1辽宁省葫芦岛地区妊娠糖尿病的筛查与治疗的临床研究旨在针对葫芦岛地区妊娠糖尿病的筛查与治疗的临床研究。方法随机抽取1068名孕妇进行50g葡萄糖筛查。 对异常者进行口服葡萄糖耐量试验（OGTT）。 对诊断明确的患者进行有效治疗，以观察母子的预后。结果筛查阳性54例，OGTT阳性54例，确诊GDM 39例，发生率约3。65。 对于明确诊断的患者应使用胰岛素治疗。妊娠结局良好。结论进一步筛查妊娠糖尿病的必要性进一步提高，同时有效治疗孕妇与胎儿，婴儿的交界处。 妊娠期糖尿病葡萄糖耐量试验妊娠期糖尿病的胰岛素治疗GDM指的是在首次发现或怀孕期间因不同程度的葡萄糖耐量和糖尿病而引起的不同程度的高血糖。发病率因国家而异，全球患病率逐年增加。14，即2。5？3。1[1]。研究表明，怀孕期间的血糖水平与围产期死亡率严重相关[2]。 妊娠合并糖尿病对母婴的影响主要是由于妊娠糖尿病的漏诊或误诊造成的，对母婴的治疗效果不理想，导致围产儿死亡率和发病率较高，容易引起产科 并发症并被归类为高危妊娠，而先前妊娠中GDM的恢复和重建30？69[3]。 因此，如何治疗孕妇已成为妇产科医生临床工作中的重要课题。自2006年9月以来我院？2008年3月，对1068例孕妇进行了50 g葡萄糖筛查，对异常孕妇进行了口服葡萄糖耐量试验（OGTT）。GDM的早期诊断，GDM危险因素的早期干预和药物治疗的替代取得了良好的效果，现报告如下。1临床资料21。1一般信息请在我院妇产科门诊，孕产妇和儿童预防健康科选择妊娠24？研究对象为28周，年龄22岁？38岁，平均26岁。7岁，包括985例初产妇。有83例产后妇女，66例糖尿病家族病史，314例肥胖症，先前无法解释的死产，29例自然流产和2例新生儿死亡。有2例大孩子。 在这种怀孕中，体重增加过快，有羊水过多18例，胎儿过多5例，外阴瘙痒和真菌性阴道炎65例。1。2方法第二届国际GDM研讨会提出了口服50克葡萄糖负荷试验（GGT）。 孕妇早上空腹，从200至300毫升水中加入50克葡萄糖粉，并在5分钟内喝完，从第一次Count饮开始计时并抽出静脉血以在1小时内检查血糖， 如果血糖大于或等于7。8mmol /升，然后转移到内分泌科OGTT，这是要粉碎75g葡萄糖粉200？服1杯前后5分钟之内喝300毫升水。在测试前2h检查血糖，禁食前至少8h禁食，服用葡萄糖后血糖降低，并且不吸烟。同时检测糖化血红蛋白（HbA1c），使用葡萄糖氧化酶方法进行葡萄糖测量，使用x±s进行统计。1。3使用仪器1。3。1血糖检测Olympus 640自动生化分析仪。1。3。2糖化血红蛋白分析仪拜耳糖化血红蛋白分析仪。1。4诊断标准基于1998年WHO的糖尿病诊断标准[4]。1。4。1糖尿病（DM）空腹血糖≥7。0mmol / L，糖负荷后2h血糖≥11。1mmol / L或OGTT 1h血糖≥11。1mmol / L或2h血糖≥11。1mmol /升1。4。2葡萄糖耐量（IGT）受损7。8mmol / L <2h blood glucose <11。1mmol / L.Glycated hemoglobin (HbA1c) ≥6.0.Diabetes and impaired glucose tolerance together constitute gestational diabetes (GDM).2 Results Of the 31,068 pregnant women, 54 had positive screening tests, 54 had OGTT tests, and 39 had confirmed GDM (fasting blood glucose (9.26 ± 1.07) mmol / L, 2h after sugar load (1381 ± 2.13) mmol / L, abnormal glucose tolerance in 2 cases, and 13 cases were excluded.573 cases of glycated hemoglobin HbA1c were detected, of which ≥6.0 35 cases.39 cases of GDM age 26?36 years old, average 28.96 years old, body mass index (BMI) 26.8?30.2. There were 18 cases of excessive weight gain during pregnancy, 12 cases with family history of diabetes, 4 cases of spontaneous abortion, 3 cases of artificial abortion, 1 case of stillbirth with unknown cause, 1 case of huge child, and 7 cases of polyhydramnios.We educate these GDM patients with diabetes, moderate exercise, reasonable diet and insulin injection therapy.36 patients had stable blood glucose control.See Table 1 for details.Table 1 Comparison of blood glucose before and after treatment Note P <0.05 The difference is significant. In all cases, there were 2 cases of cesarean delivery through vaginal delivery, 30 cases of cesarean section (27 cases of cesarean section by my request and social reasons), including 2 cases of huge children (maternal weight ≥4kg), 7 cases of amniotic fluidThe amount is significantly reduced.Three patients died due to uncontrolled diet and insulin therapy. One patient was transferred to the outpatient hospital with HELLP syndrome at 35 weeks of gestation. One patient died of severe diabetic inflammation, septic shock, and ketoacidosis at 36 weeks of gestation.One case gave birth to a huge child with neonatal hypoglycemia.4 cases were not delivered until the end of pregnancy and were under observation and treatment.All newborns are normal and without deformities.At the same time we have 33 pregnant women postpartum 1?Two months later, the OGTT test was conducted again, and 6 patients with type 2 diabetes (T2DM), 4 patients with impaired glucose tolerance (IGT), and 23 patients returned to normal.3 Discussion DM during pregnancy There are two types of DM combined with pregnancy and GDM, and their pathophysiology is relatively relative or absolute lack and resistance to glucose metabolism syndrome caused by resistance[1].Because the placenta secretes 深圳代孕妇服务网 4 placental prolactin and estrogen on insulin resistance during pregnancy, the peak period is in pregnancy 24?At 28 weeks, the insulin requirement of pregnant women also peaked at this time, which was manifested by impaired glucose tolerance.Therefore, GDM appears at least in the third trimester of pregnancy, and the sugar screening test is started from the second trimester. It is found that the abnormality is further subject to the OGTT glucose tolerance test to early diagnosis and early control of blood glucose to meet the standard, reducing the incidence of maternal and infant complications.This article is about 1068 cases of 24 pregnancy in our hospital?After a 28-week pregnant woman's sugar screening, 39 cases of GDM were diagnosed, accounting for 3.65.The screening positive rate is lower than domestic reports such as 深圳嘉乐生殖医院石主任 Zhang Hong[5], and higher than that reported by Qin Guirong[6].There are many reports about the risk factors of GDM.McMahou et al. Reported that the risk factors for pregnant women in Canada are advanced age, high pre-pregnancy weight, history of miscarriage, stillbirth and chronic hypertension[7]. Jang et al. Reported that GDM is related to BMI, age, weight gain during pregnancy, and diabetes in parents[8].Age 26 in 39 GDM patients in this study36 years old, average 28.66 years old, 4 cases have a history of spontaneous abortion, 3 cases have a history of abortion, 11 cases have a family history, 10 weight gain is too fast, showing an increase in pregnancy age, pre-pregnancy weight and pregnancy weight gain too fast, DM family history, abortion historyIt is positively related to GCT and is consistent with foreign and domestic aa69在上海吗 reports such as Zhang Hong.There are also reports that chronic hypertension, prevention of high signs and preeclampsia are significantly higher in pregnant women with GDM than in non-GDM pregnant women[9], which clearly shows that there may be a relationship between the blood glucose level of GCT and the occurrence of pre-eclampsia.The GCT positive rate and blood glucose value of pregnant women with high signs were significantly higher than those with normal blood glucose.Traditional studies have also found a clear link between blood glucose levels and blood pressure in pregnant women with a family history of IGT and GDM.The pregnant women with GCT positive and those with clear GDM in our study have no history of chronic hypertension and blood pressure are within the normal 环球代孕 range. Although there is no correction of high signs, it is not excluded that correcting high signs after controlling other alternative factors is an independent risk of GCT positivefactor.As the incidence of GDM increases year by year, its near- and long-term harm to mothers and infants has gradually been recognized.GDM has high blood pressure, spontaneous abortion, elevated high signs, pre-harmonic headache, polyhydramnios, giant children, cesarean section and other risks increased significantly, is the key monitoring object of high-risk pregnancy.5 Miscarriage is mainly due to high blood sugar during pregnancy, which affects embryo development, which eventually leads to stillbirth and miscarriage. Its incidence can reach 15?30.In addition, abnormal deformity also caused abortion. In this study, 33 patients with GDM had 365助孕 better prenatal blood glucose control, and none of the deformities and miscarriages occurred.For patients with DM, we recommend that pregnancy be controlled as soon as possible after normal blood glucose control, which can reduce the incidence of spontaneous abortion.It has been reported that the incidence of polyhydramnios in patients with GDM is significantly higher than that in non-DM pregnant women, about 13?36. It may be related to the high sugar content in amniotic fluid and the increase of amniotic fluid secretion[11]. Of the 39 cases of GDM in this study, 7 cases had too much amniotic fluid, accounting for 17.95. The amniotic fluid volume was significantly reduced after strict blood sugar control.Pregnancy with diabetes mellitus DM is still likely to be complicated by pregnancy-induced hypertension syndrome due to thickening of small blood vessel endothelial cells and 嘉宝助孕中心 shrinking of the lumen., Produces a large amount of insulin, activates the amino acid transfer system, promotes plasma body protein, trace synthesis increases, but inhibits micro-decomposition, promotes excessive intrauterine growth and development in the diet, resulting in huge children.In addition, due to the accompanying large children, obesity and soft birth canal injury are prone to occur during childbirth, which can cause contraction of fatigue and postpartum hemorrhage, and premature delivery.In this study, none of the high symptoms occurred, which was considered to be related to the stability of prenatal glycemic control.2 cases of huge children (newborns weighed 4kg and 4, respectively).5kg), so cesarean section, dystocia, no birth canal injury and postpartum hemorrhage. Dketoacidosis (DKA) is a serious acute complication of diabetes. It penetrates into mothers and children with hypertension. Dehydration of ketosis metastatic women leads to hypovolemia, acidosis and absorption disorders. In severe cases, it can cause kidney failure and coma.,death.In this study, 1 case was not strict in diet control at 36 weeks of gestation, without systemic treatment combined with amylitis, DKA, and septic shock and died.Therefore, for GDM, it is necessary to predict the rationality and necessity of the diet structure, avoid a large number of high-fat foods and fullness, and parallel drug treatment to control blood sugar within the normal range.Have you reported 19?34 GDM pregnant women still have abnormal glucose metabolism after delivery, and the risk of DM 6 also increases significantly[11].In GDM, the insulin response to glucose is reduced, and the function of islet B cells is significantly impaired.Studies have found that the complication of DM occurs 5 years after delivery 47, 55 in 6 years[3], Aibareds and other studies of GDM in Spain showed that the cumulative risk of abnormal DM and glucose tolerance is 13.8. About 11 years of illness recovery 42.4.Some scholars found that the education level and family income are low, and the diagnosis of GDM is fasting blood glucose (FBG)> 5，糖负荷达到6mmol / L后，血糖> 10 2h。3mmol / L和HbA1c> 4。3是未来2型糖尿病发展的易感性因素。分娩后一个月，我们对33名GDM患者进行了OGTT检查。 6名2型糖尿病患者，4例葡萄糖耐量（IGT）受损和23例恢复正常。对于1的IGT？两个月后，再次进行OGTT检查，其中1例转变为2型糖尿病，2例仍为IGT，其余恢复正常。GDM对胎儿骨折的影响。几乎所有围产期的发病率和死亡率都高于正常妊娠，并且对后代的长期影响也已成为人们关注的问题。GDM可引起宫内死产，影响食物发育，并引起宫内发育迟缓； 胎儿先天畸形可高达6？13.GDM期间围产期死亡率高达100‰？150‰。1890年胰岛素问世之前的国外报道？该组孕妇的围产期死亡率在1922年高达650‰。将来，由于使用胰岛素来控制疾病，围产期婴儿的死亡率逐年降低，从1940年代的380‰降至1980年代的38‰。 围产期婴儿的死亡原因是先天性畸形，宫内缺氧，早产，新生儿特发性呼吸窘迫综合征（ARDS），出生伤等。现在通过适当的治疗，母亲的代谢紊乱得以纠正，并且由于宫内监护和新生儿监护的增加，围产期婴儿的死亡率已大大降低。GDM对胎儿的最大作用是增加子宫内致死率和新生儿死亡率。数据显示，GDM孕妇的围产期新生儿死亡率高达35。原因如下：（1）孕妇的高血糖症通过胎盘转移血糖，降低心肌收缩力，影响有效循环血容量。（2）孕妇的红细胞氧气释放减少，胎盘血流量减少，胎儿氧气消耗增加，导致宫内缺氧。 （3）糖尿病性微血管病变，胎盘功能异常加重高血压和宫内急症，影响胎儿发育。7（4）妊娠糖尿病容易发生DKA。 酮体是氧化的血红蛋白的形成，其减少了子宫中的氧化性缺氧。 （5）高血糖刺激引起的高胆固醇血症，促进蛋白质和微合成，控制轻微分解，形成巨大的孩子，导致分娩困难，分娩伤害，并容易发生新生儿低血糖[3]，高胆固醇血症也可见血红蛋白血症，低钙血症，红细胞增多症以及青少年过度青春期的风险增加。在这项研究中，除了有2名巨大的孩子外，所有患有血栓性微血管病（HELLP）综合征的GDM患者，除了1名没有饮食控制和药物治疗的患者，都去医院治疗，但是有适当的孕妇治疗方法 胎儿的监测在适当的时候，出生的胎儿没有畸形和其他疾病的情况。妊娠期糖尿病患者将血糖维持在正常范围内是决定高血压预后的重要因素。许多研究还表明，通过对GDM患者进行早期教育和干预治疗，可以很好地控制妊娠的基线水平，这给孕妇带来了明显的好处，可以显着减少大孩子的发病率，还可以减少剖宫产和分娩伤害.据报道，妊娠期高血糖患者可进行产前保健，饮食和胰岛素治疗。 结果表明，与胰岛素治疗组相比，体重超过4 kg的出生婴儿数量显着减少，流产也有所减少。