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目的:对3种妊娠期糖尿病(GDM)的诊断标准及结局进行比较,并予以临床评价。方法:对21023例孕妇进行50g葡萄糖筛查试验,阳性者进行75g葡萄糖耐量试验(OGTT)。按Meltzer资料组、美国糖尿病学会(ADA)和国内董志光等的标准对孕妇进行GDM诊断分组,分析3组母儿的妊娠结局。结果:OGTT试验达到国内董志光标准、ADA、Meltzer资料组分别为3.6%(754/21023)、4.4%(934/21023)、5.1%(1078/21023)。各GDM组间在子痫前期、产后出血、剖宫产率、巨大儿、新生儿病率的发生率方面均存在统计学意义(根据比值比和95%CI)。结论:3种诊断标准围产期结局有显著性差异,GDM的诊断有必要遵循诊断从宽、管理从严,以改善母婴预后。本文推荐的GDM诊断采用ADA标准,可降低巨大儿、子痫前期、产后出血的发生率,降低剖宫产率。
OBJECTIVE: To compare the diagnostic criteria and outcomes of three gestational diabetes mellitus (GDM) and to evaluate their clinical outcome. Methods: A total of 21023 pregnant women underwent 50g glucose screening test. The positive patients were given 75g glucose tolerance test (OGTT). According to Meltzer data group, the American Diabetes Association (ADA) and the domestic Dong Zhiguang and other standards of GDM diagnosis of pregnant women were grouped to analyze the pregnancy outcome of 3 groups of maternal and child. Results: The OGTT test reached the standard of Dong Zhiguang in China. The ADA and Meltzer data sets were 3.6% (754/21023), 4.4% (934/21023) and 5.1% (1078/21023), respectively. There was a statistically significant (based on odds ratio and 95% CI) incidence of preeclampsia, postpartum hemorrhage, cesarean section, macrosomia, neonatal morbidity between GDM groups. Conclusion: There are significant differences in perinatal outcome among the three diagnostic criteria. The diagnosis of GDM is necessary to follow the wide diagnosis and strict management to improve the prognosis of maternal and infant. The proposed diagnosis of GDM using ADA standards, can reduce the huge children, preeclampsia, postpartum hemorrhage incidence, reduce the rate of cesarean section.