两种诊断标准下妊娠期糖尿病发病率与妊娠结局的回顾性研究

目的：比较国际糖尿病与妊娠研究组（ International Association 0f Diabetes in Pregnancv Study Groups， IADPSG）妊娠期糖尿病（ gestational diabetes mellitus，GDM）诊断标准与美国国家糖尿病数据组（ National Diabetes data Group，NDDG）GDM诊断标准下GDM发病率及妊娠结局。方法：选取太原市妇幼保健院2011-2012年分娩的、接受规范的GDM筛查和诊断的非孕前糖尿病产妇5340例，对其病历资料进行回顾性分析，比较两种诊断标准计算的妊娠期糖尿病的发生率及对妊娠结局的影响；以同期妊娠分娩的糖代谢正常孕妇为对照。结果：发病率：NDDG诊断标准下，妊娠期糖尿病的发病率为4．87％，IADPSG诊断标准下发病率为11．7％；2011年该院按照NDDG标准诊治，回顾性将所有孕妇按照IADPSG标准诊断，新增GDM78例未经治疗，与新标准下的非GDM孕妇比较妊娠结局，未经治疗的GDM孕妇妊娠期高血压疾病、子痫前期、羊水过多、剖宫产率、产后出血、巨大儿、新生儿高胆红素血症的发生率明显增高（ P﹤0．05）；2012年该院按照IADPSG标准对GDM进行诊治，其中有123例GDM未达到NDDG标准，子痫前期、剖宫产率、巨大儿发生率明显低于2011年未治疗的新增GDM孕妇（ P﹤0．05）。结论：IADPSG诊断标准降低，可使更多患者被纳入到GDM的规范管理系统中，GDM孕妇经治疗后明显减少了巨大儿及剖宫产率，提示新的诊断标准对母婴保健是有意义的。

A Retrospective Study of the Incidence of Gestational Diabetes and Pregnancy Out-come in the Two Diagnostic Criteria

Objective：To compare gestational Diabetes,gestational Diabetes mellitus（ GDM）in diagnostic criteria by the International Diabetes and Pregnancy Group,the International Association of Diabetes and Pregnancv Study Groups（ IADPSG）with incidence of GDM diagnosis and pregnancy outcome in diagnostic criteria by the national Diabetes Data Group（ NDDG）. Methods：5340 cases of maternal non-diabetes before pregnancy in Taiyuan Hospital Health Center for Women and Children from January 2011 to December 2012 were selected,who were accepted the GDM screening and standard diagnosis,and whose medical records were retrospectively analyzed. The incidence of gestational diabetes and the impact on the pregnancy outcome were compared under two diagnostic standards,as far as the glucose metabolism of pregnancy childbirth normal pregnant women were concerned in the same period as controls. Results：The incidence of NDDG diagnostic criteria was 4 . 87%,the IADPSG gestational diabetes incidence was 11 . 7%;In 2011 all pregnant women in accordance with the IADPSG standard diagnosis and using the NDDG criteria were made a diagnosis and given the treatment;new GDM 78 cases without treatment were compared under the new standard of GDM pregnant with the pregnancy outcomes. Gestational hypertension,preeclampsia,hydramnios,postpartum hemorrhage and macro-somia,cesarean section rate were neonatal significantly higher as well as the incidence of high blood bilirubin for un-treated GDM pregnant women. There was significant difference（P﹤0. 05）;According to the IADPSG criteria,in 2012 the treatment of GDM was made a diagnosis,of which 123 cases of GDM NDDG criteria were not achieved. Preeclampsia,cesarean section rate,incidence of macrosomia were significantly lower than the untreated new GDM pregnant women in 2011（ P﹤0 . 05 ）. Conclusion：Lowering IADPSG criteria for the diagnosis can benefit more patients with the specification of the management system by being incorporated in the GDM. The macrosomia and cesarean section rate have been significantly reduced for the GDM pregnant women after treatment prompt. The new diagnostic criteria is meaningful for maternal and infant health care.