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目的探讨孕期血糖管理对妊娠期糖尿病胎盘超微结构的影响,为优化孕期管理提供科学佐证。方法将2013年1月至2014年12月于南通市第一人民医院常规产检至分娩的妊娠期糖尿病孕妇,根据血糖控制情况分为血糖控制满意组及血糖控制不满意组;同期产检的正常孕妇为对照组。检测3组孕妇的血糖水平并采用透射电镜观察相应的胎盘超微结构。结果 (1)经整个孕期的管理及追踪,最终共有57例孕妇纳入研究。妊娠期糖尿病孕妇占56.14%(32/57),其中血糖控制满意组占35.09%(20/57),血糖控制不满意组占21.05%(12/57);对照组孕妇占43.86%(25/57)。(2)3组孕妇的年龄、口服葡萄糖耐量试验(OGTT)检查时孕周、分娩时孕周、血压及体质量指数差异均无统计学意义(P>0.05)。(3)经孕期血糖管理,3组孕妇的空腹血糖差异无统计学意义(P=0.099);血糖控制满意组与对照组的餐后2h血糖、夜间血糖及糖化血红蛋白差异均无统计学意义(P>0.05);血糖控制不满意组的餐后2h血糖、夜间血糖及糖化血红蛋白均高于血糖控制满意组及对照组,差异有统计学意义(P<0.01)。(4)血糖控制满意组与对照组的胎盘超微结构有改变者所占比例差异无统计学意义(P>0.05),血糖控制不满意组的胎盘超微结构有改变者所占比例与血糖控制满意组、对照组相比差异均有统计学意义(P<0.01)。结论高血糖是胎盘超微结构改变的危险因素,孕期需加强血糖管理,减少或避免妊娠期糖尿病孕妇胎盘超微结构的改变,减少不良妊娠结局的发生。
Objective To investigate the influence of glycemic control during pregnancy on placental ultrastructure of gestational diabetes mellitus, and provide scientific evidence for optimizing pregnancy management. Methods From January 2013 to December 2014, we randomly divided the pregnant women with gestational diabetes mellitus who were routinely given birth to delivery in Nantong First People’s Hospital from January 2013 to December 2014 and divided them into two groups: the control group with satisfactory blood glucose control and the group with unsatisfactory glycemic control according to their glycemic control status. For the control group. Blood glucose levels were measured in 3 groups of pregnant women and the corresponding ultrastructures of the placenta were observed by transmission electron microscopy. Results (1) Throughout the pregnancy management and tracking, a total of 57 pregnant women were finally included in the study. Pregnant women with gestational diabetes accounted for 56.14% (32/57), of which 35.09% (20/57) were satisfied with the control of blood glucose, 21.05% (12/57) were not satisfied with the control of blood glucose, and 43.86% 57). (2) There were no significant differences in the age, gestational age, gestational age at childbirth, blood pressure and body mass index during oral glucose tolerance test (OGTT) test in the three groups (P> 0.05). (3) There was no significant difference in fasting plasma glucose between the three groups during pregnancy (P = 0.099); there was no significant difference in postprandial blood glucose, nocturnal glucose and glycosylated hemoglobin between the two groups P> 0.05) .2h postprandial blood glucose, nocturnal blood glucose and glycosylated hemoglobin in the unsatisfied group were significantly higher than those in the control group and the control group (P <0.01). (4) There was no significant difference in the proportion of placental ultrastructure between the control group and the control group (P> 0.05). The proportion of those with changed placental ultrastructure in the control group with no glycemic control was positively correlated with the blood sugar There were significant differences between control satisfaction group and control group (P <0.01). Conclusion Hyperglycemia is a risk factor for the changes of placental ultrastructure. It is necessary to strengthen the management of blood glucose during pregnancy to reduce or avoid the change of placental ultrastructure in pregnant women with gestational diabetes mellitus and reduce the occurrence of adverse pregnancy outcomes.