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目的:探讨IADPSG标准诊断妊娠期糖尿病(GDM)的妊娠结局。方法:2011年12月~2012年8月采用IADPSG诊断标准诊断为GDM孕妇共410例,其中符合教科书(乐杰主编的第7版《妇产科学》)诊断标准共122例为教课书组,不符合教科书诊断标准共288例为新诊断组,选取2011年2月~2011年11月因采用教科书诊断标准漏诊GDM孕妇126例为漏诊组,比较3组孕妇妊娠结局。结果:2011年12~2012年8月按照教科书诊断标准,GDM发生率为4.78%(122/2 555),按照IADPSG诊断标准GDM的发生率为16.04%(410/2 555),两组发病率比较有统计学差异(P<0.05)。教科书组孕妇羊水过多、巨大儿发生率分别为3.28%(4/122)、22.95%(28/122),均高于新诊断组(P<0.05)。漏诊组孕妇胎膜早破、巨大儿、羊水过少、妊娠期高血压疾病、胎儿窘迫发生率分别为20.63%(26/126)、19.05%(24/126)、22.22%(28/126)、30.16%(38/126)、28.57%(36/126)均高于新诊断组(P<0.05)。教科书组和漏诊组中潜伏期延长、胎儿窘迫、羊水过少、巨大儿、头盆不称为手术指征发生率均高于新诊断组(P<0.05),手术指征中社会因素比率和剖宫产率3组比较无统计学差异(P>0.05)。结论:采用IADPSG标准,更多的GDM孕妇被诊断,通过对其膳食及生活方式的干预和对其病情轻重程度进行有效的分层管理,以期待降低剖宫产率,改善母婴预后。
Objective: To investigate the pregnancy outcome of gestational diabetes mellitus (GDM) by IADPSG standard. Methods: From December 2011 to August 2012, 410 pregnant women diagnosed as GDM by IADPSG diagnostic criteria were enrolled. Among them, 122 diagnostic criteria of textbook (obstetrics and gynecology, 7th edition) , A total of 288 cases that did not meet the diagnostic criteria of textbooks were newly diagnosed. Totally 126 cases of GDM pregnant women missed diagnosis by textbook diagnostic criteria were selected as missed diagnosis group from February 2011 to November 2011. Pregnancy outcomes were compared among the three groups. Results: According to the textbook diagnostic criteria, the incidence of GDM was 4.78% (122/2 555) between December 2011 and August 2012. The incidence of GDM was 16.04% (410/2 555) according to the diagnostic criteria of IADPSG. The incidence of GDM There was a statistically significant difference (P <0.05). In the textbook group, there were too many amniotic fluid, the incidence of macrosomia was 3.28% (4/122) and 22.95% (28/122) respectively, both of which were higher than that of the newly diagnosed group (P <0.05). Premature rupture of membranes, macrosomia, oligohydramnios, gestational hypertension and fetal distress in the missed diagnosis group were respectively 20.63% (26/126), 19.05% (24/126) and 22.22% (28/126) , 30.16% (38/126), 28.57% (36/126) were higher than the new diagnosis group (P <0.05). The incidence of surgical indications in the textbook group and the missed diagnosis group was longer than that in the newly diagnosed group (P <0.05), the latent period of fetal distress, oligohydramnios, macrosomia, There was no significant difference in uterine output between the three groups (P> 0.05). Conclusion: According to the IADPSG standard, more pregnant women with GDM are diagnosed. Through the intervention of their diet and lifestyle and the effective stratification of the severity of their illness, it is hoped to reduce the rate of cesarean section and improve their prognosis.