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目的:分析妊娠期糖尿病(gestational diabetes mellitus,GDM)合并巨大儿的临床资料,探讨降低GDM合并巨大儿发生率的有效方法。方法:选取南京医科大学附属妇产医院2015年7月—2016年6月收治的GDM患者,根据其分娩新生儿出生体重分为研究组(新生儿出生体重≥4 000 g)和对照组(2 500 g≤新生儿出生体重<4 000 g),回顾性分析两组患者临床资料,探讨GDM合并巨大儿的发生原因及临床结局。结果:研究组患者基础体重指数(body mass index,BMI)、GDM诊断孕周、75 g糖耐量试验(oral glucose tolerance test,OGTT)结果与对照组无差异;研究组孕期空腹血糖(fasting plasma glucose,FPG)水平、孕晚期糖化血红蛋白(hemoglobin A1c,HbA1c)、血甘油三酯(triglyceride,TG)水平均高于对照组,差异有统计学意义(P<0.05)。研究组分娩孕周延迟、新生儿体重显著大于对照组,剖宫产率增加,产后出血、产褥感染的发生率均高于对照组,差异均具有统计学意义。结论:加强对GDM患者的管理,促进其糖、脂代谢正常,可降低巨大儿的发生率、减少不良妊娠结局发生。
OBJECTIVE: To analyze the clinical data of gestational diabetes mellitus (GDM) complicated with giant children, and to explore an effective way to reduce the incidence of GDM complicated with giant children. Methods: GDM patients admitted to the Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University from July 2015 to June 2016 were divided into study group (birth weight ≥ 4000 g) and control group (2) according to their birth weight 500 g ≤ neonatal birth weight <4 000 g), the clinical data of two groups were retrospectively analyzed to explore the causes and clinical outcomes of GDM combined with giant children. Results: The body mass index (BMI), gestational age at diagnosis of GDM and oral glucose tolerance test (OGTT) in study group were similar to those in control group. The fasting plasma glucose , FPG), the level of hemoglobin A1c (HbA1c) and triglyceride (TG) in the third trimester of pregnancy were significantly higher than those in the control group (P <0.05). The gestational age of the study group was delayed, the weight of the newborn was significantly greater than that of the control group, the rate of cesarean section increased, the incidence of postpartum hemorrhage and puerperal infection were higher than the control group, the differences were statistically significant. Conclusion: To strengthen the management of GDM patients to promote their normal glucose and lipid metabolism, can reduce the incidence of giant children, reduce the incidence of adverse pregnancy outcomes.