妊娠合并糖尿病的管理解析.ppt

Thank you ! * 2011年开始ADA指南对妊娠糖尿病的诊断标准进行了更新，其中空腹血糖、OGTT 2小时血糖的诊断标准下调。更为重要的是，原来的诊断标准需要2个血糖值异常才可以诊断，而现在的标准是只要有1个血糖值异常就可以诊断未妊娠糖尿病 * * * * * 左图为HAPO研究结果：在未达GDM诊断标准的孕妇中，血糖水平与胎儿出生体重、剖宫产、临床诊断的新生儿低血糖和脐血C-肽水平密切相关。另外，其他的研究也显示，高血糖会带来37%的不良结局和4%的严重不良结局 * 妊娠合并糖尿病患者只有通过规范化的诊断、尽早接受胰岛素治疗，才能更好的控制血糖。那么妊娠期间患者的血糖要控制在什么范围呢，让我们来看一下。 妊娠期间的孕妇的血糖控制目标更严格，先来看GDM患者的血糖控制目标：是空腹或餐前30分钟血糖3.3- 5.3mmol/L，餐后2h≤4.4-6.7mmol/L；夜间血糖4.4-6.7mmol/L；再来看一下孕前1型或2型DM妊娠患者的血糖控制目标：在不发生低血糖的情况下，餐前、睡前及夜间 3.3–5.5 mmol/L，餐后血糖峰值 5.6 –7.2mmol/L，HbA1c尽可能控制在6.0%以下。相比于其他糖尿病患者的血糖控制目标，妊娠期间的血糖控制更严格。 * 有研究显示正常的孕妇在怀孕期间的血糖水平一直都处于建议的GDM血糖控制目标范围内，如图所示，即便孕38周的血糖水平也没有超过血糖控制目标，所以建议的妊娠期间的血糖控制目标是可以达到的。 OBJECTIVE: To assess the 24-h glucose levels in a group of nondiabetic, nonobese pregnant women and to verify the presence of correlations between maternal glucose levels and sonographic parameters of fetal growth. RESEARCH DESIGN AND METHODS: A total of 66 Caucasian nonobese pregnant women with normal glucose challenge tests (GCT) enrolled in the study; from this population, we selected 51 women who delivered term (from 37 to 42 weeks completed) live-born infants without evidence of congenital malformations. The women were requested to have three main meals and to perform daily glucose profiles fortnightly from 28-38 weeks without modifying their lifestyle or following any dietary restriction. All subjects were taught how to monitor their blood glucose by using a reflectance meter. Fetal biometry was evaluated by ultrasound scan according to standard methodology at 22, 28, 32, and 36 weeks of pregnancy. RESULTS: The overall daily mean glucose level during the third trimester was 74.7 +/- 5.2 mg/dl. Daily mean glucose values increased between 28 (71.9 +/- 5.7 mg/dl) and 38 (78.3 +/- 5.4 mg/dl) weeks of pregnancy. We found a significant positive correlation at 28 weeks between 1-h postprandial glucose values and fetal abdominal circumference (AC). At 32 weeks, we documented positive correlations between fetal AC and maternal blood gluco