妊娠合并糖尿病管理—规范诊疗 母婴获益.ppt

Presentation title * * OBJECTI VE— To examine factors associated with variation in the risk for type 2 diabetes in women with prior gestational diabetes mellitus (GDM). RESEARCH DESIGNANDMETHODS— We conducted a systematic literature review of articles published between January 1965 and August 2001, in which subjects underwent testing for GDM and then testing for type 2 diabetes after delivery. We abstracted diagnostic criteria for GDM and type 2 diabetes, cumulative incidence of type 2 diabetes, and factors that predicted incidence of type 2 diabetes. RESULTS— A total of 28 studies were examined. After the index pregnancy, the cumulative incidence of diabetes ranged from 2.6% to over 70% in studies that examined women 6 weeks postpartum to 28 years postpartum. Differences in rates of progression between ethnic groups was reduced by adjustment for various lengths of follow-up and testing rates, so that women appeared to progress to type 2 diabetes at similar rates after a diagnosis of GDM. Cumulative incidence of type 2 diabetes increased markedly in the first 5 years after delivery and appeared to plateau after 10 years. An elevated fasting glucose level during pregnancy was the risk factor most commonly associated with future risk of type 2 diabetes. CONCLUSIONS— Conversion of GDM to type 2 diabetes varies with the length of follow-up and cohort retention. Adjustment for these differences reveals rapid increases in the cumulative incidence occurring in the first 5 years after delivery for different racial groups. Targeting women with elevated fasting glucose levels during pregnancy may prove to have the greatest effect for the effort required. * 正常妊娠孕早期血糖水平大致正常，孕中期开始由于胎儿在宫内生长需要以及妊娠肾脏血流量增加、糖阈下降，尿糖增多，并且胰岛素在空腹时清除糖能力增加，因此正常妊娠在孕12周以后，空腹血糖偏低直至孕足月。 * * * * 胰岛素是治疗妊娠期高血糖的理想药物 ，这是因为胰岛素是大分子蛋白，不通过胎盘，妊娠期应用不会对胎儿造成不良影响。所以胰岛素是治疗妊娠期高血糖的金标准。我们知道，在药物治疗方面，迄今为止，CFDA(国家食品药品监督管理局)没有批准任何口服降糖药用于治疗妊娠期间的高血糖。 虽然有一些国外研究证实格列苯脲和二甲双胍用于妊娠期间的血糖控制有效、安全。如果正在口服格列苯脲和二甲双胍过程中发现怀孕不建议终止妊娠。但是格列苯脲的应用可能通过胎盘且