课件：妊娠合并糖尿病的管理—兼顾血糖及妊娠结局-0428.pptVIP

* * * 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 * 左图为时代杂志2010年10月4号，176卷14期，封面为一个怀孕的女性，这一期有一项重要的内容是“How the first nine months shape the rest of your life”，强调了宫内环境对胎儿的长期影响。 * 一个系统综述总结了28个研究，发现GDM患者产后发生2型糖尿病的发生率最高可达70% OBJECTIVE— 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. * * * 对GDM患者和正常孕妇进行的研究显示，GDM患者整体的摄入量较正常孕妇要少，这可能与其更加注意血糖的控制有关，同时GDM患者酮体的水