Sun Wei-Jie, Yang Hui-Xia
Department of Obstetrics and Gynaecology, First Hospital, Peking University, Beijing 100034, China.
Zhonghua Fu Chan Ke Za Zhi. 2007 Jun;42(6):377-81.
To understand the incidence of abnormal glucose metabolism during pregnancy and the maternal and neonatal outcomes after standard management.
A retrospective study of maternal and neonatal outcomes was conducted in 1490 pregnant women who were diagnosed and treated for abnormal glucose metabolism and delivered in the Department of Obstetrics and Gynecology of First Hospital of Peking University from Jan 1995 to Dec 2004 by reviewing the medical records. The selected cases consisted of 79 women with diabetes mellitus (DM group), 777 with gestational diabetes mellitus (GDM group), including 355 cases of A1, 316 with A2 and 106 cases unclassified, and 634 with gestational impaired glucose test (GIGT group). Maternal and fetal outcomes were analysed in comparison with the controls of 19 013 pregnant women with normal glucose metabolism who delivered during the same period.
(1) The total incidence of gestational abnormal glucose metabolism was 7.3% and increased gradually from 1995 to 2004. The first stage, from Jan 1995 to Dec 1999, saw a slow increase in the incidence [4.3% (376/8739)]; the second stage, from Jan 2000 to Dec 2001, showed a fast increasing trend. The average incidence was 10.8% (445/4133). The incidence in the third stage kept stable at 8.9% (678/7640) from Jan 2002 to Dec 2004. (2) The incidence of macrosomia, preeclampsia and preterm birth were 12.1% (180/1490), 9.5% (141/1490) and 9.4% (140/1490), which were significantly higher than those women with normal glucose metabolism (P < 0.01). A significant difference was found in the incidence of preeclampsia, preterm birth, intrauterine infection, polyhydramnios and ketonuria among the three groups (P < 0.05), but not in the incidence of macrosomia (P > 0.05). (3) The perinatal mortality rate (PMR) of abnormal glucose metabolism group was 1.19% (18/1513) which was significantly higher in the DM group (4.93%) than GDM (1.14%) and GIGT groups (0.78%, P < 0.01), while the incidence of neonatal asphyxia, hypoglycemia, malformation and admission to NICU in the DM group were all higher than GDM and GIGT groups (P < 0.01). (4) NRDS was found in 9 cases among 1505 neonates (0.6%) and all were delivered preterm.
(1) The incidence of gestational abnormal glucose metabolism is increasing and the screening and diagnosis of diabetes in pregnancy should be strengthened. (2) Macrosomia, preeclampsia and preterm birth remain the first three common complications even after standardized glycemic management, but the maternal and neonatal complications are reduced in the GIGT group except for macrosomia. Those women in the DM group has a higher rate of maternal and neonatal complications than those in GDM and GIGT groups, so management in these patients should be strengthened. (3) NRDS is no longer a primary neonatal complication provided proper management is performed.
了解妊娠期糖代谢异常的发生率以及标准管理后的母婴结局。
回顾性研究1995年1月至2004年12月在北京大学第一医院妇产科诊断并治疗糖代谢异常且分娩的1490例孕妇的母婴结局，查阅病历资料。所选病例包括79例糖尿病患者（糖尿病组），777例妊娠期糖尿病患者（妊娠期糖尿病组），其中A1级355例，A2级316例，未分类106例，以及634例糖耐量受损孕妇（糖耐量受损组）。将母婴结局与同期分娩的19013例糖代谢正常孕妇的对照组进行比较分析。
（1）妊娠期糖代谢异常的总发生率为7.3%，1995年至2004年呈逐渐上升趋势。第一阶段，1995年1月至1999年12月，发生率缓慢上升[4.3%（376/8739）]；第二阶段，2000年1月至2001年12月，呈快速上升趋势，平均发生率为10.8%（445/4133）。第三阶段，2002年1月至2004年12月，发生率稳定在8.9%（678/7640）。（2）巨大儿、子痫前期和早产的发生率分别为12.1%（180/1490）、9.5%（141/1490）和9.4%（140/1490），显著高于糖代谢正常的孕妇（P<0.01）。三组子痫前期、早产、宫内感染、羊水过多和酮尿症的发生率存在显著差异（P<0.05），但巨大儿发生率无显著差异（P>0.05）。（3）糖代谢异常组的围产儿死亡率（PMR）为1.19%（18/1513），糖尿病组（4.93%）显著高于妊娠期糖尿病组（1.14%）和糖耐量受损组（0.78%，P<0.01），糖尿病组新生儿窒息、低血糖、畸形和入住新生儿重症监护病房的发生率均高于妊娠期糖尿病组和糖耐量受损组（P<0.01）。（4）1505例新生儿中有9例发生呼吸窘迫综合征（NRDS）（0.6%），均为早产。
（1）妊娠期糖代谢异常的发生率在增加，应加强妊娠期糖尿病的筛查和诊断。（2）即使经过标准化血糖管理，巨大儿、子痫前期和早产仍是前三大常见并发症，但糖耐量受损组除巨大儿外母婴并发症有所减少。糖尿病组母婴并发症发生率高于妊娠期糖尿病组和糖耐量受损组，因此应加强对这些患者的管理。（3）如果进行适当管理，呼吸窘迫综合征不再是主要的新生儿并发症。
