张新丽 李玉琴

[摘要] 目的 探討不同引产时机对足月A1级妊娠期糖尿病（GDM）孕妇妊娠结局的影响。方法 收集2012年6月—2015年12月在该院分娩的足月GDM产妇1 640例，≤40周引产的为A组187例，40～41周引产的为B组218例，≥41周引产的为C组188例，≤40周自然临产的为D组613例，40～41周自然临产的为E组434例。分析比较各组分娩方式、引产成功率、剖宫产适应征及母儿并发症等。 结果 引产组（A、B、C组）剖宫产率明显高于自然临产组（D、E组）（χ2=88.94， P<0.05）。其中A组剖宫产率最高，达43.85%，C组在3组引产组中剖宫产率最低为27.66%，而自然临产组剖宫产率差异无统计学意义（P>0.05）。A组因引产失败和社会因素剖宫产明显高于C组，差异有统计学意义 （χ2=105.53， P<0.05）。3组引产组产后出血的比率均高于自然临产组，各组新生儿窒息和新生儿低血糖的比率无明显差别。结论 A1级GDM孕41周引产并未增加剖宫产率和产后出血、新生儿窒息等母儿并发症。

[关键词] 妊娠期糖尿病;血糖;足月;引产时机

[中图分类号] R4          [文献标识码] A          [文章编号] 1672-4062（2018）09（a）-0001-03

Discussion on the Timing of Induction of Gestational Diabetes Mellitus with Good Glycemic Control

ZHANG Xin-li， LI Yu-qin

Xiamen Changgeng Hospital， Xiamen， Fujian Province， 361023 China

[Abstract] Objective To investigate the effect of different induction time on pregnancy outcome in pregnant women with term A1 gestational diabetes mellitus （GDM）. Methods From June 2012 to December 2015， 1 640 cases of full-term GDM were delivered in the hospital. 187 cases of group A were induced by ≤40 weeks， and 218 cases of group B were induced by 40-41 weeks. The induction of labor in 41 weeks was 188 cases in group C， 613 cases in group D with ≤40 weeks of natural labor， and 434 cases in group E in 40-41 weeks. Analyze and compare the delivery mode of each component， the success rate of induction of labor， indications for cesarean section and complications of mother and child. Results The cesarean section rate of the induction group （groups A， B， and C） was significantly higher than that of the natural labor group （groups D and E）（χ2=88.94， P<0.05）. The cesarean section rate of group A was the highest， reaching 43.85%. The cesarean section rate of group C was the lowest in the three groups of induction group （27.66%）， but there was no significant difference in cesarean section rate between the two groups. The cesarean section of group A was significantly higher than that of group C due to failure of induction of labor and social factors （χ2=105.53， P<0.05）. The rate of postpartum hemorrhage in the three groups was higher than that in the natural labor group. There was no significant difference in the ratio of neonatal asphyxia to neonatal hypoglycemia. Conclusion A1 grade GDM induction of labor at 41 weeks of pregnancy did not increase the cesarean section rate and postpartum hemorrhage， neonatal asphyxia and other maternal and child complications.

[Key words] Gestational diabetes; Blood glucose; Full-term ; Indnced labor time

妊娠期糖尿病（gestational diabetes mellitus， GDM ）是妊娠期最常见的合并症之一，可给母婴造成一系列并发症，因此诊断及孕期管理至关重要。对于单纯饮食控制血糖良好的GDM孕妇即A1级GDM 孕妇终止妊娠时机目前尚存在分歧，该研究选取2012年6月—2015年12月收治的足月GDM产妇1 640例为研究对象，分析血糖控制良好的足月GDM即A1级足月GDM不同终止妊娠时机母婴围产结局，探讨不同引产时机对足月A1级GDM孕妇妊娠结局的影响，现报道如下。

1  资料与方法

1.1  一般资料

收集该院在该院门诊产检诊断为GDM、通过饮食指导、血糖控制良好、孕周≥37周并在该院住院分娩的产妇1 640例。排除既往GDM、糖尿病、剖宫产史或有内外科合并症者，均为单胎，头先露。

1.2  诊断标准

参照 2011 年我国卫生部卫生行业诊断标准 GDM 诊断标准度：孕 24～28 周行 75 g 口服葡萄糖耐量试验 （OGTT） 检查，诊断标准值： 空腹、餐后 1、2 h 血糖值分别 为 5.1、10.0、8.5 mmol/L，任何 1 項血糖值达到或 超过上述标准值则诊断为 GDM[1]。……