孕前糖尿病对围产儿结局的影响

发布时间：2018-06-08 14:08

  本文选题：孕前糖尿病 + 围产儿结局　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的探讨孕前糖尿病孕妇的发生率变化趋势及规范管理血糖后对围产儿结局的影响。方法2012年1月1日至2016年12月31日在大连医科大学附属第一医院产科分娩的孕前糖尿病患者共162例,根据孕期血糖控制情况,分为血糖控制良好组83例(A组)和血糖控制不良组79例(B组)。采用回顾性分析的方法对孕前糖尿病的围产儿结局进行分析,并对孕前糖尿病患者的发生率进行统计。结果(1)孕前糖尿病患者在2012年1月1日—2016年12月31日5年的总发生率为2.25%,每年的发生率分别为1.48%、2.09%、1.45%、4.03%、3.12%,总体呈上升趋势。(2)A、B两组患者在年龄、孕周、孕次、产次、不良孕娩史、家族史差异无统计学意义(P0.05)。(3)A组围产儿不良结局中的流产、巨大儿、低血糖、高胆红素血症、新生儿呼吸窘迫综合征的发生率明显小于B组(P0.05);胎儿畸形、死胎(死产)、新生儿死亡、早产儿、FGR、胎儿窘迫、转入NICU发生率两组相比无显著性差异(P0.05)。(4)两组孕妇的分娩孕周无明显差异(P0.05),A组的出生体重明显小于 B 组(P0.05)。(5)A组孕前及孕早期干预比率高于B组,有统计学意义(P0.05);A组依靠饮食+运动治疗的比率分别小于B组,加胰岛素治疗的比率高于B组(P0.05);A组中阴式分娩和剖宫产的比率与B组相比无明显差别(P0.05)。结论(1)2012年-2016年每年的发生率呈上升趋势,应重视对孕前糖尿病的筛查、诊断和干预。(2)孕前糖尿病的血糖控制良好时可明显改善围产儿结局,降低流产、巨大儿、低血糖、高胆红素血症、RDS等发生率。(3)对孕前糖尿病患者的血糖干预时间提前可改善围产儿结局。(4)孕前糖尿病病情相对较长、较重,规范管理血糖可明显改善围产儿结局。
[Abstract]:Objective to investigate the incidence trend of pregestational diabetes in pregnant women and the influence of blood glucose management on perinatal outcome. Methods from January 1, 2012 to December 31, 2016, 162 cases of pregestational diabetes were given birth in the first affiliated Hospital of Dalian Medical University. The patients were divided into two groups: group A (83 cases) and group B (79 cases) with poor blood glucose control. The perinatal outcome of pregestational diabetes mellitus and the incidence of pregestational diabetes mellitus were analyzed retrospectively. Results (1) the total incidence of pregestational diabetes in the 5 years from January 1, 2012 to December 31, 2016 was 2.25, and the annual incidence was 1.48, 2.09 and 1.45, respectively. There was an overall rising trend in the age, gestational week, pregnancy, labor, and history of poor pregnancy in the two groups. There was no significant difference in family history. The incidence of miscarriage, macrosomia, hypoglycemia, hyperbilirubinemia and neonatal respiratory distress syndrome in group A was significantly lower than that in group B (P 0.05). Stillbirth (stillbirth, neonatal death, premature FGR, fetal distress, There was no significant difference between the two groups in the incidence of transfer to NICU (P 0.05) there was no significant difference in the gestational weeks of delivery between the two groups. The birth weight of group A was significantly lower than that of group B (P 0.05). The rate of intervention before pregnancy and in early pregnancy in group A was significantly higher than that in group B. The ratio of diet and exercise therapy in group A was significantly lower than that in group B, and the rate of insulin therapy was higher than that in group B (P 0.05). There was no significant difference in the rates of midvaginal delivery and cesarean section between group A and group B. There was no significant difference between group B and group B in the proportion of midvaginal delivery and cesarean section. Conclusion (1) the annual incidence of pregestational diabetes is on the rise from 2012 to 2016. We should pay attention to the screening of pre-gestational diabetes, diagnosis and intervention. 2) when blood glucose control of pre-gestational diabetes is good, it can obviously improve perinatal outcome and reduce abortion, macrosomia and hypoglycemia. The incidence of hyperbilirubinemia / RDS et al.) the intervention time of blood glucose in patients with pre-gestational diabetes could improve perinatal outcome. (4) the condition of pre-gestational diabetes was relatively long and severe, and standardized blood glucose management could significantly improve the perinatal outcome.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256
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本文编号：1996054