基于新诊断标准妊娠期糖尿病妊娠结局分析

摘要

Objective Assessment the impact of the new International Diabetes and Pregnancy Study Group ( IADPSG) gestational diabetes (GDM) diagnostic criteria on GDM prevalence and pregnancy outcomes. Methods 75 g Oral glucose tolerance test(OGTT) was used to screen for GDM at 24 ~28 weeks. The diagnosis of GDM were according to two diagnostic criteria: ADA(2010) and IADPSG. The outcomes of the mother and the neonate of the two groups were compared. Results Of the participants, 21. 96% and 10. 38% were diagnosed with GDM using IADPSG and ADA (2010) criteria respectively. By IADPSG and ADA(2010) criteria, the incidence of macrosomia were 4. 3% and 8. 8% , while the incidence of large for gestational age were 20. 7% and 26. 4% respectively. There were significant differences between two groups (P <0. 05). There were 177 women who were diagnosed with GDM using IADPSG criteria but normal glucose tolerance using ADA(2010) criteria. The incidence of pregnancy induced hypertension, macrosomia, large for gestational age and neonatal asphyxia in that group was significantly higher than that of group ADA ( 2010) and group IADPSG ( P < 0. 05 ) . Conclusion The IADPSG diagnostic criteria could not significantly reduced the risk of maternal complications of patients with GDM, but for the role of reducing the risk of perinatal disease. IADPSG diagnosis lowered the standard, will enable more patients to be included in GDM management system in order to reduce parents and their offspring morbidity in the better to avoid the occurrence of poor pregnancy outcomes.%目的 评估新的国际糖尿病与妊娠研究组(the International Association of Diabetes and Pregnancy Study Groups,IADPSG)妊娠期糖尿病(gestational diabetes mellitus,GDM)诊断标准对GDM的检出率和分娩结局的影响.方法 对中山大学附属第一医院2011年1月1日至12月31日期间产检并住院分娩的孕妇,按照2010年美国糖尿病协会(the American Diabetes Association,ADA)和IADPSG两种诊断标准对孕妇进行妊娠期糖尿病诊断,对母儿分娩结局进行比较.结果 对1月1日至6月30日住院分娩产妇采用ADA(2010年)标准,7月1日至12月31日产妇采用IADPSG标准,GDM的检出率分别为21.96％和10.38％.IADPSG组与ADA组巨大儿、大于胎龄儿的发生率分别为4.3％与8.8％,20.7％与26.4％,差异有统计学意义(P＜0.05).1月1日至6月30日住院分娩产妇按2010年ADA诊断标准正常,但使用IADPSG标准可被诊断为GDM的177例妇女,其妊娠高血压疾病、巨大儿、大于胎龄儿、新生儿窒息的发生率较7月1日至12月30日使用IADPSG标准诊断排除GDM的孕妇升高,差异有统计学意义(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,以减少相关的母儿疾病的发病率,较好地避免妊娠不良结局的发生.