perinatal factors and the short-term adverse outcomes larger gestational age infants and gestational diabetes mellitus mothers

doi:10.11852/zgetbjzz2021-0382

Abstract

Abstract: Objective To analyze the perinatal factors and the short-term adverse outcomes of large gestational age (LGA) infants delivered by gestational diabetes mellitus (GDM) mothers, so as to provide scientific reference for clinical management of LGA. Methods The clinical data of 817 cases in the obstetrical department of Ma'anshan Maternal and Child Health Hospital from January to May 2019 were collected. Logistic regression was used to analyze the association between perinatal factors and LGA infants in mothers with GDM. The relationship of short outcome between LGA infants and appropriate for gestational age (AGA) infants was analyzed by χ² test. Results Multivariate analysis of LGA infants revealed the following risk factors: Maternal body mass index (BMI)>23.9 kg/m²(OR=1.139, 95%CI:1.082—1.198, P＜0.001), maternal triglyceride(TG)≥2.3 mmol/L (OR=1.115, 95%CI: 1.020-1.219, P=0.016), male neonates (OR=1.089, 95%CI: 1.050-1.129,P＜0.001) and neonatal gestational age (OR=1.403,95%CI:1.205-1.634, P＜0.001) were the risk factors for LGA infants. There was no significant difference of hospitalization between LGA infants and AGA infants (11.2% vs. 12.4%, χ²=0.239, P＞0.05). Conclusions It is supposed to strictly control maternal BMI and TG levels of GDM, and to pay more attention to the long-term adverse of LGA infants in order to promoting mother-infant health. The short-term outcomes of LGA and AGA infants are not distinctly different, so the long-term outcome should be further monitored.

Key words: gestational diabetes mellitus, large for gestational age infants, perinatal

摘要： 目的分析糖尿病母亲新生儿大于胎龄儿的相关围产因素及其近期不良结局的情况,为大于胎龄儿新生儿期的临床管理提供科学依据。方法收集2019 年1—5 月马鞍山市妇幼保健院产科817例妊娠期糖尿病孕妇及其所分娩的新生儿临床资料,采用多因素Logistic二元回归模型对糖尿病母亲新生儿发生大于胎龄儿相关围产因素进行分析;用χ²检验分析大于胎龄儿与适于胎龄儿近期不良结局的关系。结果糖尿病母亲新生儿发生大于胎龄儿危险因素是母亲孕晚期体重指数 (BMI>23.9 kg/m²,OR=1.139,95%CI:1.082~1.198,P<0.001),甘油三酯 (TG≥2.3 mmol/L,OR=1.115,95%CI:1.020～1.219,P=0.016)、男性婴儿(OR=1.089,95%CI:1.050～1.129,P＜0.001)及新生儿胎龄(OR=1.403,95%CI:1.205～1.634,P＜0.001);大于胎龄儿与适于胎龄儿转入新生儿科的发生率,差异无统计学意义(11.2% vs. 12.4%,χ²=0.239,P>0.05)。结论应积极控制妊娠期糖尿病孕妇孕晚期的BMI及TG水平,对胎龄大以及男性婴儿需警惕大于胎龄儿的发生,促进母婴健康;大于胎龄儿近期结局与适于胎龄儿无明显差别,应着重于其日后远期不良结局的监测。

关键词: 妊娠期糖尿病, 大于胎龄儿, 围生期

CLC Number:

YANG Yun, ZHANG Shi-fa. perinatal factors and the short-term adverse outcomes larger gestational age infants and gestational diabetes mellitus mothers[J]. Chinese Journal of Child Health Care, 2021, 29(10): 1125-1129.

杨云, 张士发. 糖尿病母亲新生儿大于胎龄儿的危险因素及近期结局[J]. 中国儿童保健杂志, 2021, 29(10): 1125-1129.

References

[1] Khambalia AZ, Algert CS, Bowen JR , et al. Long-term outcomes for large gestational age infants born at term[J].J Paediatr Child Health,2017,53(9):876-881.
[2] 中华医学会妇产科学分会产科学组,中华医学会围产医学分会妊娠合并糖尿病协作组.妊娠合并糖尿病诊治指南(2014)[J].中华妇产科杂志,2014,49(8):561-569.
[3] 王卫平,孙锟,常立文.儿科学[M].9版.北京:人民卫生出版社,2019:86-139.
[4] 邱海元.空腹血糖、血清果糖胺及糖化血红蛋白联合检测在妊娠期糖尿病诊断中的临床意义[J].中国妇幼保健, 2020, 35(6):1018-1020.
[5] Joint Committee for the Prevention and Treatment of Dyslipidemia in Chinese Adults.Guidelines for the prevention and treatment of dyslipidemia in Chinese adults[J].Chin J Cardiol,2016,44(10):833-850.
[6] Leng J,Shao P,Zhang C,et al. Prevalence of gestational diabetes mellitus and its risk factors in Chinese pregnant women:a prospective population - based study in Tianjin,China[J]. PLoS One,2015,10:e0121029.
[7] 王光花,吴娟丽,赵苗苗,等.妊娠期糖尿病与新生儿不良结局关系的meta分析[J].同济大学学报(医学版),2016, 37(1): 65-72.
[8] 罗碧莲,桂曌环,陈亚军.广州市某社区2～6岁儿童超重肥胖与生命早期因素研究[J].中国学校卫生,2019,40(12):1788-1790.
[9] 霍亭竹,罗小丽,毛萌.妊娠期糖尿病对子代健康的影响:代谢综合征的传递[J].中国儿童保健杂志,2017,25(7): 687-691.
[10] 郑薇,张莉,田志红,等.大于胎龄儿发生风险的人群归因危险度分析[J]. 中华妇产科杂志, 2019, 54(12): 833-839.
[11] 马玲,黄新梅,刘军,等.妊娠糖尿病(GDM)患者糖代谢指标对妊娠结局的预测作用[J]. 复旦大学(医学版),2019,46(2):281-284.
[12] Alberico S,Montico M,Barresi V,et al. The role of gestational diabetes,pre - pregnancy body mass index and gestational weight gain on the risk of newborn macrosomia:results from a prospective multicentre study[J].BMC Pregnancy Childbirth,2014,14:23.
[13] Son GH,Kwon JY,Kim YH. Maternal serum triglycerides as pre- dictive factors for large-for-gestational age newborns in women with gestational diabetes mellitus[J].Acta Obstet Gynecol Scand,2010,89 (5):700-704.
[14] 崔云静,张申华,杨艳华,等. 妊娠期糖尿病患者晚孕期血脂水平与新生儿出生体重的相关性研究[J].中国妇产科临床杂志,2015,16(3):252-253.
[15] Schaefer-graf UM,Graf K,Kulback I,et al.Maternal lipids as strong determinants of fetal environment and growth in pregnancies with gestational diabetes mellitus[J].Diabetes Care,2008,31(9):1858-1863.
[16] 夏莉,胡红琳,王长江,等.妊娠期糖尿病患者血脂水平与胰岛素抵抗相关性分析[J].安徽医科大学学报,2017,52(5):749-752.
[17] Ryckman KK, Spracklen CN, Smith CJ,et al.Maternal lipid levels during pregnancy and gestational diabetes:a systmatic review and meta-analysis[J].BJOG,2015,122(5):643-654.
[18] Ortega-Senovilla H, Schaefer-Graf U, Meitzner K, et al.Decreased concentrations of the lipoprotein lipase inhibitor angiopoietin-like protein 4 and increased serum triacylglycerol are associated with increased neonatal fat mass in pregnant women with gestational diabetes mellitus[J].J Clin Endocrinol Metab,2013,98(8):3430-3437.
[19] 郭冰冰,卫雅蓉,许吟,等. 妊娠期糖尿病对不同性别新生儿体脂含量差异的影响[J].中国儿童保健杂志,2016,24(5):452-454.
[20] 孔令英,杨慧霞,孟文颖,等.妊娠期血脂与妊娠期糖尿病、巨大儿的关系研究[J],中华糖尿病杂志,2016,8(12):735-740.
[21] 沈文霞,周清,杨志峰,等.胎龄别出生体重相关因素分析[J],浙江医学,2018,40(2):112-115.
[22] Mitanchez D,Yzydorczyk C,Siddeek B,et al. The offspring of the diabetic mother--short- and long-term implications [J]. Best Pract Res Clin Obstet Gynaecol,2015,29 (2): 256-269.
[23] McGrath RT, Glastras SJ, Hocking SL, et al.Large-for-gestational-age neonates in type 1 diabetes and preganancy:Contribution of factors beyond hyperglycemia [J].Diabetes Care,2018,41(8):1821-1828.
[24] 中国新生儿死亡原因及相关因素多中心调查协作组.多中心大于胎龄儿新生儿期死亡原因及风险的病例对照研究[J]. 中国循证儿科杂志, 2019,14(6):401-406.
[25] 杨慧霞,赵怿,段晓华,等.妊娠期糖代谢异常对母儿结局影响的前瞻性对照研究[J].中国全科医学,2004,7(14):1044-1045,1067.