妊娠期糖尿病的干预治疗与妊娠结局的临床分析

目的 探讨妊娠期糖尿病(GDM)经干预治疗后对妊娠结局的影响.方法 选取2009年1月至2011年6月于本院门诊确诊为GDM的125例患者的临床病历资料为研究对象,纳入研究组.对其采取控制血糖的方法包括单纯饮食及运动干预与饮食及运动+胰岛素治疗.随机选择同期在本院住院分娩的125例血糖正常孕妇的临床病历资料纳入对照组.采用回顾性分析方法,比较两组孕妇一般情况、妊娠合并症发生情况及妊娠结局,并进行相关统计学处理(本研究遵循的程序符合本院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书).结果 两组孕妇分娩前体重指数(BMI)、分娩孕周等比较,差异均无统计学意义(P＞0.05).研究组孕妇的年龄高于对照组,差异有统计学意义(P＜0.01).研究组患者经饮食及运动治疗后,血糖控制满意、病情稳定者共计93例(74.4％),妊娠结局良好;其余32例同时采用胰岛素治疗后,30例血糖控制良好,妊娠结局无特殊,另外2例血糖控制不满意孕妇,合并子痫前期,均于35～36孕周终止妊娠,在计划终止妊娠前48 h行羊膜腔穿刺术了解胎肺成熟情况,并羊膜腔内注入地塞米松促胎肺成熟.两组孕妇妊娠结局及母儿并发症发生情况比较,差异均无统计学意义(P＞0.05).结论 孕妇的年龄是GDM发病的高危因素之一.GDM患者经饮食及运动和及时合理的胰岛素治疗,有利于减少围生期并发症,改善妊娠结局.

Clinical Analysis of Treatment for Gestational Diabetes Mellitus and Pregnancy Outcomes

Objective To study the effects of treatment on the pregnancy outcomes in gestational diabetes mellitus ( GDM ) women.Methods From January 2009to June 2011 , 125case of GDM women diagnosed at outpatient department were included in the study group.The methods of controlling blood glucose levels included diets control and exercises only , diets control and exercises + insulin therapy. Anather 125cases with normal blood glucose who delivered in the same hospital were selected randomly as control group.The differences on gravid general situations and pregnancy outcomes between two groups were observed.Clinical data were restrospectively analyzed.Informed consent was obtained from all participants.Results There were no significant differences in body mass index ( BMI ) before delivery and gestational ages at delivery ( P>0.05 ), while there had significant difference in ages between two groups ( P<0.01 ) .In study group , there were 93cases ( 74.4% ) who had been treated by diets control and exercises had satisfactory blood glucose levels and pregnancy outcomes ; the other 32cases who had been treated by insulin , Among them there were 30cases had satisfactory blood glucose levels and pregnancy outcomes , only 2 cases whose blood glucose levels controlled unsatisfactorily and complicated with preeclampsia , were terminated pregnancy at 35～36 weeks.In order to evaluate fetal lung maturation , amniocentesis was performed before 48hof termination , and dexamethasone was given in amniotic cavity for enhancement of fetal lung maturation.There were no significant differences in pregnancy outcomes , maternal and neonatal complications between two groups.Conclusions Maternal age is one of the high risk factors of GDM.Diets control , exercises , timely and properly use of insulin for GDM would reduce perinatal complications and improve perinatal outcomes.