以妊娠预后评估妊娠期糖耐量受损异质性

目的 从妊娠预后角度，探讨不同时点妊娠期糖耐量受损（gestational impaired glucose tolerance，GIGT）之间是否存在异质性。方法 选取2000年至2006年在上海交通大学附属第一医院行50g糖筛查异常的孕妇1145例为研究对象，进行75g葡萄糖耐量试验，同时进行胰岛素释放试验，计算血糖曲线下面积及胰岛素敏感性指数，并随访至妊娠终止。比较1145例孕妇中，OGTT 1h异常（68例）及2h／3h异常（40例）两种糖耐量受损患者之间预后的差异，并与妊娠期糖尿病（gestational diabetes mellitus，GDM）患者（38g例）及糖代谢正常（normal glucose tolerance，NGT）孕妇（655例）进行比较。结果 1h GIGT孕妇巨大儿和新生儿低血糖发生率（10．29％和13．24％）与2h／3h糖耐量受损孕妇（5．00％和5．00％）及NGT患者（4．42％和4．73％）比较明显升高（P〈0．01），而2h／3h糖耐量受损孕妇巨大儿及新生儿低血糖发生率显著低于GDM组（11．26％和17．80％）（P〈0．01）。结论 妊娠期糖耐量受损孕妇存在异质性。

Different pregnancy outcomes show the heterogeneity in women with gestational impaired glucose tolerance

Objective To investigate the heterogeneity in women with gestational impaired glucose tolerance(GIGT) by reviewing pregnancy outcomes. Methods Totally, 1145 pregnant women with abnormal 50 g glucose challenge test (GCT) and 75 g oral glucose tolerance test (OGTT) were included and the insulin sensitive index (ISI) was calculated. All women were followed up and divided into four groups according to the results of OGTT: GDM (gestational diabetes mellitus) group (n=655), 1 h GIGT group (n=68), 2 h/3 h GIGT group (n=40) and normal glucose tolerance (NGT) group (n=655). Pregnant outcomes were compared. Results The incidence of macorsomia, neonatal hypoglycemia was higher in 1 h GIGT group compared with 2 h/3 h GIGT and NGT groups (10.29% vs 5.00% and 4.42%, 13.24% vs 5.00% and 4.73%, P<0.01), while those of the in 2 h/3 h GIGT group were significantly lower than GDM group (11.26% and 17.80%, P<0.01). Conclusion GIGT is a heterogeneous metabolic disorder as defined by pregnancy outcomes.