH治疗组与未治疗组间差异无统计学意义（P＞0.05）。SCH组的GDM发生率高于对照组,差异有统计学意义（P=0.000）。SCH治疗组的GDM发生率低于未治疗组（P=0.035）。SCH治疗组的GDM发生率与对照组比较,差异无统计学意义（P＞0.05）,而SCH未治疗组的GDM发生率显著高于对照组,差异有统计学意义（P＜0.01）。结论：SCH会增加GDM的发病风险,尽早使用LT4正规治疗,可能对降低SCH孕妇的GDM发生率,减少SCH合并GDM对母儿的危害有积极作用。     

妊娠期亚临床甲状腺功能减退与脂质代谢的相关性研究

目的探讨妊娠期亚临床甲状腺功能减退(妊娠期亚甲减)与脂质代谢的相关性。方法收集2019年7月至2020年1月在郑州大学第三附属医院妇产科行定期围产保健并分娩的妊娠期亚甲减孕妇(30例)与正常孕妇(30例)的临床资料,采用液相质谱色谱分析(LC-MS)技术对孕妇血浆进行分析,得出两组间差异脂质代谢物,并用KEGG数据库分析代谢途径,最后用酶联免疫吸附试验(ELISA)技术对特定差异代谢物进行验证。结果两组间甘油三酯(TG)、C反应蛋白(CRP)等水平存在差异(P<0.005)。根据相对强度,选取磷脂酰甘油(PG)等30个差异脂质代谢物为潜在生物标志物。相关性分析表明,促甲状腺素(TSH)与TG存在正相关性(P<0.05),与磷脂酰乙醇胺(PE)(36∶5)、PG(46∶2)等代谢物存在负相关性(P<0.05)。KEGG代谢通路分析得出,差异脂质代谢物主要参与甘油磷脂代谢、致病性大肠杆菌感染等途径。结合KEGG通路分析及相对强度,选取磷脂酰乙醇胺等3个脂质分子进行ELISA验证,其在两组间差异均有统计学意义(P<0.05)。结论妊娠期亚甲减与脂代谢存在相关性,甘油磷...     

妊娠合并甲状腺功能减退症或亚临床甲状腺功能减退症77例临床分析

目的 探讨甲状腺功能减退症(简称甲减)及亚临床甲减对孕产妇妊娠结局及围产儿的影响.方法 回顾性分析2005年1月至2008年3月在北京协和医院妊娠合并甲减(57例)或亚临床甲减(20例)分娩孕妇77例,随机选取同期分娩的正常孕妇79例作为对照,分析三组孕妇的一般临床资料、产时产后并发症及嗣产儿结局.结果 3年间我院妊娠合并甲减的患病率为0.74%,合并亚临床甲减的患病率为0.26%,凡呈逐年升高趋势.妊娠合并甲减组新生儿平均出生体重低于对照组[(3191.8±659.4)g和(3301.9±423.1)g,P<0.05],妊娠期糖代谢异常发生率(24.6%)及小于胎龄儿的发生率(12.3%)均高于对照组(分别为11.4 %和2.5%)(P<0.05).妊娠合并亚临床甲减组各项妊娠期并发症的发生率与对照组比较,均无统计学意义.结论 妊娠合并甲减及亚临床甲减的患病率逐年上升,即使经过治疗,甲减或亚临床甲减孕妇小于胎龄儿等并发症的发生几率仍增加.对高危人群早期筛查、充分治疗是改善妊娠结局的最好方法.     

Gestational diabetes mellitus (GDM) screening in morbidly obese pregnant women

Objective

To study the outcomes of two-stage GDM screening of morbidly obese women in our obstetric unit and to evaluate the diagnostic performance of 20-week oral glucose tolerance test (OGTT) values in predicting or excluding late onset GDM.

Study design

A retrospective study in which 190 pregnant women with BMI ≥40 had two-stage screening: a 75 g OGTT is performed at 20 weeks and repeated at 28 weeks if the 20-week OGTT was normal. Receiver operating characteristic (ROC) curves for 20-week OGTT values were constructed in order to obtain an optimal cut-off value of fasting and/or 2-h glucose at 20 weeks from which GDM could be predicted or excluded at 28 weeks. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were determined for each of the fasting and 2-h post-load glucose values at 20 weeks.

Results

Forty six (24%) women were diagnosed with GDM. Thirty-two (70%) were diagnosed at 20 weeks and 14 (30%) at 28 weeks. The 2-h cut-off value of ≥6 mmol/l at the 20-week OGTT had a negative likelihood ratio of 0.12 to predict GDM at 28 weeks. The low negative likelihood ratio reduces the probability of detecting GDM at 28 weeks from 9% (pre-test probability) to 1% (post-test probability).

Conclusion

Nearly 70% of the women were diagnosed with GDM at 20 weeks, which gives an early opportunity to treat maternal hyperglycaemia with consequent health benefits. A 2-h cut-off glucose value of 6 mmol/l at 20 weeks OGTT has a low negative likelihood ratio which virtually excludes GDM at 28 weeks. Hence women with a 2 h value of <6 mmol/l at 20 weeks can avoid a repeat 28 week OGTT test.     

妊娠期糖尿病孕妇糖化血红蛋白水平与母婴结局的关系

目的:分析妊娠期糖尿病(GDM)患者中不同糖化血红蛋白(HbAlc)水平与母婴妊娠结局的相关性,探讨HbAlc在产前糖尿病病情监测中的意义。方法:选取2014年1月至12月在青海省妇女儿童医院行产前检查并分娩的119例GDM孕产妇,根据产前HbAlc控制水平将119例产妇分为达标组(5%≤HbAlc6%,68例)、未达标组(6%≤Hb Alc7%,51例)。选取同期55例HbAlc正常产妇为对照组。比较3组的母婴结局,分析不同HbAlc水平与母婴结局的相关性。结果:妊娠期间高血压(25.5%vs 10.3%vs5.5%)、羊水过多(17.6%vs 7.4%vs 3.6%)、胎膜早破比例(29.4%vs 5.9%vs 3.6%)、子痫前期比例(15.7%vs 5.9%vs 3.6%)及剖宫产比例(76.5%vs 45.6%vs 47.3%)由高到低依次为未达标组达标组正常组。未达标组的妊娠高血压、胎膜早破、妊娠周期、剖宫产比例与达标组比较,差异有统计学意义(P0.05)。Pearson积矩相关分析显示,HbAlc与妊娠周期呈显著负相关(r=-0.166,P=0.028)。围产儿中早产比例(27.5%vs 11.8%vs 7.3%)、巨大儿比例(29.4%vs 10.3%vs 3.6%)、1min Apgar评分≤7分比例(25.5%vs 11.8%vs 7.3%)、新生儿体重[(3702.7±402.5)g vs(3561.3±380.4)g vs(3252.8±345.7)g]、新生儿低血糖比例(33.3%vs 11.8%vs 10.9%)高到低排序为未达标组达标组正常组。未达标组的早产儿比例、巨大儿比例、1min Apgar评分≤7分比例、新生儿低血糖比例均显著高于达标组(P0.05)。Pearson积矩相关分析显示,Hb Alc与新生儿1min Apgar评分呈显著负相关(r=-0.156,P=0.040)。结论:GDM产妇体内HbAlc水平与母婴结局密切相关,HbAlc水平越高,妊娠与分娩期间发生母婴并发症的几率就越大;可将HbAlc作为孕妇血糖控制的重要监测指标。     

Perinatal outcomes in patients with gestational diabetes mellitus by race/ethnicity

Objective.?To determine if racial/ethnic differences exist in perinatal outcomes in women with gestational diabetes mellitus (GDM).

Methods.?This is a retrospective cohort study of singleton pregnancies with GDM cared for by the Sweet Success: California Diabetes and Pregnancy Program (CDAPP) between 2001 and 2004 at inpatient obstetric and neonatal services in California. There were a total of 26,411 women with gestational diabetes who were subgrouped by four races/ethnicities: Caucasian, African-American, Latina, and Asian. The chi-squared test was used to compare the dichotomous outcomes and p?<?0.05 was used to indicate statistical significance. Multivariable logistic regression analyses were performed to control for potential confounders. Perinatal outcomes, including severity of GDM, cesarean delivery (CD), birthweight, preterm birth, intrauterine fetal demise (IUFD) and neonatal intensive care unit (NICU) admission were compared.

Results.?Compared to Caucasians, African-Americans had higher odds of primary CD [aOR?=?1.29, 95% CI (1.05–1.59)] while lower odds were seen in Latinas [aOR?=?0.84, 95% CI (0.75–0.94)] and Asians [aOR?=?0.86, 95% CI (0.77–0.96)]. Asians had lower odds [aOR?=?0.58 (95% CI 0.48–0.70)] of birthweight >4000?g. African-Americans had highest odds of IUFD [aOR?=?5.93 95% CI (1.73–20.29)]. There were no differences in NICU admission.

Conclusion.?Perinatal outcomes in women diagnosed with GDM differ by racial/ethnic group. Such variation can be used to individually counsel women with GDM.     

Decreased plasma adiponectin concentrations in women with gestational diabetes mellitus

OBJECTIVE: Adiponectin is an adipocyte-specific protein that has been found to be associated with insulin sensitivity and obesity. Because gestational diabetes mellitus is associated with obesity and decreased insulin sensitivity, we have analyzed plasma adiponectin levels in women with gestational diabetes mellitus. STUDY DESIGN: Twenty women with gestational diabetes mellitus and 21 unaffected women were included in the study. Plasma adiponectin levels were analyzed with the use of enzyme-linked immunosorbent assay. RESULTS: Women with gestational diabetes mellitus were significantly older (34.3 years vs 29.4 years; P < .001) than unaffected women. Adiponectin plasma levels were significantly lower in women with gestational diabetes mellitus when compared with women without gestational diabetes mellitus (5827 +/- 1988 ng/mL vs 8085 +/- 3816 ng/mL; P = .02). Adiponectin plasma levels were correlated negatively with plasma glucose concentrations of the oral glucose tolerance test ( r > -0.38; P < .04) and correlated positively with gestational age ( r = 0.36; P = .03). CONCLUSION: Our data show that decreased plasma adiponectin levels were found in women with gestational diabetes mellitus compared with unaffected women.     

妊娠期糖尿病合并妊娠期肝内胆汁淤积症母儿结局探讨

目的:探讨妊娠期糖尿病合并妊娠期肝内胆汁淤积症对孕产妇和国产儿结局的影响。方法:分析17例GDM合并ICP患者和85例单纯GDM患者的临床资料。结果:两组间孕妇分娩孕周差异有统计学意义(P<0.05)。两组先兆早产、早产、酮症、胎膜早破、羊水过多、胎盘早剥、剖宫产、产后出血、宫内生长受限、胎儿宫内窘迫、巨大儿、新生儿低血糖、新生儿窒息和呼吸窘迫综合征、胎儿畸形、死胎、死产发生率比较,差异均无统计学意义(P>0.05)。结论:对妊娠期糖尿病合并妊娠肝内胆汁淤积症患者早诊早治,有效控制血糖及胆汁酸,适时终止妊娠可改善围产儿结局。     

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.)     

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。