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目的:探讨IADPSG标准多诊断出的轻型GDM孕妇是否进行规范化产科管理的相应妊娠结局及适宜产科管理模式。方法:对深圳市妇幼保健院孕24~28周行OGTT检查诊断为GDM并住院分娩的1 441例孕妇的病历资料进行回顾性分析,按照乐杰主编第七版《妇产科学》的诊断标准(以下简称旧标准)和IADPSG推荐的诊断标准(以下简称新标准)对孕妇进行GDM诊断,将采用新标准诊断为GDM而采用旧标准并未诊断为GDM及GIGT的孕妇(以下简称为轻型GDM)按照是否接受产科规范化管理分为管理组(A组)和未管理组(B组);另随机选择同期新、旧标准均为非GDM的120例孕妇为对照组(C组),比较3组孕妇的妊娠结局。结果:旧标准诊断为GDM及GIGT患者共1 224例,新标准诊断GDM患者共1 441例,IADPSG标准较旧标准多诊断出了217例GDM孕妇。轻型GDM B组其产妇为经产妇的比率、早产率、产后出血率、Apgar 1 min<7分的发生率明显高于A组及C组,差异均有统计学意义(P<0.05);不论是否进行血糖控制,其妊娠期高血压疾病、巨大儿、LGA、SGA、胎膜早破、剖宫产等不良妊娠结局的发生率均与糖代谢正常孕妇组差异无统计学意义(P>0.05)。结论:重视轻型GDM孕妇的规范化管理可明显改善妊娠结局。
OBJECTIVE: To investigate whether the pregnant women with GDM with multi-diagnosis of IADPSG have the appropriate pregnancy outcomes and appropriate obstetric management mode for standardized obstetric management. Methods: The data of 1 441 pregnant women with OGTT diagnosed as GDM and hospitalized for delivery were retrospectively analyzed in 24- 28 weeks of maternal and child health care in Shenzhen. According to the diagnostic criteria of the seventh edition of Obstetrics and Gynecology (Hereinafter referred to as the “old standard”) and IADPSG recommended diagnostic criteria (hereinafter referred to as the new standard) to diagnose GDM in pregnant women, the new standard will be used to diagnose GDM and the old standard pregnant women who have not been diagnosed as GDM and GIGT ) Were divided into management group (group A) and unmanaged group (group B) according to whether obstetrics and standardized management was accepted or not. Another 120 pregnant women with non-GDM in the same period were randomly selected as the control group (group C) Group pregnant women’s pregnancy outcome. Results: A total of 1 224 cases of GDM and GIGT were diagnosed in the old criteria. A total of 1 441 cases of GDM were diagnosed in the new standard. 217 pregnant women with GDM were diagnosed by IADPSG standard more than the old standard. The incidence of maternal women in the GDM group B was significantly higher than those in the A and C groups (P <0.05). The incidence of preterm birth, postpartum hemorrhage, Apgar 1 min <7 was significantly higher than that of the A and C groups The incidence of adverse pregnancy outcomes such as hypertensive disorder complicating pregnancy, macrosomia, LGA, SGA, premature rupture of membranes and cesarean section were not significantly different from those with normal glucose metabolism (P> 0.05) ). Conclusion: The standardized management of pregnant women with GGD can significantly improve pregnancy outcomes.