Abstract: Objective　To evaluate the effects of glucose levels at different time points after oral glucose tolerance test （OGTT） on the diagnosis of gestational diabetes mellitus （GDM） and pregnancy outcomes.Methods　516 pregnant women admitted to Department of Obstetrics in the Second Xiangya Hospital of Central South University for delivery were collected from May to September in 2015.75 g glucose OGTT was performed at 24 to 28 weeks of gestation.GDM was detected in 109 cases.According to the time points for diagnosis of GDM and excluding 13 cases with GDM diagnosed at two or more time points,the patients were divided into 3 groups:35 cases in group diagnosed at fasting blood glucose（group A）,20 cases in group diagnosed at OGTT 1 h blood glucose（group B）,41 cases in group diagnosed at OGTT 2 h blood glucose（group C）.Clinical data of pregnant women with GDM were retrospectively analysed,including:maternal age,pre-pregnancy body mass index（BMI）,body mass growth during pregnancy,neonate birth weight and pregnancy outcomes（premature rupture of membranes,macrosomia,preterm delivery,fetal distress,neonatal pathologic jaundice,gestational hypertension）.Results　In all 516 pregnant women,GDM was detected in 109 cases,the detection rate of GDM was 21.12%.The detection rate of GDM was 6.78% by diagnosed at fasting blood glucose.The detection rate of GDM was 3.88% by diagnosed at OGTT 1 h blood glucose.The detection rate of GDM was 7.95% by diagnosed at OGTT 2 h blood glucose.There were statistically significant difference in the detection rate of GDM according to blood glucose levels at different OGTT time points（χ2=7.80，P=0.02）.The detection rate of GDM by diagnosed at OGTT 1 h blood glucose was lower than diagnosed at fasting blood glucose and OGTT 2 h blood glucose（P<0.01）.There were statistically significant difference in maternal age among the 3 groups（P<0.05）.The maternal age in group A was lower than group B and group C（P<0.05）.There were no statistically significant difference in pre-pregnancy BMI,body mass growth during pregnancy and neonate birth weight among the 3 groups（P>0.05）.There was statistically significant difference in the incidence of fetal distress among the 3 groups（P<0.05）.The incidence of fetal distress in group C was lower than group B（P<0.01）.There were no statistically significant difference in premature rupture of membranes,macrosomia,preterm delivery,neonatal pathologic jaundice,gestational hypertension among the 3 groups（P<0.05）.Conclusion　The detection rate of GDM was 21.12%.There are some differences in the diagnosis of GDM according to blood glucose levels at different OGTT time points.The detection rate at OGTT 1 h blood glucose is lower than fasting blood glucose and OGTT 2 h blood glucose.The incidence of fetal distress is higher in group diagnosed at OGTT 1 h blood glucose.

Key words: Diabetes,gestational, Glucose tolerance test, Diagnosis, Pregnancy outcome

摘要： 目的　探讨口服葡萄糖耐量试验（OGTT）不同时间点血糖水平诊断妊娠期糖尿病（GDM）的差异及其对妊娠结局的影响。方法　选取2015年5—9月在中南大学湘雅二医院产科进行分娩的孕妇516例，妊娠24～28周时行75 g葡萄糖OGTT。检出GDM 109例，根据孕妇诊断GDM的时间点不同进行分组，剔除两个及以上时间点均诊断为GDM的孕妇13例，其中空腹血糖诊断组（A组）35例、服糖后1 h血糖诊断组（B组）20例、服糖后2 h血糖诊断组（C组）41例。回顾性分析GDM孕妇的临床资料，包括：孕妇年龄、妊娠前体质指数（BMI）、妊娠期体质量增长、新生儿出生体质量及妊娠结局（胎膜早破、巨大儿、早产、胎儿窘迫、新生儿病理性黄疸、妊娠期高血压）。结果　516例孕妇，检出GDM 109例，GDM检出率为21.12%。OGTT空腹血糖水平升高GDM检出率为6.78%，服糖后1 h血糖水平升高GDM检出率为3.88%，服糖后2 h血糖水平升高GDM检出率为7.95%，3个时间点血糖水平升高GDM检出率比较，差异有统计学意义（χ2=7.80，P=0.02）;其中服糖后1 h血糖水平升高GDM检出率低于空腹血糖水平和服糖后2 h血糖水平（P<0.01）。3组孕妇年龄比较，差异有统计学意义（P<0.05）；其中A组孕妇年龄低于B组和C组（P<0.05）。3组孕妇妊娠前BMI、妊娠期体质量增长、新生儿出生体质量比较，差异均无统计学意义（P>0.05）。3组胎儿窘迫发生率比较，差异有统计学意义（P<0.05）；其中C组胎儿窘迫发生率低于B组（P<0.01）。3组胎膜早破、巨大儿、早产、新生儿病理性黄疸及妊娠期高血压发生率比较，差异均无统计学意义（P>0.05）。结论　GDM检出率为21.12%。OGTT不同时间点血糖水平诊断GDM存在一定的差异，服糖后1 h血糖水平升高GDM检出率明显低于空腹血糖水平和服糖后2 h血糖水平。服糖后1 h血糖诊断组胎儿窘迫发生率较高。

关键词: 糖尿病,妊娠, 葡糖耐量试验, 诊断, 妊娠结局