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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。
Objective To understand the diagnosis and treatment of diabetes mellitus (DM) complicated with pregnancy and to provide strategies for improving the pregnancy outcome in DM patients. Methods The data of patients with DM combined with prenatal care and delivery during pregnancy and childbirth in the First Hospital of Peking University from January 2000 to December 2009 were retrospectively analyzed. According to the data from the International Diabetes and Pregnancy Study Group (IADPSG) Diagnostic criteria for reclassification, in line with DM combined with pregnancy criteria were 266 cases, of which 117 cases of pre-pregnancy diagnosis (pre-pregnancy diagnosis group), 149 cases of pregnancy diagnosis (pregnancy diagnosis group), the diagnosis and treatment of the two groups were analyzed. Results The prevalence of DM complicated with pregnancy rose from 0.8% in 2000 to 1.16% in 2009. Only 41.9% (49/117) of pre-pregnancy diagnoses received pre-pregnancy counseling and had blood glucose management prior to pregnancy. 38.9% (58/149) of the pregnant women in the diagnostic group had a high risk of DM, and only 26.8% (40/149) were diagnosed 24 weeks before gestation. The incidence of pregnancy complications (including preeclampsia, premature birth, diabetic ketosis and macrosomia) in the two groups showed no significant difference (all P> 0.05). There were 15 cases of intrauterine fetal death (5.6%), 5.1% (6/117) in preconception diagnosis group and 6.0% (9/149) in pregnancy diagnosis group, with no significant difference (P = 0.958 ). There were 23 cases (8.6%) of congenital malformations, 13 cases (11.1%) in preconception diagnosis group and 10 cases (6.7%) in pregnancy diagnosis group. There was no significant difference between the two groups (P> 0.05). Neonatal death in 3 cases, all accompanied by severe congenital malformations, no significant difference between the two groups (P> 0.05). Conclusion For women with high risk but not diagnosed before pregnancy, DM should be examined during the first prenatal care to diagnose and control hyperglycemia in time to minimize the impact of DM on the mother and child.