妊娠期糖尿病危险因素分析

目的:探讨妊娠期糖尿病(GDM)的危险因素。方法:运用多因素非条件Logistic回归分析对39名GDM病例及156名正常孕妇进行病例对照研究。结果:进入多因素非条件Logistic回归模型的因素有年龄、糖尿病阳性家族史、孕前体重指数(BMI)和孕期体重指数增加率(P<0.05)。其中年龄OR值为2.4322,糖尿病阳性家族史OR值为4.1254,孕前体重指数OR值为8.1826,孕期体重指数增加率OR值为89.1274。重复序列方差分析两组孕期体重指数的增加有差异,F=494.605(P<0.000)。结论:年龄、糖尿病阳性家族史、孕前体重指数、孕期体重指数增加率均为GDM的危险因素;孕期体重指数增长快,发生GDM的危险大。     

饮食管理联合运动训练对妊娠期糖尿病孕妇分娩结局的影响

目的:探讨饮食管理联合运动训练对妊娠期糖尿病孕妇血糖水平、分娩方式及结局的影响。方法:选取2017年10月—2019年10月收治的246例妊娠期糖尿病孕妇为研究对象,按照入院先后顺序将其分为对照组和观察组各123例。对照组孕妇给予常规护理干预,观察组孕妇给予饮食管理指导联合运动训练干预。观察并比较两组孕妇血糖水平、分娩方式及分娩结局。结果:观察组孕妇空腹血糖、餐前30 min血糖、餐后2 h血糖及夜间血糖水平均显著低于对照组孕妇(P<0.05),观察组孕妇中选取剖宫产分娩方式的人数显著低于对照组孕妇,产后出血、胎膜早破、羊水过多及妊娠期高血压等不良妊娠结局发生率显著低于对照组孕妇(P<0.05),观察组发生胎儿畸形、早产、死胎、新生儿窒息、新生儿巨大及新生儿窘迫等不良结局发生率显著低于对照组(P<0.05)。结论:饮食管理指导联合运动训练干预能够有效控制妊娠期糖尿病孕妇血糖水平,降低母婴不良并发症及改善分娩结局。     

糖化血红蛋白和糖化白蛋白在 GDM 诊断中的价值

目的：评估血清糖化白蛋白（GA）和糖化血红蛋白（HbA1c）在妊娠期糖尿病（GDM）患者早期检测中的作用。方法选择2015年1月1日至12月31日在昔阳县人民医院妇产科进行产前保健检查的单胎孕妇138例（孕期22～24周）,根据美国糖尿病协会（ADA）的建议,以口服75g葡萄糖耐量试验（OGTT）测定值作为诊断GDM的标准,将138例妊娠妇女分为正常妊娠组100例,GDM组38例,同时测定两组的HbA1c、GA、FGP和OGTT。使用受试者工作特征曲线（ ROC）将HbA1c和GA水平作为GDM的筛查指标进行统计学分析。结果①GDM组HbA1c、GA明显高于正常妊娠组（ t值分别为8．622、7．554,均P＜0．05）;②相比较OGTT,HbA1c和GA的检出率存在差异（χ2值分别为62．490、40．601,均P＜0．05）;③分别应用HbA1c、GA在正常妊娠组中检出8．00％和12．00％可疑血糖异常患者;④ROC曲线分析HbA1c取5．90％,灵敏度为78．90％,特异度为89．00％～94．00％;GA取15．50％,灵敏度为65．80％～68．40％,特异度为66．00％～88．00％。结论 HbA1c在GDM诊断中敏感性高于GA,与OGTT联合对GDM的诊断有重要价值。     

妊娠糖尿病对母婴的影响

进一步研究糖尿病对母婴的影响及早期防治IDMs并发症,降低病死率,减少后遗症已越来越受到重视。     

1例妊娠期糖尿病患者预后的临床证据

目的从循证医学角度探讨1例妊娠期糖尿病患者的预后。方法计算机检索ACPJournalClub(1991～2006年10月)、Cochrane图书馆(2006年第4期)、MEDLINE(1990～2006年10月)和中国生物医学文献数据库,查找妊娠期糖尿病预后的队列研究、病例-对照研究和病例系列研究等,并对所获证据的质量进行评价。结果临床证据表明,妊娠期糖尿病患者结束妊娠后6周至28年,2型糖尿病的发病率为2.6%～70%,发生自发性早产的几率为6.7%,患高血压和代谢综合征的比例增加,有感染阴道念珠菌的危险。结论患妊娠期糖尿病的妇女较未患糖尿病的孕妇结束妊娠后糖尿病的患病率增加,自发性早产、高血压、代谢综合征及阴道感染等并发症发病率增加。但其长期终点事件发生率有待进一步研究。     

Lipidomic analysis reveals the significant increase in diacylglycerophosphocholines in umbilical cord blood from pregnant women with gestational hypercholesterolemia

Gestational hypercholesterolemia has been recognized as a risk factor of some pregnancy complications. We supposed that maternal hypercholesterolemia modified the lipid profile of the fetus. Thirty pregnant women with hypercholesterolemia and matched controls were recruited and cord blood was sampled. Lipidomic analysis was used to evaluate the lipid profile change between the two groups. The results showed that the content of diacylglycerophosphocholines (PC) was significantly high in cord blood from hypercholesterolemic pregnant women. PC (16:0/20:4) and PC (18:0/20:4) were selected as the most important lipid species in cord plasma and their contents were positively related to the total cholesterol and high-density lipoprotein cholesterol levels in cord blood. The contents of these two PCs were significantly higher in the hypercholesterolemic group than in the control group. These results suggested that gestational hypercholesterolemia might program the phospholipid metabolism in offspring.     

妊娠期糖尿病早期诊断治疗对母儿影响的分析

目的:研究妊娠期糖尿病(GDM)早期诊断、早期治疗对有效控制血糖,减少孕妇及围生儿并发症的积极作用。方法:回顾性分析2003年1月至2004年8月期间门诊接诊GDM患者经系统治疗,并在本院分娩49例病例,与未经任何治疗GDM患者,并在本院分娩60例病例,按治疗与否分成治疗组(A组,49例)与对照组(B组,60例),观察母儿并发症及分娩方式及新生儿窒息情况。结果:治疗组中病理妊娠、手术产率、围生儿并发症的发生率,均比对照组明显减低,两组相比差异有显著性(P<0.05)。结论:GDM要早诊断,早治疗,对降低孕妇并发症以及围生儿发病率有积极意义。     

糖化血红蛋白在妊娠期糖尿病筛查中的应用

目的:探讨糖化血红蛋白(HbA1C)在妊娠期糖尿病(GDM)筛查中的应用价值.方法:2008年1月～2011年12月,在我科门诊就诊的孕妇236例,其中符合GDM诊断标准的21例为GDM组,其余215例为非GDM组.分别对2组进行空腹血糖(FBG)、口服葡萄糖耐量试验(OGTT)及HbA1C进行检测.比较3种检测方法的检测结果,并对检测结果进行评价.结果:GDM组FBG、OGTT及HbA1C均明显高于非GDM组,差异有统计学意义(P＜0.05),在3种诊断方法中,HbA1C的灵敏度、特异性和阳性预测值最高,分别为90.9％、80.0％、83.3％,提示HbA1C在诊断GDM的3种检查中效果最好.结论:HbA1C水平在GDM患者中明显升高,诊断GDM具有较高的阳性率,早期干预治疗可减少母婴发病率及死亡率.HbA1C为糖尿病的血糖水平监测提供了新的方法,是临床上筛查、诊断、监测妊娠期糖尿病的简单、可靠的方法.     

Evaluation of B-cell secretion and peripheral insulin resistance during pregnancy and after delivery in gestational diabetes mellitus with obesity

Summary Nine pregnant women with gestational diabetes mellitus (GDM) were studied. Six normal pregnant women and six normal nonpregnant women were evaluated as control groups. All the women underwent oral glucose tolerance test and glucose clamp during the third trimester of pregnancy and two months after delivery. During OGTT, glucose, C-peptide and insulin plasma levels were determined. C-peptide and insulin values in the late phase of OGTT were higher during pregancy than after delivery in both groups. In gestational diabetic women, the M-value in the second steady-state during glucose clamp was lower than in controls, both during pregnancy and after delivery. Nevertheless, in both groups the M-value during pregnancy was lower than after delivery. Moreover, in gestational diabetic women there was an inverse correlation between M-value in the second steady-state and ponderal excess index after delivery. In conclusion, the impaired peripheral glucose utilization and the pancreatic pattern of gestational diabetic women compared to normals suggested altered B-cell secretion response, increased peripheral resistance and overweight to be the main changes in GDM.