妊娠期糖尿病诊断标准的探讨

目的:探讨适合我国的妊娠期糖尿病诊断标准。方法:选择2OO8年1～12月在西丽人民医院确诊的妊娠期糖尿病(GDM)患者43例,妊娠期糖耐量受损患者(GIGT)57例,用美国糖尿病协会(ADA)、世界卫生组织(WHO)和美国国家糖尿病数据组(NDDG)的诊断标准进行重新诊断,同时分析比较不同诊断标准的母儿结局。结果:《妇产科学》第6版的诊断标准与ADA诊断标准比较,GDM检出率无统计学意义(P0.05);与WHO诊断标准和NDDG诊断标准比较,GDM检出率有统计学意义(P0.05);与ADA、WHO诊断标准检出GDM的母儿结局比较无统计学意义(P0.05);与NDDG诊断标准比较,两组检出GDM的剖宫产、巨大儿、妊高征、羊水过多的发生率无统计学意义(P0.05),但被NDDG诊断标准排除的GDM患者中,包括1例因GDM死胎患者,2例GDM发生胎儿窘迫患者。结论:采用ADA诊断标作为GDM的诊断标准是可行的。

Exploration on diagnostic criteria of gestational diabetes mellitus

Objective:To explore a feasible diagnostic criteria for gestational diabetes mellitus (GDM) for Chinese pregnant women.Methods:43 cases diagnosed as GDM and 57 cases diagnosed as gestational impaired glucose tolerance (GIGT) from January to December 2008 were selected and re-diagnosed according to diagnostic criteria of American Diabetes Association (ADA),World Health Organization (WHO) and National Diabetes Data Group (NDDG),then the outcomes of mothers and infants were compared among different kinds of diagnostic criteria.Results:There was no significant difference in detection rate of GDM between diagnostic criteria of the sixth edition Gynecology and diagnostic criteria of ADA (P>0.05); there was significant difference in detection rate of GDM between diagnostic criteria of the sixth edition Gynecology and diagnostic criteria of WHO,NDDG (P<0.05); there was no significant difference in outcomes of mothers and infants between diagnostic criteria of the sixth edition Gynecology and diagnostic criteria of ADA,WHO; there was no significant difference in rate of cesarean section,incidences of macrosomia,hypertensive disorder complicating pregnancy and polyhydramnios between diagnostic criteria of the sixth edition Gynecology and diagnostic criteria of NDDG (P>0.05),but among the GDM cases excluded by diagnostic criteria of NDDG,1 case with fetal death and 2 cases with fetal distress were found.Conclusion:It's feasible to adopt diagnostic criteria of ADA as diagnostic criteria of GDM.