Department of Endocrinology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Diabetes Technol Ther. 2012 Nov;14(11):1002-7. doi: 10.1089/dia.2012.0142. Epub 2012 Oct 9.
This study identified the impact of intensive therapy on neonatal outcomes in women with gestational diabetes mellitus (GDM) and determined the effects on the postpartum metabolic status of the mothers.
In total, 127 pregnant women with GDM were randomly selected to receive an intensive treatment regimen, which included one-to-one education, lifestyle intervention, scheduled clinic visits, strict glucose control, and frequent glucose self-monitoring. Meanwhile, 148 age-matched pregnant women with GDM were selected as controls and given the standard treatment regimen. Pregnancy outcomes including parameters related to the GDM mothers and to their neonates were comparatively analyzed between the two treatment groups. GDM patient follow-up (range, 1-3 years after delivery) included an oral glucose tolerance test and measurements of lipid concentration and insulin secretion. The insulinogenic index (ΔInsulin(30 min)/ΔBlood glucose(30 min)) and homeostasis model assessment index of β-cell function and insulin resistance were calculated. The patients' demographic and anthropometric data were also recorded for comparative analysis.
Compared with GDM patients receiving standard treatment, GDM patients receiving intensive treatment had lower instances of premature delivery (2.4% vs. 8.3%, P<0.05) and neonatal care unit admission (21.3% vs. 33.3%, P<0.05) and lower neonatal birth weight (3.26±0.53 vs. 3.45±0.55 kg, P<0.0001). At follow-up, GDM patients from the intensive treatment group had a smaller waist circumference (75.83±3.11 vs. 78.34±4.20 cm, P<0.01), lower 30-min glucose levels after a 75-g glucose load (8.26±1.85 vs. 9.46±2.74 mmol/L, P<0.05), and higher high-density lipoprotein levels (1.30±0.24 vs. 1.18±0.23 mmol/L, P<0.05).
The intensive GDM treatment regimen led to healthier outcomes for the women, the neonates, and the birth event and was associated with better maternal metabolic situations in the months and years after delivery.
本研究旨在探讨强化治疗对妊娠期糖尿病（GDM）患者母婴结局的影响，并确定其对母亲产后代谢状态的影响。
共纳入 127 例 GDM 孕妇，随机分为强化治疗组（一对一教育、生活方式干预、定期门诊随访、严格血糖控制和频繁自我血糖监测）和常规治疗组（常规治疗）。比较两组孕妇的妊娠结局（包括母亲和新生儿相关参数）。GDM 患者产后随访（产后 1-3 年）包括口服葡萄糖耐量试验和血脂浓度、胰岛素分泌测定。计算胰岛素原指数（ΔInsulin（30 min）/ΔBlood glucose（30 min））和β细胞功能及胰岛素抵抗的稳态模型评估指数。记录患者的人口统计学和人体测量学数据进行比较分析。
与接受常规治疗的 GDM 患者相比，接受强化治疗的 GDM 患者早产率（2.4% vs. 8.3%，P<0.05）和新生儿入住新生儿重症监护病房率（21.3% vs. 33.3%，P<0.05）较低，新生儿出生体重较低（3.26±0.53 vs. 3.45±0.55 kg，P<0.0001）。随访时，强化治疗组患者的腰围较小（75.83±3.11 vs. 78.34±4.20 cm，P<0.01），75 g 葡萄糖负荷后 30 分钟血糖水平较低（8.26±1.85 vs. 9.46±2.74 mmol/L，P<0.05），高密度脂蛋白水平较高（1.30±0.24 vs. 1.18±0.23 mmol/L，P<0.05）。
强化 GDM 治疗方案改善了母婴结局和分娩事件，且产后数月和数年内产妇的代谢状况更好。
