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目的分析妊娠晚期因超声检查异常行75g葡萄糖耐量试验(OGTT)的结果及影响妊娠期糖尿病(GDM)诊断的因素。方法选择2010年9月至2011年1月间北京大学人民医院产科门诊,妊娠中期常规GDM筛查和诊断试验阴性,晚期因超声提示羊水过多和(或)胎儿大再次行75gOGTT的孕妇116例为研究对象,分为GDM组和非GDM组,对可能影响GDM诊断的因素进行统计学分析。结果诊断GDM19例(16.4%)。单因素分析提示年龄>30岁及常规筛查或诊断试验孕周<24周的孕妇GDM诊断阳性率高于年龄≤30岁和常规筛查或诊断试验孕周≥24周的孕妇(P<0.05)。多因素分析提示相对于年龄≤30岁的孕妇,>30岁的孕妇患GDM的OR>30(P<0.05);相对于超声检查时体质指数(BMI)较孕前增幅<4的孕妇,增幅>6的孕妇患GDM的OR=0.08(P<0.05),但增幅>6的孕妇超声检查孕周晚于增幅<4的孕妇(P<0.01)。结论对于妊娠中期常规筛查或诊断试验阴性的孕妇来说,妊娠晚期超声检查提示羊水过多和(或)胎儿大时,年龄>30岁的孕妇患GDM的可能性增加,超声检查时BMI较孕前增幅>6的孕妇可能性减少,但须考虑孕周的影响。
Objective To analyze the result of abnormal glucose tolerance test (OGTT) of 75g due to sonography in late pregnancy and the factors affecting the diagnosis of gestational diabetes mellitus (GDM). METHODS: From September 2010 to January 2011, Peking University People’s Hospital obstetrics and gynecology clinics, the second trimester GDM screening and diagnostic tests were negative in the second trimester of pregnancy, 116 cases of pregnant women with ultra amniotic fluid hyperintense and / or fetus again 75gOGTT As the research object, divide into GDM group and non-GDM group, and make statistical analysis on the factors which may influence the diagnosis of GDM. Results GDM was diagnosed in 19 cases (16.4%). Univariate analysis showed that the positive rate of GDM in diagnosis of pregnant women aged> 30 years and gestational weeks <24 weeks in routine screening or diagnostic tests was higher than that of pregnant women ≤30 years of age and gestational weeks ≥24 weeks in routine screening or diagnostic tests (P <0.05 ). Multivariate analysis showed that the GDM OR of 30-year-old pregnant women was> 30 (P <0.05) compared with that of pregnant women ≤30 years of age. Compared with the BMI of pregnant women> 4 before pregnancy, the increase> 6 pregnant women with GDM OR = 0.08 (P <0.05), but the pregnant women with an increase of> 6 had gestational weeks later than the pregnant women with gestational weeks <4 (P <0.01). Conclusions For pregnant women of the second trimester screening or diagnostic tests are negative, ultrasound examination in late pregnancy suggests an increased likelihood of GDM in pregnant women> 30 years of age with polyhydramnios and / or fetuses, and a higher BMI at ultrasound Pre-pregnancy increase in the probability of less than 6 pregnant women, but to consider the impact of gestational age.