不同诊断标准诊断妊娠期糖尿病与不良妊娠结局关系的探讨

目的 探讨国际糖尿病与妊娠研究组织（IADPSG）标准和美国国家糖尿病数据组（NDDG）标准诊断妊娠期糖尿病（GDM）与不良妊娠结局关系.方法 随机选择从2012年1月-2014年1月在门诊完成产检,住院分娩且临床资料完整的单胎孕妇.在孕24-28周时进行口服75 g葡萄糖耐量试验（oral glucose tolerance test,OGTT）,分别采用IADPSG及NDDG两种标准确诊为GDM患者的共323例（GDM组）,其中达到NDDG标准的为A组（174例）,达到IADPSG标准但未达到NDDG标准的为B组（149例）,另选择同期住院分娩的非GDM正常孕妇323例为对照组,分别统计分析各组新生儿高胆红素血症、新生儿低血糖、新生儿呼吸窘迫、子痫前期、胎膜早破、羊水过多及巨大儿不良结局的发生率.分别分析两组间差异有无显著统计学意义.结果 统计分析比较各组不良结局的发生率.其中,GDM组：高胆红素血症（2.8％ vs 0.6％）,新生儿低血糖（2.2％ vs o.3％）,子痫前期（1.9％ vs 0.0％）及胎膜早破率（2.2％ vs 0.0％）的发生率明显高于正常对照组,两组间差异有统计学显著性意义（χ^2=4.5-7.5,P值均＜0.05）,新生儿呼吸窘迫（2.2％ vs 0.6％）,羊水过多（1.5％ vs 0.3％）和巨大儿（3.1％vs 1.2％）的发生率高于对照组,但两组间差异无统计学意义（（χ^2=2.6-2.9,P值均＞0.05）;A组：新生儿高胆红素血症（2.9％vs 2.7％）,新生儿低血糖（2.3％ vs 2.0％）,新生儿呼吸窘迫（2.3％vs 2.0％）,痫前期（2.3％vs 1.3％）,胎膜早破（1.7％vs 0.7％）,羊水过多（1.7％vs 1.3％）及巨大儿（3.4％vs 2.7％）的发生率均高于B组,但两组间差异无统计学显著性意义（χ^2=0.01-0.80,P值均＞0.05）.结论 IADPSG诊断标准的敏感度比NDDG标准高,将达不到NDDG标准的轻型GDM患者纳入妊娠期血糖管理中,有效地降低其不良妊娠结局的发生率.

Different Diagnostic Criteria for Gestational Diabetes Mellitus and Adverse Pregnancy Outcomes of Pregnancy

Objective To discussion respectively by the International Association of Diabetes and Pregnancy Study Groups （IADPSG） standard and America National Diabetes Data Organization （NDDG） diagnostic criteria for gestational diabetes mellitus （GDM） and adverse pregnancy outcomes.Methods From January 2012 to Jannuary 2014,the singlefetus were randomly selected by clinic examination,and had complete clinical data.Oral Glucose Tolerance Tests were performed on 75g at 24-28 weeks of gestation （OGTT）.323 caces were GDM patients diagnosed by two standard of IADPSG and NDDG patients,with standard of IADPSG diagnosis of 174 cases （group A）,using the NDDG criteria for diagnosis of 149 cases （group B）.At the same time,selected hospital delivery of non GDM in 323 cases of normal pregnancy as control group.Statistics for GDM common neonatal hyperbilirubinemia,neonatal hypoglycemia,respiratory distress,preeclampsia,premature rupture of membranes,polyhydramnios,incidence of adverse outcomes such as fetal macrosomia,analysis of differences between the two groups had no statistical significance.Result Did statistical analysis of the incidence of adverse outcome in each group.Among them,group GDM：hyperbilirubinemia （2.8 % vs 0.6 %）,neonatal hypoglycemia （2.2 % vs 0.3 %）,preeclampsia （1.9% vs 0%） and the rate of premature rupture of membranes （2.2% vs 0%） was significantly higher than that in the normal control group,there was significant difference between the two groups （χ^2 =4.5-7.5,P〈0.05）,neonatal respiratory distress （2.2% vs 0.66%）,polyhydramnios （1.5% vs 0.3%） and macrosomia （3.1% vs 1.2%） was higher than the control group,but there was no significant difference between the two groups （χ^2 =2.6-2.9,P〈0.05） ;Group A：neonatal hyperbilirubinemia （2.9 % vs 2.7 %）,neonatal hypoglycemia （2.3 % vs 2.0 %）,neonatal respiratory distress （2.3 % vs 2.0%）,preeclampsia （2.3% vs 1.3%）,premature rupture of membranes （1.7% vs 0.7%）,polyhydramnios （1.7% vs