真实世界临床实践中妊娠期糖尿病患者血糖管理不达标与不良妊娠结局的关系：一项回顾性研究。
Unsatisfactory Glucose Management and Adverse Pregnancy Outcomes of Gestational Diabetes Mellitus in the Real World of Clinical Practice: A Retrospective Study.
机构信息
Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University; Shandong Clinical Medical Center of Endocrinology and Metabolism; Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China.
Department of Obstetrics, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, China.
出版信息
Chin Med J (Engl). 2018 May 5;131(9):1079-1085. doi: 10.4103/0366-6999.230718.
BACKGROUND
Facing the increasing prevalence of gestational diabetes mellitus (GDM), this study aimed to evaluate the management of GDM and its association with adverse pregnancy outcomes.
METHODS
The data of 996 inpatients with GDM who terminated pregnancies in our hospital from January 2011 to December 2015 were collected. Treatments during pregnancy and the last hospital admission before delivery were analyzed. Pregnancy outcomes of the GDM patients were compared with 996 nondiabetic subjects matched by delivery year and gestational age. The association between fasting plasma glucose (FPG) and adverse pregnancy outcomes was examined by logistic regression analyses.
RESULTS
The average prevalence of GDM over the 5 years was 4.4% (1330/30,191). Within the GDM patients, 42.8% (426/996) received dietary intervention, whereas 19.1% (190/996) received insulin treatment. Adverse outcomes were more likely to occur in patients with unsatisfactory control of blood glucose such as respiratory distress syndrome (RDS, χ = 13.373, P < 0.01). Elevated FPG was identified as an independent risk factor for premature birth (odds ratio [OR] = 1.460, P < 0.001), neonatal care unit admission (OR = 1.284, P < 0.001), RDS (OR = 1.322, P = 0.001), and stillbirth (OR = 1.427, P < 0.001).
CONCLUSIONS
Management of GDM in the real world of clinical practice was unsatisfactory, which might have contributed to adverse pregnancy outcomes.
背景
面对妊娠期糖尿病（GDM）患病率的不断增加，本研究旨在评估 GDM 的管理及其与不良妊娠结局的关系。
方法
收集了 2011 年 1 月至 2015 年 12 月期间在我院终止妊娠的 996 例 GDM 住院患者的数据。分析了孕期和分娩前最后一次住院的治疗情况。将 GDM 患者的妊娠结局与按分娩年份和孕周匹配的 996 例非糖尿病患者进行比较。通过 logistic 回归分析检查空腹血糖（FPG）与不良妊娠结局的关系。
结果
5 年内 GDM 的平均患病率为 4.4%（1330/30191）。在 GDM 患者中，42.8%（426/996）接受了饮食干预，19.1%（190/996）接受了胰岛素治疗。血糖控制不理想的患者更有可能出现不良结局，如呼吸窘迫综合征（RDS，χ=13.373，P<0.01）。升高的 FPG 被确定为早产（比值比[OR] = 1.460，P<0.001）、新生儿重症监护病房入住（OR=1.284，P<0.001）、RDS（OR=1.322，P=0.001）和死胎（OR=1.427，P<0.001）的独立危险因素。
结论
临床实践中 GDM 的管理并不令人满意，这可能导致了不良的妊娠结局。
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