论文部分内容阅读
目的探讨妊娠合并糖代谢异常孕妇的发生率变化趋势及经规范治疗后的不同类型糖代谢异常的母、儿结局。方法 1995年1月至2004年12月,在北京大学第一医院妇产科分娩的妊娠合并糖代谢异常患者共1490例,按照糖代谢异常情况分为糖尿病合并妊娠79例(DM 组),妊娠期糖尿病777例(GDM 组,其中 A1型355例,A2型316例,分型不明106例),妊娠期糖耐量异常634例(GIGT 组)。采用回顾性分析的方法对3组的母、儿结局进行分析,并对糖代谢异常孕妇的发生率进行统计。同期分娩的19013例糖代谢正常孕妇作为对照组。结果 (1)妊娠合并糖代谢异常的总发生率为7.3%,呈逐年上升的趋势。第一阶段即1995年1月至1999年12月,发生率呈缓慢增长,平均为4.3%(376/8739);第二阶段即2000年1月至2001年12月,发生率呈快速增长趋势,平均为10.8%(445/4133);第三阶段为2002年1月至2004年12月,基本稳定于8.9%(678/7640)。(2)3组糖代谢异常孕妇总的巨大胎儿、子痫前期、早产的发生率分别为12.1%(180/1490)、9.5%(141/1490)和9.4%(140/1490),均明显高于对照组孕妇(P<0.01)。3组糖代谢异常孕妇子痫前期、早产、宫内感染、羊水过多、酮症的发生率相互比较,差异有统计学意义(P<0.05),而3组的巨大儿发生率比较,差异无统计学意义(P>0.05)。(3)3组糖代谢异常孕妇围产儿总死亡率为1.19%(18/1513),其中,DM 组为4.93%(4/81),显著高于 GDM 组的1.14%(9/787)和 GIGT 组的0.78%(5/645)(P<0.05)。而且,DM 组新生儿窒息、低血糖及转诊的发生率均高于 GDM 组和 GIGT 组(P<0.01)。(4)3组1505例新生儿中仅有0.6%(9/1505)发生呼吸窘迫综合征(RDS),均发生于早产儿。结论 (1)妊娠合并糖代谢异常的发生率逐年上升,应重视提高对孕期糖尿病的筛查、诊断和处理。(2)经过孕期规范化管理,巨大儿、子痫前期和早产仍是糖代谢异常孕妇最常见的并发症,DM孕妇的母、儿合并症显著高于 GDM 和 GIGT 孕妇,今后应进一步加强该类型糖尿病孕妇管理。(3)新生儿 RDS 已不再是新生儿的主要合并症。
Objective To investigate the changing trend of pregnant women with abnormal glucose metabolism during pregnancy and the outcomes of different types of abnormal glucose metabolism after standardized treatment. Methods From January 1995 to December 2004, 1490 pregnant women with abnormal glucose metabolism during delivery of obstetrics and gynecology in Peking University First Hospital were divided into diabetes mellitus (79 cases), diabetes mellitus (DM group), pregnancy 777 cases of stage diabetes mellitus (GDM group, including 355 cases of type A1, 316 cases of type A2 and 106 cases of unknown type) and 634 cases of abnormal glucose tolerance during pregnancy (GIGT group). The retrospective analysis of the three groups of maternal and child outcomes were analyzed and the incidence of abnormal glucose metabolism statistics for pregnant women. The same period of 19013 cases of normal glucose metabolism in pregnant women as a control group. Results (1) The incidence of abnormal glucose metabolism in pregnancy was 7.3%, showing an increasing trend year by year. The first stage, from January 1995 to December 1999, saw a slow increase with an average of 4.3% (376/8739). In the second stage, from January 2000 to December 2001, the incidence showed a rapid increase , An average of 10.8% (445/4133); the third phase from January 2002 to December 2004, the basic stable at 8.9% (678/7640). (2) The incidence of total macrosomia fetuses, preeclampsia and preterm birth were 12.1% (180/1490), 9.5% (141/1490) and 9.4% (140/1490) respectively in the three groups with abnormal glucose metabolism, which were significantly Higher than the control group pregnant women (P <0.01). 3 groups of abnormal glucose metabolism pregnant women preeclampsia, preterm birth, intrauterine infection, polyhydramnios, ketosis were compared with each other, the difference was statistically significant (P <0.05), while the incidence of macrosomia in the three groups, the difference No statistical significance (P> 0.05). (3) The total perinatal mortality in pregnant women with abnormal glucose metabolism was 1.19% (18/1513) in the three groups, which was 4.93% (4/81) in DM group and 1.14% (9/787) in GDM group 0.78% (5/645) of the GIGT group (P <0.05). Moreover, the incidence of neonatal asphyxia, hypoglycemia and referral in DM group were higher than those in GDM group and GIGT group (P <0.01). (4) Respiratory distress syndrome (RDS) occurred in only 0.6% (9/1505) of 1505 newborns in 3 groups, both of which occurred in preterm infants. Conclusion (1) The incidence of abnormal glucose metabolism in pregnancy increased year by year, should pay attention to improve the screening, diagnosis and treatment of diabetes during pregnancy. (2) After pregnancy, standardized management, macrosomia, preeclampsia and premature labor are still the most common complications of pregnant women with abnormal glucose metabolism, DM maternal and child complications were significantly higher than GDM and GIGT pregnant women, the future should further strengthen the type Diabetes pregnant women management. (3) neonatal RDS is no longer a major complication of newborns.