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目的探讨不同孕周使用胰岛素对妊娠合并糖尿病孕妇的母婴结局及安全性。方法选择妊娠合并糖尿病(均为GDM)且在本院分娩的孕产妇186例。以孕周<32周时开始应用胰岛素治疗的孕产妇90例为早期组,孕周≥32周时开始应用胰岛素治疗的孕产妇96例为晚期组,两组孕产妇在胰岛素治疗的基础上进行适量运动及饮食控制。对比分析两组孕产妇血糖变化及妊娠结局。结果分娩时,早期组空腹血糖(FPG)及餐后2 h血糖(2h PBG)值明显低于晚期组,差异有统计学意义(P<0.05);两组剖宫产发生率差异无统计学意义(P>0.05);早期组产后出血及感染、妊娠高血压、新生儿低血糖、高胆红素血症、新生儿窒息、巨大儿发生率均明显低于晚期组,差异有统计学意义(P<0.05);早期组新生儿1分钟Apgar评分明显高于晚期组,差异有统计学意义(P<0.05);早期组发生低血糖3例,不良反应发生率为33.33%,晚期组发生低血糖4例,不良反应发生率为41.67%,两组比较,差异无统计学意义(P>0.05)。结论 GDM患者及时发现并及早给予胰岛素治疗可以有效控制孕产妇血糖水平,也可以改善母婴不良结局,有较高的安全性。
Objective To explore the maternal and infant outcomes and safety of different gestational weeks using insulin in pregnant women with gestational diabetes mellitus. Methods 186 cases of pregnant women with gestational diabetes mellitus (both GDM) were delivered in our hospital. Ninety-nine pregnant women who started insulin treatment at gestational weeks <32 weeks were in the early group. Ninety-three pregnant women who started insulin treatment at the gestational age> 32 weeks were in the advanced group. The two groups of pregnant women were treated on the basis of insulin therapy Moderate exercise and diet control. Comparative analysis of two groups of pregnant women, blood sugar changes and pregnancy outcomes. Results During delivery, fasting blood glucose (FPG) and postprandial 2h blood glucose (2h PBG) values in the early group were significantly lower than those in the late group (P <0.05). There was no significant difference in the incidence of cesarean section between the two groups (P> 0.05). The incidence of postpartum hemorrhage and infection, pregnancy-induced hypertension, neonatal hypoglycemia, hyperbilirubinemia, neonatal asphyxia and macrosomia in early group were significantly lower than those in advanced group, the difference was statistically significant (P <0.05). Apgar scores of neonates in early stage were significantly higher than those in advanced stage at 1 minute (P <0.05). There were 3 cases of hypoglycemia in early stage and the incidence of adverse reactions was 33.33% 4 cases of hypoglycemia, the incidence of adverse reactions was 41.67%, no significant difference between the two groups (P> 0.05). Conclusion GDM patients timely detection and insulin treatment can effectively control the blood sugar levels of pregnant women, maternal and child can also improve the adverse outcomes, with higher safety.