INTENSIFIED VERSUS CONVENTIONAL MANAGEMENT OF GESTATIONAL DIABETES
INTENSIFIED VERSUS CONVENTIONAL MANAGEMENT OF GESTATIONAL DIABETES
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DOI：
10.1016/s0002-9378(94)70097-4
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发表时间：
1994-04-01
影响因子：
9.8
通讯作者：
ARREDONDO, F
中科院分区：
文献类型：
--
作者：
LANGER, O;RODRIGUEZ, DA;ARREDONDO, F
目的：我们检验了这样一个假设，即在严格控制血糖的基础上加强对妊娠期糖尿病的管理，验证血糖数据，并坚持既定的胰岛素起始标准，可使血糖控制接近正常，并减少不良结局。一项前瞻性、基于人群的研究比较了常规（n = 1316）和强化（n = 1145）管理对围产期结局的影响。组分配是基于在进入程序时基于内存的反射率计的可用性。同期随机对照组（非糖尿病，n = 4922）selected.RESULTS：糖尿病组在人口统计学特征和不良妊娠结局的高风险相关因素，如既往巨大儿，既往妊娠期糖尿病，糖尿病家族史。对照组更年轻，肥胖程度更低，以前的巨大儿发生率也更低。强化管理组的巨大儿、剖宫产、代谢并发症、肩难产、死产、新生儿重症监护室天数和呼吸系统并发症的发生率低于常规管理组，与非糖尿病对照组相当。其他产妇并发症的发生率，如先兆子痫、慢性高血压和感染，在三组中相似。平均血糖水平是围产期结局的良好预测因子。分娩时的胎龄、既往巨大儿史和总体平均血糖水平是两组糖尿病患者出生体重百分位数的唯一显著预测因素（logistic回归分析）。结论：强化管理方法与提高围产期结局显著相关。这种管理策略阐明了血糖控制和新生儿结局之间的关系。
OBJECTIVE: We tested the hypothesis that intensified management of gestational diabetes mellitus on the basis of stringent glycemic control, verified glucose data, and adherence to an established criterion for insulin initiation results in near normoglycemia control and reduction of adverse outcomes.STUDY DESIGN: A prospective, population-based study compared the effect on perinatal outcome of conventional (n = 1316) and intensified (n = 1145) management. Group assignment was based on availability of memory-based reflectance meters at entry to the program. A contemporaneous randomized control group (nondiabetic, n = 4922) was selected.RESULTS: The diabetic groups were comparable in demographic characteristics and in factors associated with higher risk for adverse pregnancy outcome, such as previous macrosomia, previous gestational diabetes mellitus, and family history of diabetes. The control group was younger, less obese, and had a lower rate of previous macrosomia. The intensified management group had rates of macrosomia, cesarean section, metabolic complications, shoulder dystocia, stillbirth, neonatal intensive care unit days, and respiratory complications lower than those in the conventional management group and comparable to those of the nondiabetic controls. Other maternal complication rates, such as for preeclampsia, chronic hypertension, and infection, were similar for the three groups. Mean blood glucose levels were a good predictor of perinatal outcome. Gestational age at delivery, previous history of macrosomia, and overall mean blood glucose levels were the only significant predictors of birth weight percentile in both diabetic groups (logistic regression).CONCLUSION: The intensified management approach is significantly associated with enhanced perinatal outcome. This management strategy clarifies the relationship between glycemic control and neonatal outcome.