妊娠合并糖尿病诊治指南().pptVIP

* * * 左图为HYPO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、首次剖宫产、临床诊断的新生儿低血糖和脐血C-肽水平密切相关。 尤其是，孕妇体内血糖水平越高，则出生大体重婴儿的几率越高，发生脐血高C-肽水平的几率越高。以空腹血糖水平为例，血糖最低和最高分级分别对应的出生体重第90百分位的发生率为5.3%和26.3%；首次剖宫产的发生率为13.3%和27.9%；临床诊断新生儿低血糖发生率为2.1%和4.6%，脐带血血清C肽第90百分位的发生率为3.7%和32.4%。 * 2010年10月4号，176卷14期 * 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. * * * Aim: To measure ketonemia in a control population of pregnant women and in