Hopp H, Vollert W, Ragosch V, Pritze W, Ebert A, Entezami M, Weitzel H
Fraenklinik und Poliklinik, Universitätsklinikum Steglitz, FU Berlin.
Geburtshilfe Frauenheilkd. 1995 Jan;55(1):28-31. doi: 10.1055/s-2007-1022769.
Only 10% of all gestational diabetic mothers in Germany are diagnosed with the current risk-screening. The elevated perinatal risks in case of an unrecognized or insufficiently treated gestational diabetes remains controversial. The purpose of our study was to determine if the number of recognized cases could be increased by a general screening method, and with intensive medical diagnostics the complication rate reduced. Routine blood glucose samplings during the outpatient care were performed throughout the pregnancy. In case of values over 100 mg/dl a 75 g OGTT was done for an exclusion of gestational diabetes. In case of gestational diabetes the patients were asked to follow a special exercise and diet programme as well as self-blood glucose determinations throughout the day. The amniotic fluid insulin level was of substantial value for the indication of insulin therapy. In 6% of the screened patients a gestational diabetes was diagnosed. There was a significant increase (p < 0.001) of fetal macrosomia and diabetic fetopathy in the group without amniocentesis (n = 22) in comparison to the group with invasive (n = 81). We demand the introduction of a general screening for every pregnant patient. By an intensification of the diagnostic methods as well as by a strictly appropriate therapy it should be possible to reduce the fetal and neonatal complications.
在德国，目前的风险筛查仅能诊断出10%的妊娠期糖尿病母亲。对于未被识别或治疗不充分的妊娠期糖尿病，其围产期风险升高仍存在争议。我们研究的目的是确定通过一种通用筛查方法能否增加确诊病例数，并通过强化医学诊断降低并发症发生率。在整个孕期的门诊护理期间进行常规血糖采样。如果血糖值超过100mg/dl，则进行75g口服葡萄糖耐量试验以排除妊娠期糖尿病。如果诊断为妊娠期糖尿病，患者需遵循特殊的运动和饮食计划，并全天进行自我血糖测定。羊水胰岛素水平对胰岛素治疗的指征具有重要价值。在6%的筛查患者中诊断出妊娠期糖尿病。与进行侵入性检查的组（n = 81）相比，未进行羊膜穿刺术的组（n = 22）中巨大儿和胎儿糖尿病病变显著增加（p < 0.001）。我们要求对每位孕妇进行通用筛查。通过强化诊断方法以及严格适当的治疗，应该有可能降低胎儿和新生儿并发症的发生率。
