Retrospective Analysis Of Clinical Application Of IADPSG Diagnosis Standard Of Gestational Diabetes Mellitus

Background and objectiveGestational diabetes mellitus(GDM) concept has a history of 60 years since the first time in the 50’s of the last century. GDM is a common disease and refers to the first occurrence of different degrees of abnormal glucose tolerance in pregnant women excluded cases of diabetes before pregnant. Diabetes mellitus is a common endocrine and metabolic diseases. The underlying pathophysiological mechanism is insulin sensitivity decreased, and related carbohydrate and lipid metabolism is abnormal. Glucose in vivo can reach the fetus through the placenta, high levels of blood glucose can stimulate the proliferation of fetal islet beta cells, thus promote the synthesis of protein and fat, leading to fetal macrosomia and a higher rate of dystocia, and accompanied by cephalopelvic disproportion and increased rate of cesarean section. High levels of blood glucose promoted insulin concentration was increased in fetal blood, the function of pancreatic beta cell is still in the state of hyperthyroidism after delivery,leading to neonatal hypoglycemia which may have an effect on neonatal health. There is still no unified diagnosis standard for GDM. Diagnostic criteria of all countries in the world are not the same, leading to great differences of morbidity reported in various regions. Studies have reported, the incidence of GDM was 1%~14%. However, studies have also shown that, the incidence of GDM is 10.6%~14.7% according to the ADA diagnosis standard. Because the GDM diagnosis standard and eating habits are different, The degrees of attention of diagnostic screening of GDM are also different, there are great differences of the incidence of GDM. With the gradual improvement of people’s living level, the incidence of GDM is increased year by year. If GDM can’t be timely and effective intervented, the maternal and fetal health will be directly affected, leading to the occurrence of the risk of vascular lesions and increased maternal gestational hypertension disease, postpartum hemorrhage of cesarean section, and the incidence will increase obviously, but the incidence of fetal pregnancy complications and death also can increase. Most of pregnant women with GDM have no typical symptoms of diabetes. The most of the GDM will be found until the last period of pregnant and confirmed if the routine screening is not be executed. Early detection and diagnosis, and timely control of blood glucose level is an effective prevention and effective measures to prevent the occurrence of GDM and pregnancy complications, it is also an important way to reduce the perinatal diseases. According to the prospective results from American National Institutes of health center: a part of blood glucose levels did not exceed the upper limit of normal, but with the blood glucose level increased gradually, the rates of cesarean delivery, neonatal hypoglycemia, macrosomia will rise. IADPSG in 2010 recommended OGTT critical value: the value of fasting blood glucose was 5.1 mmol/L, 1 h, 2 h after oral glucose values were 10 mmol/L, 8.5 mmol/L. The blood glucose value in this standard was lower than the previous GDM diagnosis standard. Some scholars worried about diagnosis standard was too high which would make the part of the GDM maternal missed diagnosis, it will lead to excessive diagnosis and treatment, so as to increase women’s psychological and medical burden. Because race, region and diet structure are different, so it should be in-depth studied if IADPSG standard is in accordance with the basic situation of of pregnant women in our country. MethodsPregnant women received regular prenatal care and hospital delivery from January 2010 to December 2013 were selected. ADA diagnostic criteria was used for diagnosis of gestational diabetes mellitus in pregnant women from January 2010 to December 2011. IADPSG diagnostic criteria was used for diagnosis of gestational diabetes mellitus in pregnant women from January 2012 to December 2013. All pregnant women diagnosed as GDM received gestational diabetes mellitus knowledge to improve the understanding of this disease. Intervention measures were executed, such as adjusting dietary structure, reasonable allocation of diet. Pregnant women with diabetes mellitus were identified by two kinds of diagnostic criteria for gestational diabetesmellitus. Tntervention measures were taken recording to the different criteria, maternal and neonatal indicators and pregnancy outcomes were compared. The data were analyzed statistically. Results1. 123 cases from 2462 pregnant women in ADA group were detected according to ADA criteria, the detection rate was 5%. There were 65 cases(no intervention) conformed to ADA diagnostic criteria but not IADPSG diagnostic criteria, accounting for 2.64%, the remaining were 2274 cases, accounting for 92.36%. 217 cases from 2517 pregnant women in IADPSG group were detected according to IADPSG criteria, the detection rate was 8.62%. There were 71 cases(no intervention) conformed to IADPSG diagnostic criteria but not ADA diagnostic criteria, accounting for 2.82%, the remaining were 2300 cases, accounting for 91.38%. The differences were statistically significant between two groups(χ 2=25.712,P<0.001).2. There were no significant differences of complications and pregnancy outcome between two groups(P>0.05). The differences of each index were not statistically significant between two groups(P>0.05).3.There were significant differences of the rate of cesarean section, macrosomia, pre-eclampsia between patients with different results in ADA group and control group(P<0.05). There were no significant differences of the rate of premature delivery, premature rupture of membranes, polyhydramnios, low birth weight infants between two groups(P>0.05).4.There were no significant differences of the rate of cesarean section, macrosomia, pre-eclampsia between patients with different results in IADPSG group and control group(P>0.05).5.There were significant differences of the rate of cesarean section(P<0.05) and no significant differences of the incidence of macrosomia, eclampsia(P>0.05)between patients with different results in two groups. ConclusionsThe diagnosis criteria of IADPSG can take more pregnant women with abnormal glucose tolerance in the range of GDM, intervention measures could be executed earlier to improve the pregnancy complications and pregnancy outcome, more conducive to ensure maternal and fetal health.The clinical benefit of IADPSG diagnosis standard still need larger sample size and the domestic randomized study results from different parts to confirm.