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Objective To explore the factors influencing pregnancy outcome of gestational diabetes mellitus (GDM) patients with isolated fasting hyperglycemia.Methods Medical records of 1 059 GDM patients with isolated fasting hyperglycemia,who gavc birth at Peking University First Hospital between January 2012 and December 2015,were retrospectively reviewed.Clinical data,including maternal age,pre-pregnancy body mass index (BMI),fasting plasma glucose (FPG) in the first trimester,results of oral glucose tolerance tests (OGTT),area under the curve (AUC) of OGTT,glycosylated hemoglobin (HbAlc),re-tested FPG (within one week after OGTT) and insulin usage,were analyzed.Patients with or without adverse pregnancy outcome,including first cesarean section,larger for gestational age,preterm birth,hypertensive disorders of pregnancy,dystocia or birth trauma,neonatal hypoglycemia and neonatal hyperbilimbinemia,were respectively divided into two groups.T or Chi-square test was used for univariate analysis.Logistic regression was used for multivariate analysis.Results Among the 1 059 patients,18 (1.7％) received insulin therapy and 591 had adverse pregnancy outcome (55.8％).Univariate analysis showed that the percentages of patients whose age ≥ 35 years old,pre-pregnancy BMI ≥ 25,AUC ≥ 13 mmol/L · h or HbAlc ≥ 5.5％ were higher in the group with adverse pregnancy outcome than in those without adverse pregnancy outcome [21.7％ (128/591) vs 13.2％ (62/468),x2=12.548;28.9％ (171/591) vs 16.2％ (76/468),x2=23.535;87.5％ (517/591) vs 78.4％ (367/468),x2=15.542;32.9％ (155/471) vs 26.2％ (99/377),x2=4.514;all P＜0.05].The average values of OGTT-1 h and OGTT-2 h in patients with adverse pregnancy outcome were higher than in those without [(8.27 ± 1.14) vs (8.11 ±-1.19) mmol/L,t=-0.367;(7.01 ±0.85) vs (6.88±0.87) mmol/L,t=-0.517;both P＜0.05].Multivariate analysis showed that pre-pregnancy BMI＜25 and AUC＜13 mmol/L · h were protective factors for adverse pregnancy outcomes [OR (95％CI):0.498 (0.355-0.698) and 0.431 (0.247-0.752),both P＜0.01].Conclusions Pre pregnancy BMI＜25 and AUC＜13 mmol/L · h are protective factors for adverse pregnancy outcomes in GDM patients with isolated fasting hyperglycemia.Clinical practitioners may regard this group of women as relatively low-risk to avoid unnecessary intervention.
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Objective To investigate whether area under the curve (AUC) of oral glucose tolerance test (OGTT) could work as a predictor of outcomes of gestational diabetes mellitus (GDM) on condition that blood glucose is controlled. Methods A total of 1 796 women who had a standard antenatal care in Peking University First Hospital and gave single live births from July 1, 2011 to December 31,2 013 were included.They should be diagnosed of GDM by the diagnosis criteria of gestational diabetes published by the Ministry of Health of PRC and diabetes pre-pregnancy excluded. Data were analyzed with SPSS 17.0, grouping by AUC. Results (1)Women with higher AUC had a rising trend of age and a downward trend of gestational weight gain, however, not statistically significant [specifically, in the four group of less than 15.00 mmol·L-1·h-1, 15.00 to 16.79 mmol · L-1 · h-1, 16.80 to 17.99 mmol · L-1 · h-1 and 18.00 mmol · L-1 · h-1 or more, gestational weight gain was (15.3±5.2), (14.1±4.8), (13.5±4.7) and (13.1±4.8) kg]. The prevalence of macrosomia raised while AUC increased. Those with an AUC of lower than 15.00 (mmol·L-1·h-1) had a lower risk of macrosomia (P=0.04) . But those with an AUC of 18.00 (mmol·L-1·h-1) or more had a higher risk of macrosomia (P=0.02). There was a rising trend in premature birth and preeclampsia with AUC increasing but not significant (the prevalence of premature birth was 4.38%, 5.36%, 7.71%and 7.94%while that of preeclampsia was 2.85%, 4.69%, 4.67% and 5.08% in these four groups).(2)The prevalence of macrosomia was 12.76% (54/423) when overweight pre-pregnancy ,significantly higher compared with 5.87%(65/1 107) in normal group. The prevalence of preeclampsia was 5.91%(25/423) and 3.34%(37/1 107) in those two groups, which was also significantly different. The obese group had a statistically highest prevalence of preeclampsia of 9.23%(12/130). (3)AUC (P<0.05, OR=1.113, 95%CI:1.008-1.218), as well as gestational weight gain (P<0.05, OR=1.520, 95%CI:1.279-1.806) and pre-pregnancy BMI (P<0.05, OR=1.183, 95%CI:1.125-1.243) made a difference in the prevalence of macrosomia. Meanwhile, pre-pregnancy BMI made sense in the prevalence of premature labor (P<0.05, OR=1.059, 95%CI:1.003-1.119) and preeclampsia (P<0.01, OR=1.202, 95%CI:1.123-1.286). Conclusions AUC, as well as pre-pregnancy BMI and gestational weight gain have a significant impact on outcomes of GDM, macrosomia especially, though blood glucose is controlled. Meanwhile, AUC might be considered as a predictor of macrosomia.
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Objective To evaluate the results of one-day care for gestational diabetes mellitus (GDM) and pregnancy outcome after application of new diagnostic criteria.Methods We retrospectively analyzed the clinical features of a GDM group (n=841) and a normal glucose metabolism group (n=3 043) who delivered in Department of Obstetrics and Gynecology,Peking University First Hospital between July 1,2011 and June 30,2012,to discuss the difference in maternal and newborn outcomes between these two groups,and to compare the maternal and newborn outcomes between the GDM one-day care group (study group,n=605) and non-GDM one-day care group (control group,n=236).Statistical analysis was performed by t test and x2 test.Results The average age of pregnant women with GDM was (31.5±4.2) years,which was higher than the normal glucose metabolism group (30.0±3.7) years (t=9.13,P＜0.01).The average age of the study group was (31.7±4.2) years,and the average age of the control group was (31.7±4.9) years,which was not a significant difference (t=2.32,P＞0.05).In the oral glucose tolerance test,fasting blood glucose level was (5.2±0.5) mmol/L,which was significantly lower than that in the control group (5.3±0.8) mmol/L (t=2.48,P＜0.05).The difference between 1 and 2 h glucose sugar levels did not differ significantly (P＞0.05) between the two groups.In the GDM and normal glucose metabolism groups of pregnant women,the incidence of macrosomia was 6.5％ (55/841) and 5.9％ (182/3 043),respectively,although the difference was not significant (x2=0.36,P＞0.05).In the GDM group,the rate of premature delivery was significantly higher than in the normal glucose metabolism group [preterm birth:10.1％ (83/841) and 7.4％ (225/3 043),x2=5.56; P＜0.05)].In the GDM group,gestational hypertension and mild pre-eclampsia were significantly more frequent than in the normal glucose metabolism group [gestational hypertension:4.2％ (35/841) vs 2.6％ (82/3 043),x2=4.85; mild pre-eclampsia:1.7％ (14/841) vs 0.9％ (26/3 043),x2=4.24; P＜0.05].The incidence of severe pre-eclampsia was 2.4％ (20/841) and 1.6％ (49/3 043),respectively,which was not significantly different (x2=2.22,P＞0.05) between the two groups.The rate of insulin use was 9.3％ (78/841) in the GDM group.In the study group,the rate of insulin use was 7.9％ (48/605),compared with 11.9％ (28/236) in the control group; this difference was not significant (x2=3.54,P＞0.05).In the study group,the incidence of macrosomia and hypertensive disorder complicating pregnancy (HDP) was similar to that in the control group [macrosomia:6.9％ (42/605) vs 5.3％ (13/236),respectively; x2=0.57; HDP:7.4％ (45/605) vs 9.9％ (24/236),x2=1.68; P＜0.05].The rate of premature delivery in the study group was significantly lower than in the control group [7.2％ (44/605) vs 16.0％ (38/236),x2=15.04,P＜0.05].In the study group,among the 561 cases of term birth,there were 42 cases of macrosomia.The average age of macrosomic and non-macrosomic pregnant women [(31.4±3.9) vs (31.7±4.2) years,t=4.27],pre-pregnancy body mass index [(23.5±3.9) vs (22.6±3.2),t=1.58],gestational weight gain [(16.1±5.6) vs (15.7± 11.4) kg,t=0.22] and pregnant weeks at visit to a one-day care clinic [(27.5 ± 4.3) vs (28.1 ± 2.8) weeks,t=0.86; P＞0.05] showed no significant differences.In women who delivered an infant with macrosomia,glycosylated hemoglobin levels in mid and late pregnancy were higher than in woman who did not deliver an infant with macrosomia [(5.6±0.4) ％ vs (5.4±0.4) ％,t=2.13,P＜0.05].Conclusions Through one-day care for GDM,the rate of preterm labor is reduced.This is a good model for group management of GDM women,and more efforts is required to improve its effect.
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Objective To explore the efficacy of treating primary dysmenorrheal with modified Shenghua decoction plus western medicine. Methods 120 patients with primary dysmenorrhea were randomly recruited into a control group and a treatment group, with 60 patients in each group. The control group was treated with prostaglandin synthetic inhibitor, and the treatment group was treated with modified Shenghua decoction on the basis of control group. Results The total effective rate of the treatment group and the control group was 90% and 73.3%, respectively, showing significant difference (X2=4.011, P <0.05 ) . Conclusion Modified Shenghua decoction plus western medicine is effective in treating, primary dysmenorrheal.