妊娠期糖尿病诊断与妊娠结局关系的研究

目的评价妊娠期糖尿病(GDM)不同诊断标准与妊娠结局的关系。方法数据主要来源于2000~2003年306医院妇产科收住产妇分娩档案,包括1856个样本。将样本按不同诊断标准分为六组,回顾性评价各组的妊娠结局。结果2000~2003年期间,按中华妇产科学的诊断标准GDM发生率为3.0%,糖耐量异常(GIGT)发生率为3.2%;按妇产科学第6版诊断标准,GDM和GIGT的发生率分别为5.5%和5.9%。GDM及GIGT孕妇巨大儿及早产发生率较正常组增加(P<0.05),而剖宫产率及新生儿窒息发生率无显著性差异(P>0.05)。根据不同诊断标准分组的GDM及GIGT的妊娠结局无显著性差异(P>0.05)。结论不同妊娠期糖尿病诊断标准没有造成妊娠结局的差异,但GDM及GIGT是增加母亲及胎儿发病率的高危因素,积极有效的管理和正确的诊断可改善预后。

Relationship of diagnosis of gestational diabetes mellitus and pregnancy outcome

Objective To examine the incidence of gestational diabetes mellitus (GDM) and impaired glucose tolerance (GIGT) between 2000 and 2003 in 306 Hospital of PLA, and to evaluate the relationship of different diagnostic standards and pregnancy outcome at the same time. Methods Data were from the 2000 to 2003 births file of 306 Hospital of PLA.1626 samples were included in this study. All the samples were divided into six groups according to different diagnostic standard. A retrospective longitudinal study of each group was assessed for pregnancy outcome. Results The prevalence of diabetes mellitus among pregnant mothers was 3.0% during 2000-2003 according to the diagnostic standards proposed by the Chinese Association of Obstetrics and Gynecology and the prevalence was 5.5% according to another diagnostic standard (Obstetrics and Gynecology, 6th ed.). The prevalence of GIGT was 3.4% and 5.9% respectively. Patients with GDM and GIGT were at increased risk of fetal macrosomia and premature labor compared to controls (P<0.05), but there was no significant difference of cesarean delivery and neonatal distress among different groups (P>0.05). Patients with GDM and GIGT in different groups had the same pregnancy outcome (P>0.05). Conclusions Different diagnostic standards would not induce the different pregnancy outcome, but GDM and GIGT remain a high-risk situation that increases maternal and infant morbidity. Timely and effective management with accurate diagnosis would improve the outcome of pregnancy.