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Analysis of the effects of gestational diabetes mellitus based on abnormal blood glucose on pregnancy outcomes

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Author:
No author available
Journal Title:
Chinese Journal of Obstetrics and Gynecology
Issue:
12
DOI:
10.3760/cma.j.issn.0529-567x.2013.12.005
Key Word:
糖尿病,妊娠;血糖;妊娠结局;Diabetes,gestational;Blood glucose;Pregnancy outcome

Abstract: Objective To investigate the relationship of different types of gestational diabetes mellitus (GDM) and pregnancy outcomes.Methods A total of 4090 cases,who received prenatal examination and delivered in Peking University First Hospital and performed a 75 g oral glucose tolerance test (75 g OGTT) at 24-28 gestational weeks,from January.1st,2011 to Jul 31st,2012,were divided into 2groups.Normal blood glucose group:the result of OGTT (fasting plasma glucose,1 hour glucose and 2 hour glucose) was normal; Gestational diabetes mellitus group (GDM group):the result of OGTT was abnormal at any time point.GDM group were separated into A,B and C.GDM A means fasting plasma glucose annormal but others were normal,GDM B:fasting plasma glucose,1 hour and/or 2 hour glucose abnormal,GDM C:fasting plasma glucose normal.To analyse the effect of different number of abnormal result of OGTT on pregnancy outcomes,GDM group were divided into Ⅰ,Ⅱ and Ⅲ.GDM Ⅰ means one abnormal blood glucose of OGTT result,GDM Ⅱ:two abnormal blood glucose and GDM Ⅲ:three abnormal blood glucose.We analyzed the pregnant outcomes of each group.Results (1) Among the 4090 cases,858 cases (21.98%) were diagnosed as GDM (GDM group),and 82 cases (9.6%,82/858) were treated with insulin,other 3232 cases with normal blood glucose (normal blood glucose group).In GDM group,the rate of cesarean section (51.9%,445/858),premature delivery (8.4%,72/858) and LGA (5.9%,51/858)were respectively significantly higher than those of normal blood glucose group [(43.5%,1406/3232),(5.8%,189/3232) and (4.2%,137/3232)] (P < 0.05).But,there was no statistically significant differences for the rate of macrosomia (P > 0.05) between the GDM group (6.8%,58/858) and normal blood glucose group (6.2%,199/3232).(2)In the GDM group,GDM A was 317 cases (36.9%),GDM B 239 cases (27.8%),GDM C 302 cases (35.2%).The incidence of Macrosomia and LGA in GDM B was significantly higher than that in GDM C and normal blood glucose group (P < 0.05).Comparing with GDM A,there was no statistically significance in GDM B and GDM C (P > 0.05).(3)In GDM group,GDM Ⅰ was 521 cases (60.7%),GDM Ⅱ203 cases (15.6%),GDM Ⅲ 134 cases (23.7%).Compared with the normal blood glucose group,GDM Ⅲ had a significantly higher incidence of macrosomia and LGA and cesarean section(P < 0.01) ;and GDM Ⅱ had only a significantly higher incidence of cesarean section (P < 0.01).(4) Among the 4090 cases,there were 1118 patients (27.3 %) whose fasting blood glucose was below 4.4 mmol/L,of which 55 cases were diagnosed as GDM.There were 4 premature infants and 1 macrosomia.Conclusions The GDM group with more than FBG ≥5.1 mmol/L had a higher incidence of adverse pregnancy uutcomes,it suggested that we should pay more attention and take actively intervented;the pregnant woman is not recommended for 75g OGTT detection when fasting blood glucose was below 4.4 mmol/L because of the low rate of GDM and adverse pregnancy outcomes among them.

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