2016年妊娠合并糖尿病治疗之.pptVIP

* * * * * * * * * * 孕前开始使用门冬胰岛素治疗患者的低血糖事件发生率为80.4事件/年，孕期开始使用为111.1事件/年； 孕前或孕期开始使用胰岛素治疗的患者在不同孕期重度低血糖发生率分别为：1.7vs 3.4, 0.8 vs 0.9, 1.5 vs 3.1； 孕前开始使用门冬或人胰岛素治疗的患者在不同孕期重度低血糖发生率分别为：0.9 vs 2.4, 0.9 vs 2.4, 0.3 vs 1.2, 0.2 vs 2.2，差异NS。 * * * * * * * * * * * 复合终点包括至少下列一项：小于胎龄儿、大于胎龄儿、早产、早期死胎、围产期死亡、新生儿死亡或存在严重畸形 P=0.551 地特胰岛素 NPH T1DM患者孕前、孕期使用地特胰岛素治疗，较NPH治疗胎儿围产期结局相当 Mathiesen ER, et al. Diabetes Care. 2012 ;35(10):2012-7. Hod M, Mathiesen ER, et al. J Matern Fetal Neonatal Med. 2014 ;27(1):7-13 Mathiesen ER, et al. Diabetes Care. 2012;35(10):2012-7. Hod M, Mathiesen ER, et al. J Matern Fetal Neonatal Med. 2014 ;27(1):7-13 T1DM患者孕前、孕期使用地特胰岛素治疗，较NPH治疗胎儿围产期结局相当 P=0.238 P=0.228 比例(%) 大于胎龄儿 小于胎龄儿 巨大儿（4000g） P=0.180 早产（37周） 地特胰岛素 NPH 新生儿低血糖 P=0.223 总结 糖尿病对母婴不良影响不仅局限于妊娠期间：孕前、孕期高血糖导致多种不良母婴妊娠结局，产后影响母亲及子代的未来健康 因此，妊娠合并糖尿病的治疗与管理需贯穿全程——孕前、孕期及产后，应遵循“孕前详计划，孕期严达标，产后重随访”原则，进行全程饮食、运动干预，对于需要进行药物干预的患者，孕前及时转换胰岛素，孕期及时起始胰岛素 作为可以在妊娠期间使用的胰岛素类似物：门冬+地特胰岛素，能更好模拟生理性胰岛素分泌，在孕前、孕期使用可以更好控制血糖，改善妊娠预后 谢谢！ * * * * * * OBJECTIVE: Our purpose was to examine the maternal and fetal outcomes of the 180 women with insulin-dependent diabetes mellitus who became pregnant during the Diabetes Control and Complications Trial. STUDY DESIGN: The Diabetes Control and Complications Trial was a multicenter controlled clinical trial that compared intensive with conventional therapy in insulin-dependent diabetes mellitus. Intensive therapy, with the aim of achieving normal glycemic control, was initiated in women originally assigned to conventional therapy who actively sought to become pregnant or who became pregnant. RESULTS: A total of 180 women completed 270 pregnancies between 1983 and 1993, with 191 total live births. The mean glycosylated hemoglobin level was significantly different between the treatment groups at conception (7.4% +/- 1.3% in intensive vs. 8.1% +/- 1.7% in conventional therapy, p = 0.0001) but was similar during gestation (6.6% +/- 0.8% and 6.6% +/- 1.3%). Nine congenital malformations were identified (