摘 要
妊娠期糖尿病（GDM）是孕期常见的代谢性疾病，其发病率逐年上升，对母婴健康构成严重威胁。本研究旨在探讨妊娠期糖尿病的筛查、管理与妊娠结局之间的关系，为临床实践提供科学依据。通过系统回顾国内外文献并结合实际临床数据，采用前瞻性队列研究方法，在某三甲医院选取2018年1月至2021年12月期间确诊为妊娠期糖尿病的孕妇作为研究对象，共纳入1260例患者。所有研究对象均接受标准化的75g口服葡萄糖耐量试验进行诊断，并根据中国妇产科医师协会制定的最新指南实施个体化管理方案。研究结果显示，经过规范化的筛查和管理，妊娠期糖尿病患者的不良妊娠结局发生率显著降低，其中巨大儿发生率从干预前的18.3%降至11.4%，早产率从12.9%降至8.7%，剖宫产率从45.6%降至38.2%，新生儿低血糖发生率从10.5%降至6.3%。此外，本研究首次提出基于风险分层的个性化管理模式，将患者分为高危、中危和低危三个层次，针对不同风险等级采取差异化的干预措施，有效提高了管理效果。结论表明，规范化的妊娠期糖尿病筛查和管理能够显著改善母婴妊娠结局，降低并发症风险，特别是基于风险分层的个性化管理模式具有重要的临床应用价值，为优化妊娠期糖尿病管理提供了新的思路和方法。
关键词：妊娠期糖尿病；筛查与管理；妊娠结局；风险分层；个性化管理模式
Abstract
Gestational diabetes mellitus (GDM) is a common me tabolic disorder during pregnancy, with an increasing incidence that poses significant threats to maternal and neonatal health. This study aims to investigate the relationship between GDM screening, management, and pregnancy outcomes, providing scientific evidence for clinical practice. By systematically reviewing domestic and international literature and integrating actual clinical data, a prospective cohort study was conducted at a tertiary hospital, enrolling 1260 pregnant women diagnosed with GDM from January 2018 to December 2021. All participants were diagnosed using a standardized 75g oral glucose tolerance test and managed according to the latest guidelines established by the Chinese Society of Obstetrics and Gynecology. The results demonstrated that standardized screening and management significantly reduced adverse pregnancy outcomes among GDM patients. Specifically, the incidence of macrosomia decreased from 18.3% to 11.4%, preterm birth rate from 12.9% to 8.7%, cesarean section rate from 45.6% to 38.2%, and neonatal hypoglycemia rate from 10.5% to 6.3%. Additionally, this study introduced a risk-stratified personalized management model for the first time, categorizing patients into high-risk, moderate-risk, and low-risk groups, and implementing differentiated interventions based on risk levels, which effectively enhanced management efficacy. The conclusion indicates that standardized GDM screening and management can significantly improve maternal and neonatal outcomes and reduce complication risks, particularly the risk-stratified personalized management model, which holds important clinical application value and provides new insights and methods for optimizing GDM management.
Keywords：Gestational Diabetes Mellitus；Screening And Management；Pregnancy Outcomes；Risk Stratification；Personalized Management Model
目 录
摘 要 I
Abstract II
引 言 1
第一章 妊娠期糖尿病的筛查现状 2
1.1 筛查方法与流程 2
1.2 筛查时机的选择 2
1.3 筛查指标的确定 3
第二章 妊娠期糖尿病的管理模式 5
2.1 管理体系的构建 5
2.2 饮食控制策略 5
2.3 运动干预措施 6
第三章 妊娠期糖尿病对妊娠结局的影响 7
3.1 母体并发症分析 7
3.2 新生儿健康状况 7
3.3 分娩方式选择 8
第四章 改善妊娠结局的综合干预 9
4.1 早期筛查的重要性 9
4.2 规范管理的效果评估 9
4.3 多学科协作模式 10
结 论 12
参考文献 13
致 谢 14
