Seshiah V, Cynthia Alexander, Balaji V, Balaji Madhuri S, Ashalata S, Sheela Rajan, Thamizharasi M, Arthi T
Dr. V. Seshiah Diabetes Care and Research Institute, 31A, Ormes Road, Kilpauk, Chennai 600010, Tamilnadu, India.
Diabetes Res Clin Pract. 2008 May;80(2):199-202. doi: 10.1016/j.diabres.2007.12.008. Epub 2008 Feb 4.
The policy of screening for gestational diabetes mellitus (GDM) between 24 and 28 weeks of gestation and care has resulted in a few women delivering big babies despite good glycemic control. Hence we undertook a study to assess the merits of care given to women in whom GDM was diagnosed in different weeks of gestation and to find out the ideal period of screening in women with history of high-risk pregnancies. A total of 207 consecutive pregnant women irrespective of trimester referred to our referral clinic for diabetes in pregnancy, underwent a 75g oral glucose tolerance test (OGTT) and GDM was diagnosed if 2h plasma glucose (PG) >/=140mg/dl. A1c was estimated in all of them. Women who failed to respond to medical nutrition therapy were advised insulin and the dose titrated to maintain fasting PG (FPG) <90mg/dl and 2h PG <120mg/dl. The mean age of the population screened was 28.38+/-4.31 years and the mean gestational age of screening was 20.05+/-10.71 weeks. Among them, 87 were diagnosed as GDM. The gestational week at diagnosis was </=12 in 36 (41.4%) women (group 1), between 13 and 23 in 18 (20.7%) (group 2), between 24 and 30 in 15 (17.2%) (group 3) and beyond 30 weeks of gestation in 18 (20.7%) (group 4). The A1c was 5.34+/-0.43% in normal glucose tolerance (NGT) women, while it was 6.93+/-1.62% in group 1, 6.03 +/-0.79% in group 2, 6.14+/-0.93% in group 3 and 6.20+/-0.31% in group 4, respectively. The birth weight of babies born to women with NGT was 3.28+/-0.50kg. The birth weight of babies born to GDM women in group 1, group 2, group 3 and group 4 was 3.15+/-0.48, 3.09+/-0.68, 3.32+/-0.51 and 3.51+/-0.63kg, respectively. Group 1 women in spite of the history of high-risk pregnancies, delivered babies appropriate for gestational age like NGT women. Screening in the first trimester of pregnancy and institution of therapy is advisable in women with high-risk pregnancies.
妊娠24至28周筛查妊娠期糖尿病（GDM）并给予相应护理的政策，导致一些女性尽管血糖控制良好，但仍产下巨大儿。因此，我们开展了一项研究，以评估对在不同孕周被诊断为GDM的女性给予护理的益处，并找出高危妊娠史女性的理想筛查期。共有207例连续妊娠的女性，无论处于妊娠第几期，均转诊至我们的妊娠糖尿病转诊诊所，接受75g口服葡萄糖耐量试验（OGTT），若2小时血浆葡萄糖（PG）≥140mg/dl，则诊断为GDM。对所有患者均进行糖化血红蛋白（A1c）检测。对未能对医学营养治疗产生反应的女性建议使用胰岛素，并调整剂量以使空腹血糖（FPG）<90mg/dl且2小时血糖<120mg/dl。筛查人群的平均年龄为28.38±4.31岁，平均筛查孕周为20.05±10.71周。其中，87例被诊断为GDM。诊断时孕周≤12周的女性有36例（41.4%）（第1组），13至23周的有18例（20.7%）（第2组），24至30周的有15例（17.2%）（第3组），妊娠30周以后的有18例（20.7%）（第4组）。糖耐量正常（NGT）女性的A1c为5.34±0.43%，而第1组为6.93±1.62%，第2组为6.03±0.79%，第3组为6.14±0.93%，第4组为6.20±0.31%。NGT女性所生婴儿的出生体重为3.28±0.50kg。第1组、第2组、第3组和第4组GDM女性所生婴儿的出生体重分别为3.15±0.48、3.09±0.68、3.32±0.51和3.51±0.63kg。第1组女性尽管有高危妊娠史，但所产婴儿与NGT女性所产的适于胎龄儿一样。对高危妊娠女性，建议在妊娠早期进行筛查并开始治疗。
