Nasrat H, Fageeh W, Abalkhail B, Yamani T, Ardawi M S
Department of Obstetrics and Gynecology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
Int J Gynaecol Obstet. 1996 May;53(2):117-23. doi: 10.1016/0020-7292(95)02635-5.
To describe the experience of management of gestational diabetes 'GDM' among a high-risk population and to determine the relative contribution of maternal risk factors and some indices of glucose intolerance on pregnancy outcome.
A total of 173 antenatal patients with GDM, matched to 337 non-diabetic controls were evaluated. Incidences of fetal macrosomia, large birth weight (> 4000 g), and operative delivery were noted. Patients with GDM were subgrouped into group I and II, according to the fasting blood glucose (FBG) level on the glucose tolerance test 'GTT', whether > or = or < 5.8 mmol/l, respectively. A logistic regression model was then developed with predictive variables, i.e. maternal weight, height, parity, gestational week at diagnosis of GDM, degree of glucose tolerance, treatment and means of fasting and post-prandial blood glucose measurements as independent variables against each of the outcome measures as dependent variables.
Compared with non-diabetics, patients with GDM were older in age, weight and parity. The mean fetal birth weight, incidences of macrosomia and babies > 4 kg were significantly higher among GDM patients. In patients with GDM the degree of glucose intolerance (determined by FBG on the GTT) and maternal weight were the only variables that significantly increased the risk of macrosomia and operative delivery. Within group I patients (FBG > or = 5.8 mg/dl) only 'maternal weight' significantly increased the risk of both having a baby > 4 kg, and operative delivery.
Among patients with gestational diabetes, a GTT with a FBG level > or = 5.8 mmol/l is a strong predictor for perinatal outcome. Maternal weight is an independent risk factor that increases the risk of both macrosomia and operative delivery.
描述高危人群中妊娠糖尿病（GDM）的管理经验，并确定母亲风险因素和一些糖耐量指标对妊娠结局的相对影响。
对173例患有GDM的产前患者和337例非糖尿病对照者进行评估。记录巨大儿、出生体重较大（>4000 g）和手术分娩的发生率。根据葡萄糖耐量试验（GTT）中的空腹血糖（FBG）水平，将GDM患者分为I组和II组，FBG水平分别>或 = 或<5.8 mmol/l。然后建立一个逻辑回归模型，将预测变量，即母亲体重、身高、产次、GDM诊断时的孕周、糖耐量程度、治疗以及空腹和餐后血糖测量方法作为自变量，将每个结局指标作为因变量。
与非糖尿病患者相比，GDM患者年龄更大，体重更重，产次更多。GDM患者的平均胎儿出生体重、巨大儿和出生体重>4 kg的婴儿发生率显著更高。在GDM患者中，糖耐量程度（由GTT中的FBG确定）和母亲体重是仅有的显著增加巨大儿和手术分娩风险的变量。在I组患者（FBG>或 = 5.8 mg/dl）中，只有“母亲体重”显著增加了分娩体重>4 kg婴儿和手术分娩的风险。
在妊娠糖尿病患者中，FBG水平>或 = 5.8 mmol/l的GTT是围产期结局的有力预测指标。母亲体重是增加巨大儿和手术分娩风险的独立危险因素。
