控制血糖对改善妊娠期糖尿病孕妇妊娠结局的意义

目的:探讨控制妊娠期糖尿病孕妇血糖对减少母体及围生儿并发症和改善妊娠结局的意义.方法:将70例妊娠期糖尿病孕妇根据治疗后血糖控制情况分成血糖控制满意组(A组,54例)与血糖控制不满意组(B组,16例),同80例正常孕妇的妊娠过程进行比较,分析在孕产妇和围生儿并发症方面有无差异.结果:经临床治疗后,A组只有妊娠期高血压疾病发生率高于对照组孕妇(P＜0.05),B组妊娠期高血压疾病、羊水过多、巨大儿、早产及新生儿窒息发生率均高于对照组(P＜0.05).结论:重视血糖筛查,及时诊断和治疗妊娠期糖尿病,选择合适的时间和方式终止妊娠可以有效的降低母儿并发症的发生率.     

糖尿病孕妇分娩新生儿的监护和处理

近年来 ,由于妊娠期严格控制糖尿病孕妇血糖 ,产前加强胎儿监测 ,糖尿病孕妇分娩的新生儿死亡率明显下降 ,但新生儿近期、远期并发症仍较高 ,出生后应对新生儿加强监测 ,给予及时处理。妊娠合并糖尿病对围生儿的影响程度与孕妇病变程度及妊娠期高血糖出现的时间、血糖水平等密切相关 ,糖尿病孕妇所导致的新生儿常见并发症包括[1] :巨大儿、新生儿产伤、新生儿低血糖等。远期并发症有肥胖、2型糖尿病发生率增加等。1　妊娠合并糖尿病对新生儿的影响糖尿病孕妇导致新生儿一系列合并症 (除畸形外 )均与胎儿高胰岛素血症相关。妊娠合并糖尿病时…     

妊娠合并糖代谢异常孕妇产程中血糖监测的前瞻性研究

目的　探讨妊娠合并糖代谢异常孕妇在产程中行血糖监测和处理后对新生儿血糖变化的影响。方法　选择妊娠合并糖代谢异常孕妇 4 0例 ,其中妊娠期糖尿病孕妇 30例 ,糖耐量低减孕妇8例 ,糖尿病合并妊娠孕妇 2例。产程中对其进行血糖动态监测 ,血糖异常者及时使用低剂量短效胰岛素静脉滴注 ,观察分娩后新生儿的血糖水平变化。结果　产程中糖代谢异常孕妇的血糖波动范围为 3 8～ 11 2mmol/L。其中 ,17例进行了胰岛素静脉滴注 (胰岛素用量范围为 1 5～ 3 0U) ,占糖代谢异常孕妇总数的 4 2 5 % (17/40 ) ,分娩后新生儿即刻血糖水平平均为 (4 0± 1 5 )mmol/L ,分娩后 2 4h的新生儿血糖水平为 (3 9± 1 0 )mmol/L ,发生新生儿低血糖 2例 ;2 3例未用胰岛素孕妇的新生儿生后即刻血糖水平平均为 (4 2± 1 5 )mmol/L ,分娩后 2 4h的新生儿血糖水平为 (3 9± 1 0 )mmol/L ,发生新生儿低血糖 1例。结论　妊娠合并糖代谢异常孕妇 ,在产程中行血糖监测和控制 ,可避免新生儿低血糖的发生。     

妊娠期糖代谢异常并发新生儿低血糖的相关研究

目的:探讨妊娠期糖代谢异常与新生儿低血糖的关系.方法:对我院2006年1月1日至2007年6月30日在我院产前检查及分娩的1221例单胎孕妇及其分娩的新生儿,按50 g葡萄糖筛查(GCT)和75g葡萄糖耐量试验(OGTT)检查结果将产妇分为:血糖正常孕妇组、GCT阳性组、妊娠期糖耐量减低组(GIGT组)、妊娠期糖尿病组(GDM组),同时根据GDM组患者是否应用胰岛素分为无胰岛素治疗组(GDM-A1组)和胰岛素治疗组(GDM-A2组).分别统计5组产妇分娩的新生儿中低血糖发生率及血糖均值之间的变化情况.结果:GDM-A2组的新生儿与血糖正常孕妇组、GCT阳性组、GIGT组、GDM-A1组相比,其新生儿低血糖发生率、血糖均值之间差异均有高度统计学意义(P＜0.01).结论:GDM-A2组孕妇虽经系统治疗,其分娩的新生儿仍应加强产后2小时血糖的监测,做到早发现、早处理新生儿低血糖.     

糖尿病合并妊娠和妊娠期糖尿病母儿并发症诊治探讨

目的:探讨妊娠合并糖尿病的母婴并发症及诊治。方法:回顾性分析83例糖尿病合并妊娠患者(A组)及90例妊娠期糖尿病患者(B组)的临床资料,并比较其妊娠结局,包括孕产妇并发症(妊娠期高血压疾病、胎膜早破、DKA、早产、羊水过多、胎儿宫内窘迫、剖宫产率、产后出血)及新生儿并发症(巨大儿、新生儿低血糖、胎死宫内、RDS、畸形、窒息)。结果:A组的孕妇并发症除产后出血较B组明显升高;巨大儿、新生儿低血糖、胎死宫内、畸形的发生率明显升高,差异有显著性(P<0.05)。结论:糖尿病合并妊娠对孕妇及胎儿有更大的危害,要加强对其孕前、孕期及孕后的管理。     

妊娠期糖尿病合并妊娠期肝内胆汁淤积症母儿结局探讨

目的:探讨妊娠期糖尿病合并妊娠期肝内胆汁淤积症对孕产妇和国产儿结局的影响。方法:分析17例GDM合并ICP患者和85例单纯GDM患者的临床资料。结果:两组间孕妇分娩孕周差异有统计学意义(P<0.05)。两组先兆早产、早产、酮症、胎膜早破、羊水过多、胎盘早剥、剖宫产、产后出血、宫内生长受限、胎儿宫内窘迫、巨大儿、新生儿低血糖、新生儿窒息和呼吸窘迫综合征、胎儿畸形、死胎、死产发生率比较,差异均无统计学意义(P>0.05)。结论:对妊娠期糖尿病合并妊娠肝内胆汁淤积症患者早诊早治,有效控制血糖及胆汁酸,适时终止妊娠可改善围产儿结局。     

糖尿病孕妇的分娩期处理

妊娠合并糖尿病是妊娠期间发现或发病的由不同程度糖耐量异常及糖尿病引起的不同程度的高血糖。包括妊娠前即存在的和随妊娠期而发生的两种情况。美国妊娠期糖尿病（GDM）发生率为2％-5％，我国GDM的发生率为1％～5％。妊娠糖尿病可使子癎前期、羊水过多、难产、产后出血、巨大儿、胎儿畸形、死胎、死产，新生儿呼吸窘迫综合征、低血糖等发生率增加，若血糖控制不良，易发生酮症酸中毒。分娩使糖尿病孕妇代谢和免疫功能受到影响，增加了糖尿病孕妇及胎儿的危险陛。     

妊娠期糖尿病诊治与妊娠结局的相关性分析

目的 :探讨妊娠期糖尿病 (gestationaldiabetesmellilus,GDM)的血糖控制状况与妊娠结局的关系。方法 :回顾性分析 331例经糖尿病筛查发现并确诊的GDM患者的临床资料 ,按治疗方式分为单纯饮食控制组 2 0 1例 (Ⅰ组 )、饮食控制加胰岛素治疗组 83例 (Ⅱ组 )、无系统治疗组 4 7例 (Ⅲ组 ) ,比较三组的妊娠结局 ,包括孕产妇并发症 (妊娠高血压综合征、羊水过多、产后大出血、产褥感染 )、剖宫产率、早产率、巨大胎儿发生率、围生儿死亡率及新生儿病率 (包括重度窒息、呼吸窘迫综合征、低血糖 )等。结果 :Ⅲ组的孕产妇并发症、剖宫产率、早产率、巨大胎儿的发生率、围生儿死亡率、新生儿病率均较Ⅰ组和Ⅱ组明显升高 ,而Ⅰ组和Ⅱ组间无明显差异。结论 :GDM孕妇经过合理治疗 ,有效控制血糖 ,能明显改善妊娠结局。     

羊水过少孕妇血液流变学指标变化及其围生儿预后

目的:探讨羊水过少孕妇血液流变学指标变化及其围生儿预后。方法:测定羊水过少合并贫血组、合并胎儿窘迫组、合并妊娠期高血压疾病或(和)妊娠期肝内胆汁淤积症(ICP)组、其余羊水过少组和对照组孕妇的血液流变学指标。结果:①羊水过少合并贫血组全血粘度、血细胞比容(HCT)均低于对照组(P <0 .0 5 ,P <0 .0 1) ;羊水过少合并胎儿窘迫组全血粘度、HCT和聚集指数均高于对照组(P <0 .0 5 ,P <0 .0 1) ,血沉低于对照组(P <0 .0 1) ;羊水过少合并妊娠高血压疾病或(和)ICP组全血粘度、血浆粘度、HCT和聚集指数均高于对照组(P <0 .0 1,P <0 .0 5 )。②伴发并发症的羊水过少孕妇新生儿窒息、低体重及其羊水粪染的发生率均高于对照组(P <0 .0 5 )。结论:血粘度增加和贫血可能是引起羊水过少孕妇胎盘及胎儿缺氧的因素;血液流变学指标可作为羊水过少孕妇治疗监测指标之一。     

孕前合并糖尿病孕妇的胎儿出生体重与孕期血糖控制的关系

孕前胰岛素依赖型糖尿病妇女妊娠后,实行严密监护的胰岛素治疗方案,使其血糖水平接近正常,虽可明显减少围产儿的发病率和死亡率,但巨大儿的发生率在多数报道中居高不下。为此,研究了113例孕前胰岛素依赖型糖尿病孕妇及其新生儿,目的:了解该型孕妇孕期血糖控制所能达到的程度,及孕期不同时间血糖和糖化血红蛋白(HbAlc)水平与新生儿出生体重间的关系。     

Use of insulin glargine during pregnancy: a case-control pilot study

OBJECTIVE: To determine whether the use of insulin glargine during pregnancy is associated with an increase in the incidence of fetal macrosomia or adverse neonatal outcome. DESIGN: A matched case-control study. SETTING: Women's Centre, John Radcliffe Hospital, Oxford, UK. SAMPLE: Sixty-four pregnant women treated with insulin during their pregnancies, 20 with type I diabetes and 44 with gestational diabetes. METHODS: Two groups of women were compared in matched pairs. A study group of 32 pregnant women with diabetes treated with insulin glargine during their pregnancy and a control group of 32 pregnant women treated with an intermediate-acting human insulin (isophane or insulin zinc suspension) and matched for weight at booking, height, gestation at delivery, parity, fetal sex, duration of insulin use in pregnancy and glycaemic control during the third trimester of pregnancy (glycosylated haemoglobin [HbA(1c)] concentration and mean blood glucose concentration). MAIN OUTCOME MEASURES: Birthweight, centile birthweight, the incidence of fetal macrosomia (birthweight > 90th percentile) and neonatal morbidity in the two study groups. RESULTS: There was no significant difference between the birthweight or centile birthweight of babies born to the women treated with insulin glargine during pregnancy and that of the babies born to those in the control group treated with intermediate-acting human insulin. The overall incidence of fetal macrosomia was 12/32 (37.5%) in the insulin glargine group and 13/32 (40.6%) in the control group. There was no significant difference in neonatal morbidity between the groups. CONCLUSIONS: The results of this pilot study indicate that insulin glargine treatment during pregnancy does not appear to be associated with increased fetal macrosomia or neonatal morbidity.     

孕前糖尿病合并妊娠临床管理新进展

孕前糖尿病合并妊娠母儿不良结局增加。孕前糖尿病孕妇计划妊娠是避免和减少胎儿先天畸形等的重要一步。推荐的糖化血红蛋白控制目标孕前为<6.5%,孕期为<6.0%。糖尿病合并症的筛查及管理至关重要,血压控制目标应更谨慎,尤其是有糖尿病肾脏疾病者。对于1型糖尿病患者,孕期动态血糖监测有助于改善血糖控制水平。胰岛素是孕期糖尿病患者的一线治疗方案。优化血糖控制和药物治疗方案,并密切关注并发症,能够降低孕前糖尿病合并妊娠的母儿不良结局风险,并确保孕前、妊娠期间和产后的糖尿病管理质量。     

Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: case-control study and a case report of euglycemic diabetic ketoacidosis in pregnancy.

Background and Objective: The occurrence of diabetic ketoacidosis (DKA) during pregnancy is considered a medical emergency. The aims of the present study were to evaluate the incidence of DKA in pregnant and non-pregnant women with diabetes; to compare the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women; and to show a case of euglycemic DKA in pregnancy. Methods: The subjects consisted of 90 cases of DKA in pregnant women with diabetes and 286 cases of non-pregnant female inpatients receiving treatment for diabetes during 2001 to 2005 in our hospital. The incidence of DKA in pregnant and non-pregnant women with diabetes and the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women were compared. Results: DKA had a higher incidence in pregnant women with diabetes (8/90, 8.9%) than in non-pregnant women with diabetes (9/286, 3.1%) (P < 0.05). The blood glucose levels (mmol/L) in pregnant women with DKA were significantly lower than those in non-pregnant women with DKA (16.3 +/- 4.6 vs 27.5 +/- 4.8, P < 0.001). A case of euglycemic DKA in pregnancy was described whose serum glucose level was only 6.9 mmol/L. Conclusions: DKA in pregnant women with diabetes may occur more frequently, and at lower blood glucose levels than DKA in non-pregnant women with diabetes.     

Predictive factors of developing diabetes mellitus in women with gestational diabetes

BACKGROUND: To investigate which factors during gestational diabetes pregnancies correlate with the risk of developing impaired glucose tolerance or diabetes 1 year postpartum and to compare this risk in women with gestational diabetes and women with a normal oral glucose tolerance test during pregnancy. METHODS: Of 315 women with gestational diabetes, defined as a 2-hr blood glucose value of at least 9.0 mmol/l at a 75-g oral glucose tolerance test, who delivered in Lund 1991-99, 229 (73%) performed a new test 1 year postpartum. We compared maternal and fetal factors during pregnancy with the test value at follow up. A control group of 153 women with a 2-hr test value below 7.8 mmol/l during pregnancy were invited to a new test 1 year postpartum and 60 (39%) accepted. RESULTS: At 1 year follow up, 31% of the women with gestational diabetes but only one of the 60 controls showed pathologic glucose tolerance and one had developed diabetes. The following factors in women with gestational diabetes were identified as predicting impaired glucose tolerance or diabetes at 1 year follow up: maternal age over 40 and--in a multiple regression analysis, independent of each other--a high 2-hr value at oral glucose tolerance test during pregnancy and insulin treatment during pregnancy. CONCLUSION: The risk of developing manifest diabetes after gestational diabetes may be high enough to justify a general screening or diagnostic procedure in all pregnant women to identify women with gestational diabetes and a postpartum follow up program for them. This study did not identify any particular factor during pregnancy with enough precision to predict a later progression to diabetes.     

New technologies for the management of pregestational diabetes mellitus

Purpose of the Review: The purpose of this review is to understand new modalities available to treat and manage type 1 and type 2 diabetes during pregnancy. Recent Findings: The use of new insulin analogs and oral agents, as well as new technologies to deliver insulin and monitor glucose during pregnancy remains controversial. This review will outline the advantages and disadvantages, as well as the safety profiles of these new medications and therapeutic options. Summary: There are many effective treatments for diabetes during pregnancy. New insulin analogs seem to be safe to use in pregnancy and offer the potential for better glycemic control compared with older agents. Oral hypoglycemic medications also seem to be safe and may be an option for a select group of pregnant patients with type 2 diabetes. Insulin pumps and continuous glucose monitoring systems may be beneficial in certain patients, but adequate data are not yet available in terms of outcomes and cost-effectiveness to support widespread use. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After participating in this CME activity, physicians should be better able to revise glycemic goals for pregnant patients with pregestational diabetes to be in line with our current understanding of glycemic profiles in normal pregnant women. Use new insulin analogs to treat pregnant women with abnormalities in glucose homeostasis and choose which patients will benefit from advanced technologies for diabetes management, such as insulin pumps and continuous glucose monitoring systems.     

妊娠期糖耐量异常妇女胰岛功能与胰岛素抵抗的相关研究

目的:研究妊娠期糖耐量异常与胰岛β细胞功能、胰岛素抵抗等的关系。方法:对孕24~36周上海市孕妇共4568例(孕前有糖尿病或糖尿病家族史者排除),先行50g葡萄糖筛查试验,异常者再行75g口服葡萄糖耐量试验(OGTT)-胰岛素释放试验,选取OG-TT异常者318例作为试验组,OGTT正常者中随机选取320例作为对照组,获取各阶段的血糖值及血清胰岛素值,通过计算,用胰岛素敏感指数(ISI)、稳态评估模式、胰岛素储备能力/血糖最大升高值(ΔPI/ΔPG)了解胰岛β细胞功能及外周胰岛素抵抗情况。结果:OGTT异常组的OGTT后1h血清胰岛素(PI1)、胰岛素释放曲线下面积较OGTT正常组显著增高(P<0·05),而胰岛素敏感指数、ΔPI/ΔPG及HOMA-β细胞较OGTT正常组降低(P<0.05)。糖尿病(GDM)组与妊娠期糖耐量减退(GIGT)组相比:GDM组的BMI高于GIGT组,而胰岛素敏感指数、HOMA-β细胞低于GIGT组(P<0.05)。其它指标均无明显差异。结论:妊娠期糖耐量异常形成的主要原因为胰岛素抵抗而非胰岛分泌功能降低。     

Diabetic ketoacidosis in pregnancy tends to occur at lower blood glucose levels: Case–control study and a case report of euglycemic diabetic ketoacidosis in pregnancy

Background and Objective:  The occurrence of diabetic ketoacidosis (DKA) during pregnancy is considered a medical emergency. The aims of the present study were to evaluate the incidence of DKA in pregnant and non-pregnant women with diabetes; to compare the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women; and to show a case of euglycemic DKA in pregnancy.
Methods:  The subjects consisted of 90 cases of DKA in pregnant women with diabetes and 286 cases of non-pregnant female inpatients receiving treatment for diabetes during 2001 to 2005 in our hospital. The incidence of DKA in pregnant and non-pregnant women with diabetes and the blood glucose levels at the diagnosis of DKA in pregnant and non-pregnant women were compared.
Results:  DKA had a higher incidence in pregnant women with diabetes (8/90, 8.9%) than in non-pregnant women with diabetes (9/286, 3.1%) ( P  < 0.05). The blood glucose levels (mmol/L) in pregnant women with DKA were significantly lower than those in non-pregnant women with DKA (16.3 ± 4.6 vs 27.5 ± 4.8, P  < 0.001). A case of euglycemic DKA in pregnancy was described whose serum glucose level was only 6.9 mmol/L.
Conclusions:  DKA in pregnant women with diabetes may occur more frequently, and at lower blood glucose levels than DKA in non-pregnant women with diabetes.     

Diabetes complicating pregnancy

Despite the well-documented relationship between morbidity in pregnancy and pregestational maternal diabetes, the corrected perinatal outcome is, in most series, equal to or better than that of the general reference obstetric population. No single aspect or element of contemporary management is responsible for this improvement; rather, a combination of interventions seems responsible. Targeting delivery early in term, improved compliance, better glycemic control during pregnancy, improved control at conception, improved neonatal care, family planning, and early screening for fetal abnormalities all likely contribute to improved outcome. The currently observed rates of perinatal mortality suggest that an irreducible minimum mortality rate may be reached; however, large disparities in access to care and treatment continue to result in a wide range in rates of morbidity and mortality, a fact that pertains to outcomes in general as well as to pregnancies complicated by diabetes. The identification of women with lesser degrees of hyperglycemia as diabetic by lowering the thresholds for glucose tolerance test abnormality suggests an importance of the diagnosis that is not supported by evidence of either related morbidity or therapeutic benefit. The extrapolation of risk to women with lesser degrees of hyperglycemia seems to have little basis, and the management of women with mild glucose intolerance as if they had overt diabetes is unwarranted. The excess of resources dedicated to the identification and monitoring of an increasing number of women with mild abnormalities of glucose metabolism should prompt a reevaluation of these practices. Perinatal benefits of this expenditure are difficult to document or nonexistent, and there is a predictable increase in iatrogenic morbidities associated with the diagnosis. The exception in the most recent recommendations is the addition of a random glucose measure to screen for the rare women with overt undiagnosed diabetes who presents for prenatal care, because these women are at increased risk of morbidities related to diabetes. A curious statement was made in the summary and recommendations of the fourth International Congress on Gestational Diabetes: "There remains a compelling need to develop diagnostic criteria for GDM [gestational diabetes mellitus] that are based on the specific relationships between hyperglycemia and risk of adverse outcome." If these relationships are undefined, what is the import of the diagnosis? At the author's center, application of the new diagnostic thresholds for the diagnosis of gestational diabetes mellitus has increased the incidence to over 6%. Without a clear expectation of benefit, this increase represents an unsupportable investment of resources. What are the prospects for improving understanding of the relationships between glucose intolerance and pregnancy risks? The direction of new guidelines and recommendations seems to be moving away from resolution of the relationships. The new criteria result in the diagnosis of gestational diabetes in an increasing number of women who were previously normal. It is easier to differentiate women at an extreme of hyperglycemia from normal. Investigations will be even less able to identify attributable effects of glucose intolerance in pregnancy with the inclusion of women with lesser degrees of hyperglycemia. As evidenced in O'Sullivan's original series, women with fasting hyperglycemia in pregnancy are still presumed to be at increased risk of fetal death. This risk factor remains important in clinical management if insulin treatment, fetal surveillance, and early term delivery can reduce the risk of fetal loss. At the author's center, the relationships among outpatient measures of fasting glycemia, glucose tolerance testing results, and perinatal outcomes are evaluated. Preliminary results suggest that fasting glycemia measured at the time of a 50-g glucose tolerance test is significantly correlated with and as sensitive and predictive of morbidity as the glucose tolerance test diagnosis of gestational diabetes. If these results are confirmed, it will be difficult to rationalize continued glucose tolerance testing.     

A ten-year gestational diabetes mellitus cohort at a university clinic of the mid-Anatolian region of Turkey

OBJECTIVE: The study attempts to analyze a 10-year retrospective cohort of gestational diabetes mellitus (GDM) cases, elucidating the maternal complications and perinatal morbidity and mortality. STUDY DESIGN: The study participants were 110 diabetic singleton pregnancies receiving obstetric care at the Department of Obstetrics and Gynecology, Osmangazi University School of Medicine in Eskisehir, Turkey from January 1995 to December 2004. In 70 of the GDM cases, mean age, diagnostic criteria used to define GDM, gestational age at delivery, presence of additional risk factors, method of clinical management, mode of delivery, fetal birthweights and newborn characteristics were assessed. RESULTS: The prevalence of GDM in the past ten-year period was 3.1% (110/3548). Mean age of enrolled GDM cases was 32.6 +/- 5.3 years. With regard to diagnostic criteria of GDM, 24 (37.1%) cases were diagnosed based on a 100 g, three-hour oral glucose tolerance test (OGTT), while 18 (25.7%) cases were referred to our unit without any information on the specific criteria of GDM diagnoses. In less than a third of the cases (25.7%), a one-hour 50 g glucose challenge test (GCT) resulted > or =185 mg/dl completing the diagnoses. More than half of the cases (57.1%) revealed controlled glucose homeostasis on diet, while 30 (42.9%) pregnant women needed insulin therapy to control blood glucose levels to within normal physiologic limits. Fetal macrosomia was present in 18 (25.7%) pregnancies. Meanwhile, most of the fetuses (62.9%) were within the normal growth percentiles throughout the pregnancy. There was no difference detected in body mass index (BMI) of women undergoing cesarean section and spontaneous vaginal births (25.1 +/- 1.2 vs 26.2 +/- 2.3 kg/m2, respectively, p = 0.45). Vacuum extraction and forceps applications were indicated in 10% of all GDM groups. Fetuses born to women having cesarean section were heavier at birth compared to those of women having vaginal births (3940 +/- 320 g vs 430 +/- 117 g, p = 0.08) Most frequent neonatal morbidity was hyperbilirubinemia in 25 (35.7%) newborns. Interestingly, of those women with GDM, only ten (14.3%) cases consented to follow-up evaluation of glucose intolerance between six and eight weeks postpartum. CONCLUSIONS: Proposed risks from abnormal glucose intolerance in pregnancy are multiple. Early diagnosis, patient education, proper follow-up and postpartum testing in women with GDM will certainly decrease poor perinatal outcomes, enabling also a secondary prevention of type 2 diabetes in the long term.     

GDM孕中、晚期及子代胰岛素抵抗与正常妊娠的对照研究

目的探讨妊娠期糖尿病(GMD)与正常妊娠孕中、晚期及子代胰岛素抵抗、胰岛β细胞功能及胎儿脐血流的差异。方法选择上海交通大学医学院附属国际和平妇幼保健院产检、分娩的70例GDM产妇及其子代为GDM组,同期产检、分娩的70例健康母子配对样本为对照组。两组孕妇孕24~28周OGTT筛查时行胰岛素释放试验、孕33~34周、孕37~38周检测空腹血糖、胰岛素及C肽;比较两组稳态模型评估的胰岛素抵抗指数(HOMA-IR);B超测定孕晚期胎儿脐血流;分娩时检测脐血血糖、胰岛素及C肽值并获取胎儿出生体重、胎龄等资料;比较两组母子配对样本间各项指标的差异。结果 GDM组OGTT时胰岛素峰值较对照组延迟1h;GDM组孕33~34周母血空腹胰岛素、C肽高于对照组,差异有统计学意义(P<0.05);孕37~38周母血空腹胰岛素、C肽虽仍高于对照组,但差异无统计学意义(P>0.05);GDM组孕中、晚期HOMA-IR高于对照组,差异有统计学意义(P<0.05);GDM组新生儿脐血胰岛素、C肽高于对照组,差异有统计学意义(P<0.05);两组间孕晚期胎儿脐动脉S/D值、搏动指数(PI)、阻力指数(RI)比较差异无统计学意义(P>0.05)。结论 GDM患者孕中、晚期胰岛素抵抗较正常孕妇增加,并出现胰岛β细胞功能下降,其胎儿在宫内已发生糖代谢异常,但脐血流未受到显著影响。