妊娠期糖尿病最新诊断标准与妊娠结局

目的分析按照国际糖尿病与妊娠研究组（IADPSG）诊断标准新增加的妊娠期糖尿病（GDM）患者的妊娠结局,探讨IADPSG诊断标准在我国临床应用价值。方法选择2011年1月1日至2011年6月30日于复旦大学附属妇产科医院门诊定期产检、孕24-28w行50g糖筛查试验（GCT）阳性,进一步行75g口服葡萄糖耐量试验（OGTT）,按照美国国家糖尿病数据组（NDDG）诊断标准诊断为非GDM或糖耐量受损（GIGT）的产妇332例的病历资料进行回顾性分析。按是否符合IADPSG诊断标准分为new-GDM组和non-GDM组,比较两组患者的妊娠结局。结果根据IADPSG标准新诊断出的new-GDM患者共44名,其在孕24-28w行糖筛查时的血糖筛查值明显高于non-GDM组孕妇（new-GDM组：9.0±0.9 mmol/L,non-GDM组：8.5±0.6mmol/L,P=0.002）。比较两组孕妇的妊娠结局,妊高症、胎盘早剥、剖宫产率、产后出血、胎儿窘迫、早产、新生儿低血糖的发生率无统计学意义（P〉0.05）。两组的巨大儿发生率（new-GDM组：20.5%9/44],non-GDM组：8.3%24/288],P=0.026）和新生儿出生体重（new-GDM组：3555.6±507.8g,non-GDM组：3357.2±461.5g,P=0.009）均显著升高,且有显著统计学差异。结论本研究显示采用IADPSG诊断标准可诊断出更多的GDM患者,这些患者若未进行血糖控制,其围产期并发症,尤其是巨大儿的发生率明显增加,提示IADPSG标准作为我国GDM诊断标准具有一定的临床意义。

Analysis of pregnancy outcomes with gestational diabetes mellitus by IADPSG Criteria.

Objective： To investigate the pregnancy outcomes with gestational diabetes mellitus by International Association of Diabetes and Pregnancy Study Groups （IADPSG） criteria and assess its feasibility in China. Methods： A retrospective population-based study of pregnant women who took prenatal care between 2011. 1. 1 and 2011.6. 30 in OBGYN Hospital of Fudan University with a plasma glucose level≥7.8mmol/L on a glucose challenge test （GCT） and subsequently underwent a glucose tolerance test （OGTT） . Totally, there were 332 cases not being diagnosed as gestational diabetes mellitus （GDM） or gestational impaired glucose tolerance （GIGT） according to the National Diabetes Date Group （NDDG） criteria and these women were divided into two groups according to IADPSG criteria： new-GDM group included those who meet the criteria of GDM and non-GDM group included those did not. Results： Of the 332 women, additional 44 women without GDM according to the NDDG criteria were classified as having hyperglycemia according to the IADPSG criteria. The GCT value of new-GDM group was significantly higher than that of non-GDM group （new-GDM group： 9. 0±0. 9 mmol/L, non-GDM group： 8. 5 ±0. 6mmol/L, P=0. 002） . There was no difference in the incidence of pregnancy induced hypertension, placental abruption, cesarean section, postpartum hemorrhage, fetal distress, preterm labor and neonatal hypoglycemia between the two groups （P〉0. 05） . But the incidence of fetal macrosomia （new-GDM group： 20. 5%9/44], non-GDM group： 8.3%24/288], P=0. 026） and the average birth weight （new-GDM group： 3555. 6±507. 8g, non-GDM group： 3357. 2±461.5g, P=0. 009） of new-GDM group was significantly higher than that of non-GDM group. Conclusion： The IADPSG criteria increase the number of patients with GDM, the prevalence of perinatal complications especially the incidence of macrosomia would increase in gestational hyperglycemia that achieved IADPSG criteria without intervention, so IADPSG criter