不同孕期终止妊娠对妊娠期糖尿病围生儿结局的影响

目的探讨不同孕期终止妊娠对妊娠期糖尿病(GDM)围生儿结局的影响。方法采用回顾性分析方法对2001年3月至2004年3月在中国医科大学附属第二医院确诊、住院分娩资料完整的GDM患者共191例的资料进行分析。结果GDM发生率为2.91%。母体并发症以妊娠期高血压疾病(48例,25.13%)为主。有23例(12.04%)未经治疗即终止妊娠,经过孕期单纯饮食控制或饮食控制加胰岛素治疗168例,其中血糖控制满意者78例(40.84%),血糖控制不满意者90例(47.12%)。剖宫产137例(71.73%),阴道自然分娩37例(19.37%),产钳助产11例(5.76%),穿颅术6例(3.14%)。血糖控制满意组中围生儿的患病率、死亡率和巨大儿的发生率均明显低于血糖控制不满意组及未经治疗组(P<0.01)。从孕36周开始即有巨大儿的发生,孕37～39周末终止妊娠除巨大儿外,新生儿并发症相对减少。结论控制血糖使血糖维持在正常水平是GDM治疗的关键,是降低母体并发症和减少围生儿患病率和死亡率的主要因素。孕37～39周是终止妊娠的适宜时机,但应注意有发生巨大儿的可能。

Impact of termination of pregnancy in different periods on the outcomes of GDM fetus

Objective To discuss the impact of termination of pregnancy in different periods on the outc omes of GDM fetus. Methods 191 patients with GDM diagnosed and delivered in the 2n d Affiliated Hospital of China Medical University, between March,2001 and March,2004 were analyzed retrospectively. Results The incidence of GDM was 2.91%. Pregnancy-induced hypertension syndrome was the most common maternal complications(48 cases,25.1 3%).23 cases(12.04%) had their pregnancy terminated without therapy,168 cases w ith only diet control or di et control plus insulin therapy.Among them,78(40.84%) showed blood sugar satisfied,while the other 90(47.12%) didn't.There were 137 cases( 71.73%) with CS,37(19.37%) with vaginal spontaneous labor,11(5.76%) with obst etrical forceps and 6 with countersinking skull.The morbidity and mortality of the fetus and the incidence of fetal macrosomia in satisfied blood suga r control group were significantly lower than those in unsatisfied and non-therapy group. Conclusion Controlling blood sugar in normal levels is the key to treating GDM,which is also important for decreasing maternal complications,and th e mo rtality and morbidity of fetus.Appropriate time for termination of pregnancy should be between 37 and 39 gestabvonal weeks,but be aware of the incidence of fetal macrosomia.