妊娠期糖尿病孕妇产后糖代谢异常的影响因素

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)患者产后糖代谢转归情况及产后糖代谢异常的相关因素。方法收集并分析2008年1月至2010年12月在北京妇产医院进行产前检查、分娩及产后随访的624例妊娠期糖尿病孕妇的临床资料,根据产后6～8周糖代谢恢复情况分为糖代谢正常组(444例)和糖代谢异常组(180例),了解两组转归的相关因素。结果 1)444例孕妇产后6～8周糖代谢恢复正常,占71.2%,180例孕妇产后6～8周糖代谢仍然异常,占28.8%,其中糖尿病(diabetes mellitus,DM)18例,空腹血糖受损(impaired fasting glucose,IFG)32例,糖耐量受损(impaired glucose tolerance,IGT)130例;2)产后糖代谢异常组孕期GDM诊断的孕周较糖代谢正常组早,空腹血糖、孕前及产后体质量指数(body mass index,BMI)、血脂均较正常组高,孕期应用胰岛素控制血糖、合并相关合并症、DM家族史的比例较正常组高,差异有统计学意义(P<0.05),而两组母乳喂养比例差异无统计学意义(P>0.05);3)两组孕妇的年龄、孕产次以及孕期体质量增长相比较,差异无统计学意义(P>0.05)。结论 1)大部分GDM孕妇产后6～8周糖代谢可恢复正常,28.8%(180例)的孕妇产后仍然存在糖代谢异常;2)孕妇GDM诊断孕周早、孕期空腹血糖高、DM家族史、孕期应用胰岛素控制血糖、孕期合并相关合并症、孕前及产后高BMI、高脂血症等均为产后糖代谢异常的高危因素。

The postnatal follow-up in women with gestational diabetes mellitus

Objective To investigate the prognosis and related factors of glucose metabolism in postnatal women with gestational diabetes mellitus(GDM). Methods Data of 624 women with GDM during pregnancy delivered in our hospital from January 2008 to December 2010 were collected. According to the 6~8 weeks postnatal glucose metabolism the 624 women were divided into two groups, 444 glucose metabolism; 180 abnormal postnatal glucose metabolism. Results 1) Among the 624 subjects, 444(71.2%) women glucose metabolism return to normal 6~8 weeks after delivery; 180(28.8%) still had abnormal glucose metabolism 6~8 weeks after delivery, including 18 with diabetes mellitus(DM), 32 with impaired fasting glucose(IFG), 130 with impaired glucose tolerance(IGT). 2) The time point of diagnosing GDM was earlier in abnormal glucose metabolism group than in normal glucose metabolism group, the level of fasting blood glucose, body mass index(BMI) in prenatal and postnatal and the lipid levels were higher in abnormal glucose metabolism group than in normal glucose metabolism group. Significant difference was found in using insulin during pregnancy, accompanying related complications and with DM family history between the two groups(P<0.05), which was higher in abnormal glucose metabolism group. No significant difference was found in the ratio of breast feeding(P>0.05). 3) No significant difference were found in age, the times of pregnancy and delivery and body mass gaining during pregnancy(P>0.05). Conclusion 1) Most GDM women could restore normal glucose metabolism 6~8 weeks' after delivery, only 28.8% GDM women continued to have abnormal glucose metabolism. 2) The earlier diagnosis of GDM, fasting blood glucose, DM family history, using insulin in pregnancy, accompanying related complications, BMI in prenatal and postnatal and higher lipid were high risks in postnatal glucose metabolism.