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近年来,我国妊娠合并糖尿病发生率逐年增加,通过及时孕期诊断和积极控制孕妇血糖,母、儿结局有了明显改善。由于国内外妊娠期糖尿病(GDM)、妊娠期糖耐量受损(GIGT)的诊断标准尚不统一,我国尚缺乏妊娠合并糖尿病的治疗规范,所以,临床管理相对比较混乱,以至于此病仍是导致围产儿病率甚至围产儿死亡率升高的主要原因之一。对此,中华医学会妇产科学分会产科学组以及中华医学会围产医学分会妊娠合并糖尿病协作组起草了妊娠合并糖尿病临床诊治推荐指南,供临床医师参考。现推荐指南中有关妊娠合并糖尿病的筛查、诊断标准是基于美国的标准制定的,目前缺乏基于循证医学的适合我国的诊断标准,将来随着国内外新的研究结果问世,将会不断进行该推荐指南的修改。另外,自2000年美国基于前瞻性、随机对照研究(RCT)结果已经显示,第二代璜脲类口服降糖药,用于妊娠中、晚期糖尿病的治疗安全、有效,随后国外许多医疗中心已将该药用于临床。同时,欧洲围产医学会在2006年制定的妊娠合并糖尿病的诊治规范中,也将该药列为孕期治疗方案中,由于国内缺乏该药用于妊娠期的经验,故暂未列入该临床推荐指南(草案)中。
In recent years, the incidence of diabetes mellitus in pregnancy increased year by year in China. Through timely diagnosis and positive control of blood glucose in pregnant women, the outcomes of both mother and child have been significantly improved. Due to the prevalence of gestational diabetes mellitus (GDM) at home and abroad, gestational impaired glucose tolerance (GIGT) diagnostic criteria are not uniform, our country still lacks pregnancy treatment of diabetes mellitus, and therefore, clinical management is relatively chaotic, so that the disease is still Leading to one of the main causes of perinatal morbidity and even perinatal mortality. In this regard, the Chinese Medical Association Obstetrics and Gynecology Branch of the Department of Obstetrics and Gynecology and Chinese Medical Association of Perinatal Medicine Association of Pregnancy with diabetes drafting of the clinical diagnosis and treatment of diabetes mellitus recommended treatment guidelines for clinicians. Now refer to the guidelines for the screening of pregnancy associated with diabetes, diagnostic criteria are based on the United States standards, the current lack of evidence-based medicine for our diagnostic criteria, in the future with the advent of new research results at home and abroad, will continue Amendment of this recommendation guide. In addition, the results of a prospective, randomized, controlled study (RCT) in the United States in 2000 have shown that second-generation carbamazide oral hypoglycemic agents are safe and effective for the treatment of middle- and late-stage diabetes mellitus, followed by many medical centers in foreign countries The medicine for clinical use. At the same time, the European Association of Perinatal Medicine in 2006 established in the diagnosis and treatment of pregnancy with diabetes norms, but also the drug as pregnancy treatment programs, due to the lack of domestic medicine for pregnancy experience, it has not yet included in the clinical Recommended Guide (Draft).