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目的:比较两种不同的妊娠期糖尿病(gestational diabetes mellitus,GDM)诊断标准对GDM检出率和围产期母婴结局的影响。方法:选择在南京市妇幼保健院进行糖筛查及分娩的孕产妇为研究对象,将其分为两组。分别按照我国第7版《妇产科学》GDM诊断标准及国际糖尿病与妊娠研究组(International Association of Diabetes and Pregnancy Study Groups,IADPSG)制定的GDM诊断标准进行诊断,比较两组孕妇GDM检出率、分娩方式、常见妊娠期并发症及新生儿并发症发生率的差异。结果:IADPSG诊断标准组GDM检出率明显高于《妇产科学》诊断标准组(P<0.05);IADPSG诊断标准组有指征剖宫产率显著低于《妇产科学》诊断标准组(P<0.05);IADPSG诊断标准组羊水过多、胎膜早破等并发症的发病率显著低于《妇产科学》诊断标准组(P<0.05),而妊娠期高血压疾病、糖尿病酮症酸中毒、胎儿窘迫及产后出血发生率两组无显著差异(P>0.05);IADPSG诊断标准组新生儿发生巨大儿、新生儿低血糖、新生儿呼吸窘迫综合征等并发症的发病率显著低于《妇产科学》诊断标准组(P<0.05),而早产、低体重儿、新生儿窒息、新生儿黄疸、新生儿高胆红素血症、新生儿发育畸形等发生率两组无显著差异(P>0.05)。结论:应用IADPSG标准可以有效提高GDM检出率,显著降低羊水过多、胎膜早破、巨大儿等妊娠并发症的产生,从而降低剖宫产率,并显著降低了新生儿低血糖、新生儿呼吸窘迫综合等风险的发生,改善母婴结局。
Objective: To compare the effects of two different diagnostic criteria of gestational diabetes mellitus (GDM) on the detection rate of GDM and perinatal maternal and infant outcomes. Methods: Maternal and Child Health Care Hospital of Nanjing MCH screening and delivery of maternal as the research object, divided into two groups. The diagnosis of GDM was made according to the diagnostic criteria of GDM of the 7th edition of Obstetrics and Gynecology and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) respectively. The detection rate of GDM in both groups was compared, Mode of delivery, common gestational complications and neonatal complications. Results: The detection rate of GDM in IADPSG diagnosis group was significantly higher than that in Obstetrics and Gynecology diagnosis group (P <0.05). The rate of cesarean section in IADPSG diagnosis group was significantly lower than that in Obstetrics and Gynecology diagnosis group P <0.05). The incidence of complications such as polyhydramnios and premature rupture of membranes in IADPSG diagnostic criteria group was significantly lower than that of the obstetrics and gynecology diagnostic criteria (P <0.05), while gestational hypertension, diabetic ketosis Acidosis, fetal distress and the incidence of postpartum hemorrhage were no significant difference between the two groups (P> 0.05); IADPSG diagnostic criteria group neonatal hypertensive children, neonatal hypoglycemia, neonatal respiratory distress syndrome and other complications was significantly lower In the obstetrics and gynecology diagnostic criteria group (P <0.05), while the incidence of preterm birth, low birth weight children, neonatal asphyxia, neonatal jaundice, neonatal hyperbilirubinemia, neonatal malformations in both groups was not significant Difference (P> 0.05). Conclusion: The application of IADPSG standard can effectively increase the detection rate of GDM and significantly reduce the incidence of pregnancy complications such as polyhydramnios, premature rupture of membranes, macrosomia and so on, thus reducing the rate of cesarean section and significantly reducing neonatal hypoglycemia, neonatal Children’s respiratory distress syndrome and other risks, improve maternal and child outcomes.