Kjos S L, Buchanan T A, Greenspoon J S, Montoro M, Bernstein G S, Mestman J H
Department of Obstetrics and Gynecology, University of Southern California Medical School, Los Angeles.
Am J Obstet Gynecol. 1990 Jul;163(1 Pt 1):93-8. doi: 10.1016/s0002-9378(11)90676-0.
To determine the prevalence of abnormal carbohydrate metabolism in the early postpartum period in women with gestational diabetes mellitus, we performed 2-hour oral glucose tolerance tests between 5 and 8 weeks post partum in 246 women with recent gestational diabetes mellitus. Patients were stratified into three study groups based on their fasting serum glucose level during pregnancy: (1) group A1: all fasting serum glucose levels during pregnancy less than 105 mg/dl without insulin therapy; (2) group A2: any fasting serum glucose levels greater than 105 and less than 140 mg/dl before insulin therapy; (3) group B1: any pregnancy with fasting serum glucose levels greater than 140 mg/dl. Overall, 48 (19%) of the patients had an abnormal oral glucose tolerance test in the early postpartum period; 25 (10%) had impaired glucose tolerance and 23 (9%) had diabetes mellitus. The prevalence of postpartum diabetes mellitus (2% in group A1, 9% in group A2 and 44% in group B1) increased in parallel with the degree of maternal metabolic decompensation during pregnancy (p less than 0.05 for A1 versus A2; p less than 0.001 for A2 versus B1). The prevalence of impaired glucose tolerance was likewise greater in the B1 group (26%) than in either the A1 or the A2 group (p less than 0.05). Gestational age less than 24 weeks at diagnosis of gestational diabetes mellitus was an additional risk factor for postpartum glucose intolerance. Our findings support the use of an oral glucose tolerance test in the early puerperium, especially for patients with elevated fasting serum glucose levels during pregnancy.
为了确定妊娠期糖尿病女性产后早期碳水化合物代谢异常的患病率，我们对246例近期患有妊娠期糖尿病的女性在产后5至8周进行了2小时口服葡萄糖耐量试验。根据患者孕期空腹血清葡萄糖水平将其分为三个研究组：（1）A1组：孕期所有空腹血清葡萄糖水平低于105mg/dl且未接受胰岛素治疗；（2）A2组：胰岛素治疗前任何空腹血清葡萄糖水平高于105且低于140mg/dl；（3）B1组：任何孕期空腹血清葡萄糖水平高于140mg/dl。总体而言，48例（19%）患者在产后早期口服葡萄糖耐量试验异常；25例（10%）糖耐量受损，23例（9%）患有糖尿病。产后糖尿病的患病率（A1组为2%，A2组为9%，B1组为44%）与孕期母体代谢失代偿程度平行增加（A1组与A2组相比，p<0.05；A2组与B1组相比，p<0.001）。B1组糖耐量受损的患病率（26%）同样高于A1组或A2组（p<0.05）。妊娠期糖尿病诊断时孕周小于24周是产后葡萄糖不耐受的另一个危险因素。我们的研究结果支持在产褥早期进行口服葡萄糖耐量试验，尤其是对于孕期空腹血清葡萄糖水平升高的患者。
