糖尿病与妊娠

　　【摘要】目的 本研究通过对孕妇糖耐量试验结果与妊娠结局关系的回顾分析，比较WHO及 IADPSG标准对妊娠期糖尿病(GDM)诊断的异同，并对不同诊断标准下妊娠不良结局进行比较。方法 回顾性分析2000年6月至2010年12月在解放军第306医院妇产科行孕检的初产单活胎产妇8943例，孕24~32周行75 g OGTT。比较2种诊断标准下GDM患病率及妊娠不良结局，探讨其对不良妊娠结局风险评估的价值。 结果 本研究分为NGT组、符合WHO诊断标准组(W)、符合IAPDSG诊断标准组(I)、符合WHO而不符合IAPDSG组(W-I)及符合IAPDSG而不符合WHO组(I-W)。同时符合2种诊断标准618例;符合2011年IADPSG诊断标准835例(9.3%);符合WHO诊断标准1039例(11.6%)。其中217例(17.2%)仅符合IADPSG诊断标准;421例(33.5%)仅符合WHO诊断标准。与NGT组相比，其余各组的孕妇年龄更大(P<0.05)，剖宫产率、巨大儿、低体重儿、新生儿窒息均升高(P <0.05)。结论 WHO诊断标准GDM发病率更高，但会漏诊17.2%符合IADPSG标准的患者;IADPSG则会漏诊33.5%2 h血糖异常的GDM患者。无论符合WHO还是IADPSG诊断标准的GDM患者，剖腹产及巨大儿发生率均高于NGT者。

　　【关键词】 妊娠期糖尿病;WHO诊断标准;IADPSG诊断标准;不良妊娠结局

　　[Abstract] Objetive To retrospectively analyze the relationship between the results of OGTT (oral glucose tolerance test) and pregnancy outcomes, and to compare the similarities and differences between the WHO (World Health Organization) criteria and IADPSG (The International Association of Diabetes and Pregnancy Study Groups) criteria for GDM (gestational diabetes mellitus), and to study the adverse pregnancy outcomes in the two kinds of different criteria. Methods Retrospective analysis on 8943 primiparity singleton pregnant women who undertook a 75-g OGTT test between 24 to 32 gestational weeks in Department of Obstetrics and Gynecology, The 306th hospital of Chinese PLA during the years from 2000 to 2010. To compare the morbidity and adverse pregnancy outcomes in the two kinds of diagnostic criteria. To study the reliability of the assessment on the risk of adverse pregnancy outcomes. Result The samples of this study are categorized into three groups, namely, NGT group (cases showing normal glucose tolerance), W group (cases conform to the WHO criteria), I group (cases conform to the IADPSG criteria). In particular, cases that are in the W group but not conform to the IADPSG criteria are subdivided as the W-I group, and similarly, cases that are in the I group but not conform to the WHO criteria are subdivided as the I-W group. No significant differences in gestational weeks on OGTT were shown among all groups. Of all 8943 women tested, 1039 cases are in the W group, accounting for 11.6%; 835 cases are in the I group (9.3%). Of all 1256 GDM cases (cases in either W or I group), 618 cases conform to both criteria (49.2%); 421 cases are in the W-I group (33.5%); 217 cases are in I-W group (17.2%). Compared with those in the NGT group, the ages of women are older in the other groups, and the percentages of cesarean section, macrosomia, low-birth-weight infants and neonatal asphyxia are significantly higher (P < 0.05). Conclusion The cases in W group have a higher morbidity than those in the I group, however, the WHO criteria could misdiagnose 17.2% of GDM cases, which are conform only to the IADPSG criteria. The IADPSG could misdiagnose 33.5%. For cases that are conform to either kind of criteria, the percentages of cesarean section and macrosomia are significantly higher than in NGT group.

　　[Key words] GDMGestational Diabetes Mullitus ; WHO diagnostic criteria; IADPSG diagnostic criteria; adverse pregnancy outcomes.