【摘要】 目的了解糖尿病(DM)合并妊娠的诊治现状,为改善DM患者妊娠结局提供策略。方法回顾性分析2000年1月至2009年12月在北京大学第一医院产前保健并分娩的DM合并妊娠患者的病例资料,按国际糖尿病与妊娠研究组(IADPSG)2010年提出的DM合并妊娠诊断标准进行重新分类,符合DM合并妊娠标准者共266例,其中,妊娠前诊断117例(孕前诊断组),妊娠期诊断149例(孕期诊断组),对两组的诊治情况进行分析。结果 DM合并妊娠患病率从2000年的0.8%上升至2009年的1.16%。孕前诊断组患者中仅41.9%(49/117)得到了孕前咨询,并在孕前进行了血糖管理。孕期诊断组患者中38.9%(58/149)具有DM的高危因素,仅26.8%(40/149)在妊娠24周前诊断。两组妊娠合并症(包括子痫前期、早产、糖尿病酮症及巨大胎儿)发生率比较,差异无统计学意义(P均>0.05)。15例发生胎死宫内(5.6%),孕前诊断组胎死宫内发生率5.1%(6/117),与孕期诊断组6.0%(9/149)比较差异无统计学意义(P=0.958)。先天畸形23例(8.6%),孕前诊断组13例(11.1%),孕期诊断组10例(6.7%),两组比较差异无统计学意义(P>0.05)。新生儿死亡3例,全部伴有严重的先天畸形,两组比较差异无统计学意义(P>0.05)。结论对于有高危因素而孕前未被诊断的女性,在初次产前保健时应进行DM的检查,及时诊断和控制高血糖,尽量降低DM对母儿的影响。更多还原

【Abstract】 Objective To study the current diagnostic and therapeutic situation of pregnancy complicated with diabetes mellitus( DM),in order to provide evidence to develop strategies for improving the pregnant outcome. Methods Medical records of 266 pregnant women diagnosed with DM in Peking University First Hospital between January 2000 and December 2009 were collected. Among the 266 pregnant women,117 DM were diagnosed before pregnancy named pre-gestational group,and 149 DM were diagnosed during pregnancy named gestational group. Maternal and fetal outcomes were retrospectively analyzed. Results The prevalence of DM complicated with pregnancy rised annually,from 0. 8% in 2000to 1. 16% in 2009. In pre-gestational group,only 41. 9%( 49 /117) patients had pre-conception care and glycaemic control before conception. In gestational group,there are 38. 9%( 58 /149) patients with high risk factor for DM,and 26. 8%( 40/149) women were diagnosed before 24 weeks. The incidence of preeclampsia,premature labor,ketosis and macrosomia in the two groups were all similar,( P > 0. 05). Among the 266 DM women,totally,15( 5. 6%) had fetal loss due to fetal death. The prevalence of fetal death in the pre-gestational group was 5. 1%( 6 /117),which was similar to those in the pregnancy group( 6. 0%,9 /149)( P = 0. 958). There were 23 cases with congenital malformations( 8. 6%,23 /266),including 13 in the pre-gestational group( 11. 1%),10 in the gestational group( 6. 7%). No significant difference was found between the two groups. 3 cases with neonatal deaths were all with severe congenital malformations,no significant difference was between the two groups( P = 1. 000). Conclusion Pregnant women complicated with DM increased annually,and much more poor obstetric outcome were observed,standardized management of these patients is necessary and important. The preconception care is necessary for each reproductive age women with DM. The screen for type 2 diabetes in those with risk factors during pregnancy should be done as early as possible.更多还原