妊娠期高血糖的血糖监测与评价

王艳霞, 周满红, 米阳

中国实用妇科与产科杂志 ›› 2025, Vol. 41 ›› Issue (4) : 408-411.

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中国实用妇科与产科杂志 ›› 2025, Vol. 41 ›› Issue (4) : 408-411. DOI: 10.19538/j.fk2025040107
专题笔谈: 关注妊娠期高血糖

妊娠期高血糖的血糖监测与评价

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Monitoring and evaluation of blood glucose in hyperglycemia in pregnancy

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摘要

妊娠期高血糖(HIP)是妊娠期最常见代谢性疾病之一,持续高血糖暴露会导致母儿近远期不良结局。HIP管理策略主要包括:健康教育、营养膳食、运动指导、血糖监测和药物治疗。个体化饮食运动基础上的血糖监测,有助于评估孕妇血糖控制情况,预防高血糖及低血糖的发生。通过将血糖控制在目标范围内,可降低母儿并发症的风险,从而改善妊娠结局。目前,常见的血糖监测有静脉血糖、毛细血管血糖、连续血糖监测等方法。文章将围绕HIP的血糖监测策略进行详细阐述,以期为临床实践提供参考。

Abstract

Hyperglycemia in pregnancy(HIP) is one of the most common metabolic disorders during pregnancy. Prolonged exposure to high levels of blood glucose is associated with adverse short- and long-term outcomes for both mothers and fetuses. Current management strategies for HIP mainly include health education,nutritional diet,exercise guidance,blood glucose monitoring and drug therapy. Blood glucose monitoring based on individualized diet and exercise helps to assess glycemic control in pregnant women and prevent hyperglycemia and hypoglycemia. The risk of maternal and fetal complications can be lowered through controlling blood glucose within the target range,thus improving pregnancy outcomes. At present,common methods of blood glucose monitoring include venous blood glucose monitoring,capillary blood glucose monitoring,and continuous blood glucose monitoring. This review will focus on the strategies for blood glucose monitoring in HIP,aiming to provide reference for clinical practice.

关键词

妊娠期高血糖 / 血糖监测 / 自我血糖监测 / 连续血糖监测

Key words

hyperglycemia in pregnancy / blood glucose monitoring / self-blood glucose monitoring / continuous blood glucose monitoring

引用本文

导出引用
王艳霞, 周满红, 米阳. 妊娠期高血糖的血糖监测与评价[J]. 中国实用妇科与产科杂志. 2025, 41(4): 408-411 https://doi.org/10.19538/j.fk2025040107
WANG Yan-xia, ZHOU Man-hong, MI Yang. Monitoring and evaluation of blood glucose in hyperglycemia in pregnancy[J]. Chinese Journal of Practical Gynecology and Obstetrics. 2025, 41(4): 408-411 https://doi.org/10.19538/j.fk2025040107
中图分类号: R714.147   

参考文献

[1]
Ball CM, Featherstone PJ. Glucose monitoring[J]. Anaesth Intensive Care, 2024, 52(3):143-146. DOI:10.1177/0310057X241235761.
[2]
American Diabetes Association Professional Practice Committee. 7.Diabetes Technology:Standards of Care in Diabetes-2024[J]. Diabetes Care, 2024, 47(1):S126-S144. DOI:10.2337/dc24-S007.
[3]
中国研究型医院学会糖尿病学专业委员会. 中国妊娠期糖尿病母儿共同管理指南(2024版)[J]. 中华糖尿病杂志, 2024, 16(12):1324-1345. DOI:10.3760/cma.j.cn115791-20240918-00561.
[4]
ElSayed NA, Aleppo G, Aroda VR, et al. 15.Management of diabetes in pregnancy:standards of care in diabetes-2023[J]. Diabetes Care, 2023, 46(1):S254-S266. DOI:10.2337/dc23-S015.
[5]
García-Moreno RM, Benítez-Valderrama P, Barquiel B, et al. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus:a systematic review and meta-analysis of randomized clinical trials[J]. Diabet Med, 2022, 39(1):e14703. DOI:10.1111/dme.14703.
This systematic review aims to evaluate the effect of continuous glucose monitoring (CGM) on maternal and neonatal outcomes in gestational diabetes mellitus (GDM).
[6]
American Diabetes Association Professional Practice Committee. 15. management of diabetes in pregnancy: standards of care in diabetes-2025[J]. Diabetes Care, 2025, 48(1):S306-S320. DOI:10.2337/dc25-S015.
[7]
Yoo JH, Kim JH. The benefits of continuous glucose monitoring in pregnancy[J]. Endocrinol Metab (Seoul), 2023, 38(5):472-481. DOI:10.3803/EnM.2023.1805.
Previous studies have consistently demonstrated the positive effects of continuous glucose monitoring (CGM) on glycemic outcomes and complications of diabetes in people with type 1 diabetes. Guidelines now consider CGM to be an essential and cost-effective device for managing type 1 diabetes. As a result, insurance coverage for it is available. Evidence supporting CGM continues to grow and expand to broader populations, such as pregnant people with type 1 diabetes, people with type 2 diabetes treated only with basal insulin therapy, and even type 2 diabetes that does not require insulin treatment. However, despite the significant risk of hyperglycemia in pregnancy, which leads to complications in more than half of affected newborns, CGM indications and insurance coverage for those patients are unresolved. In this review article, we discuss the latest evidence for using CGM to offer glycemic control and reduce perinatal complications, along with its cost-effectiveness in pregestational type 1 and type 2 diabetes and gestational diabetes mellitus. In addition, we discuss future prospects for CGM coverage and indications based on this evidence.
[8]
Wu Z, Li Y. New frontiers in probing the dynamics of purinergic transmitters in vivo[J]. Neurosci Res, 2020, 52:35-43. DOI:10.1016/j.neures.2020.01.008.
[9]
Tang L, Chang SJ, Chen CJ, et al. Non-Invasive blood glucose monitoring technology: a review[J]. Sensors (Basel), 2020, 20(23):6925. DOI:10.3390/s20236925.
In recent years, with the rise of global diabetes, a growing number of subjects are suffering from pain and infections caused by the invasive nature of mainstream commercial glucose meters. Non-invasive blood glucose monitoring technology has become an international research topic and a new method which could bring relief to a vast number of patients. This paper reviews the research progress and major challenges of non-invasive blood glucose detection technology in recent years, and divides it into three categories: optics, microwave and electrochemistry, based on the detection principle. The technology covers medical, materials, optics, electromagnetic wave, chemistry, biology, computational science and other related fields. The advantages and limitations of non-invasive and invasive technologies as well as electrochemistry and optics in non-invasives are compared horizontally in this paper. In addition, the current research achievements and limitations of non-invasive electrochemical glucose sensing systems in continuous monitoring, point-of-care and clinical settings are highlighted, so as to discuss the development tendency in future research. With the rapid development of wearable technology and transdermal biosensors, non-invasive blood glucose monitoring will become more efficient, affordable, robust, and more competitive on the market.
[10]
Jamieson EL, Spry EP, Kirke AB, et al. Prediabetes and pregnancy:Early pregnancy HbA1c identifies Australian Aboriginal women with high-risk of gestational diabetes mellitus and adverse perinatal outcomes[J]. Diabetes Res Clin Pract, 2021, 176:108868. DOI:10.1016/j.diabres.2021.108868.
[11]
Powers Carson J, Arora J, Carter E. Glycated albumin to predict adverse neonatal outcomes among women with diabetes and overweight or obese body mass index[J]. J Appl Lab Med, 2024, 9(6):938-948. DOI:10.1093/jalm/jfae079.
Glycated albumin (GA) has shown promise in predicting risk of adverse neonatal outcomes (ANO) in pregnant women with type 2 diabetes (T2DM) and gestational diabetes (GDM). However, previous studies showing a negative correlation between GA and body mass index (BMI) suggest that lower predictive cutoffs may be needed in populations with elevated BMI.We performed a case-control study of prospectively enrolled pregnant women with T2DM or GDM and BMI ≥25 kg/m2 matched to biobanked controls without diabetes. Serum collected during the second and/or third trimesters was used to measure the percentage of GA (% GA). Receiver operating characteristic (ROC) curves were used to examine % GA to predict an ANO composite, including macrosomia, hypoglycemia, respiratory distress syndrome, and/or hyperbilirubinemia for the second and third trimesters.The median BMIs for cases and controls were 34.0 and 31.0 kg/m2, respectively. The area under the ROC curve to predict the ANO composite was significant for second trimester values but ambiguous for third trimester due to its wide 95% CI. A cutoff of 12.3% GA during second trimester showed 100% sensitivity and 73% specificity. Transference of previously published reference ranges did not validate, suggesting lower ranges are needed for women with overweight/obesity.In this pilot study, % GA shows promise to stratify pregnant patients with diabetes and obesity into risk categories for ANO with excellent predictive ability in the second trimester. If this holds in larger studies, using second trimester % GA could allow additional intervention to improve blood glucose control and minimize ANO.© Association for Diagnostics & Laboratory Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
[12]
Nie X, Shen Y, Ma X, et al. Associations between thyroid hormones and glycated albumin in euthyroid and subclinical hypothyroid individuals: results of an observational study[J]. Diabetes Metab Syndr Obes, 2020, 13:915-923. DOI:10.2147/DMSO.S236698.
[13]
李想, 盛晴, 吴天晨, 等. 早孕期空腹血糖及高危因素对单双胎妊娠期糖尿病及其他不良围产结局的影响[J]. 中国实用妇科与产科杂志, 2025, 41(2):228-233.DOI:10.19538/j.fk2025020116.
[14]
Zhu Y, Zheng Q, Pan Y, et al. Association between prepregnancy body mass index or gestational weight gain and adverse pregnancy outcomes among Chinese women with gestational diabetes mellitus: a systematic review and meta-analysis[J]. BMJ Open, 2024, 14(2):e075226. DOI:10.1136/bmjopen-2023-075226.
The association between prepregnancy body mass index (BMI) or gestational weight gain (GWG) and adverse pregnancy outcomes among Chinese women with gestational diabetes mellitus (GDM) is unknown. This study aims to evaluate such association by synthesising the evidence.
[15]
Ke JF, Liu S, Ge RL, et al. Associations of maternal pre-pregnancy BMI and gestational weight gain with the risks of adverse pregnancy outcomes in Chinese women with gestational diabetes mellitus[J]. BMC Pregnancy Childbirth, 2023, 23(1):414. DOI:10.1186/s12884-023-05657-8.
Give the high background risk of adverse pregnancy outcomes (APOs), it is important to understand the associations of maternal pre-pregnancy body mass index (ppBMI), gestational weight gain (GWG) with APOs in women with gestational diabetes mellitus (GDM). We addressed the independent and joint associations of maternal ppBMI and GWG with APOs in Chinese women with GDM.
[16]
中华人民共和国国家卫生健康委员会. 妊娠期糖尿病妇女体重增长推荐值标准[J]. 全科医学临床与教育, 2024, 22(1):5-6. DOI:10.13558/j.cnki.issn1672-3686.2024.001.002.

基金

西安市科技局项目(24YXYJ0025)
陕西省重点研发计划(2023-YBSF-519)

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