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目的探讨不同孕期终止妊娠对妊娠期糖尿病(GDM)围生儿结局的影响。方法采用回顾性分析方法对2001年3月至2004年3月在中国医科大学附属第二医院确诊、住院分娩资料完整的GDM患者共191例的资料进行分析。结果GDM发生率为2.91%。母体并发症以妊娠期高血压疾病(48例,25.13%)为主。有23例(12.04%)未经治疗即终止妊娠,经过孕期单纯饮食控制或饮食控制加胰岛素治疗168例,其中血糖控制满意者78例(40.84%),血糖控制不满意者90例(47.12%)。剖宫产137例(71.73%),阴道自然分娩37例(19.37%),产钳助产11例(5.76%),穿颅术6例(3.14%)。血糖控制满意组中围生儿的患病率、死亡率和巨大儿的发生率均明显低于血糖控制不满意组及未经治疗组(P<0.01)。从孕36周开始即有巨大儿的发生,孕37～39周末终止妊娠除巨大儿外,新生儿并发症相对减少。结论控制血糖使血糖维持在正常水平是GDM治疗的关键,是降低母体并发症和减少围生儿患病率和死亡率的主要因素。孕37～39周是终止妊娠的适宜时机,但应注意有发生巨大儿的可能。
Objective To investigate the effect of different gestational pregnancies on perinatal outcome in gestational diabetes mellitus (GDM). Methods A retrospective analysis method was used to analyze the data of 191 patients with GDM diagnosed at the Second Affiliated Hospital of China Medical University from March 2001 to March 2004 and with complete hospitalization and delivery data. Results The incidence of GDM was 2.91%. Maternal complications in hypertensive disorders of pregnancy (48 cases, 25.13%) based. Twenty-three patients (12.04%) terminated pregnancy without treatment. After pregnancy, diet control or dietary control plus insulin therapy were given in 168 cases, of which 78 (40.84%) were satisfied with blood glucose control and 90 (47.12% ). Cesarean section was performed in 137 cases (71.73%), vaginal delivery in 37 cases (19.37%), forceps delivery in 11 cases (5.76%) and craniotomy in 6 cases (3.14%). The prevalence of perinatal morbidity, mortality and macrosomia in the group with satisfactory glycemic control were significantly lower than those in the group not treated with glycemic control and the untreated group (P <0.01). 36 weeks from the beginning of pregnancy that there is a huge child occurred, the end of pregnancy 37 to 39 weeks of pregnancy except the giant child, the relative reduction in neonatal complications. Conclusion Control of blood glucose to maintain normal blood glucose levels is the key to the treatment of GDM. It is a major factor in reducing maternal complications and reducing the prevalence and mortality of perinatal children. 37 to 39 weeks of pregnancy is the appropriate time to terminate the pregnancy, but should pay attention to the possibility of a huge child.