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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。
Objective To investigate the clinical management of pregnant women with type 1 diabetes mellitus (T1DM) and their pregnancy outcomes. Methods The clinical data of 16 patients with type 1 diabetes mellitus complicated with pregnancy delivered during obstetrics of the First Affiliated Hospital of Nanjing Medical University during 6 years (2009-12-01-2015-11-30) were retrospectively analyzed. Results Clinical features: The first-degree relatives had a family history of diabetes of 40.0%, duration of 4.5 (2-4 years), 25% (4/16) of duration of disease> 10 years and complications of diabetes (31.3%, 5/16) 43.8% (7/16) of Hb A1c> 6.0%, 62.5% (10/16) of fasting plasma glucose and 68.8% (11/16) of postprandial glycemia did not meet the overall criteria for insulin therapy. In the first affiliated hospital of Nanjing Medical University during pregnancy card 8 cases, 4 cases of building a hospital, no card not produced in 4 cases. Adverse pregnancy outcomes: preeclampsia, preterm birth was 31.3% (5/16); 1 case of diabetic ketoacidosis. 93.8% (15/16) using cesarean delivery, the first indications for cesarean section: preeclampsia. 18.8% (3/16) were macrosomia, neonatal asphyxia and fetal growth restriction (FGR) were 12.5% (2/16), neonatal hypoglycemia 43.8% (7/16), 37.5% (6/16 ) Hyperbilirubinemia, 12.5% (2/16) deformities. 37.5% (6/16) were transferred to neonatal intensive care unit. Conclusions The planned pregnancy, intensive pregnancy test, intensive blood glucose monitoring and glycemic control could be helpful to improve the prognosis of pregnant women with T1DM complicated with pregnancy.