【摘要】 目的探讨1型糖尿病(T1DM)合并妊娠孕妇的临床管理及母儿妊娠结局。方法回顾性分析南京医科大学第一附属医院产科6年期间(2009-12-01—2015-11-30)分娩的16例次1型糖尿病合并妊娠患者的临床资料。结果临床特征:一级亲属糖尿病家族史为40.0%,病程4.5(2~14)年,25%(4/16)病程>10年,出现糖尿病并发症31.3%(5/16),患者妊娠期全部使用胰岛素治疗,43.8%(7/16)糖化血红蛋白(Hb A1c)>6.0%,62.5%(10/16)空腹血糖和68.8%(11/16)餐后血糖不达标。孕期南京医科大学第一附属医院建卡8例,外院建卡4例,未建卡未产检4例。母儿不良妊娠结局:子痫前期、早产均为31.3%(5/16);1例糖尿病酮症酸中毒。93.8%(15/16)采用剖宫产术分娩,首次剖宫产手术指征第一位为:子痫前期。18.8%(3/16)为巨大儿,新生儿窒息和胎儿生长受限(FGR)均为12.5%(2/16),新生儿低血糖43.8%(7/16),37.5%(6/16)高胆红素血症,12.5%(2/16)畸形。37.5%(6/16)转入新生儿重症监护室治疗。结论计划妊娠、加强孕期检查、强化血糖监测及控制血糖达标等管理有利于改善T1DM合并妊娠的母儿预后。更多还原

【Abstract】 Objective To investigate the adverse fetal and maternal outcomes of pregnant women with type 1 diabetes mellitus(T1DM).Methods We performed a retrospective survey on 16 pregnancies in women with type 1 diabetes treated in the First Affiliated Hospital of Nanjing Medical University during 2009-12-01—2015-11-30.Results First degree relatives of diabetic family had 40.0% positive rate,The duration of diabetes was 4.5(2~14)years,4 of them(25%)were more than 10 years,and 5 cases(31.3%)had diabetic complications.Ten cases(62.5%)had positive protein urine before delivery;insulin treatment had been used in all cases.Adverse outcomes:the rate of hypertensive complications and preterm birth was 31.3%(5/16),respectively;there was one case of ketoacidosis.15/16 cases(93.8%)had delivery by cesarean section,and the first indication for the first-time operation was preeclampsia.The proportion of macrosomia was 18.8%(3/16),and 2 cases(12.5%)had neonatal asphyxia and fetal growth restriction,respectively.The rates of neonatal hypoglycemia and hyperbilirubinemia was 43.8%(7/16)and 37.5%(6/16),respectively.There were 2 cases of congenital malformations.The rate of admission to the neonatal intensive care unit was 37.5%(6 /16).Conclusion It’s helpful in improving maternal and fetal outcome in pregnant women with T1 DM to have planned pregnancy,strengthen examinations and blood sugar monitoring and to control it in the normal range.更多还原