妊娠期糖尿病对婴儿出生后并发症及智能行为发育的影响
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摘要
目的探讨妊娠期糖尿病(GDM)对婴儿出生后并发症及智能行为发育的影响。方法收集108例妊娠期糖尿病母亲婴儿(GDM组)及120例健康母亲婴儿(对照组)的临床资料,按母亲糖代谢控制程度将GDM组分为血糖控制正常组87例(GDM1组)及血糖控制不良组21例(GDM2组)。比较GDM组与对照组、GDM1组与GDM2组出生后的并发症发生情况。对所有婴儿进行随访,比较对照组、GDM1组与GDM2组出生42 d、3月龄和6月龄的盖泽尔智能评分。结果 GDM组的低血糖、高胆红素血症、早产、窒息、大于胎龄儿(LGA)、小于胎龄儿(SGA)、红细胞增多症、先天畸形、肺炎的发生率均高于对照组(P<0.05)。GDM2组的低血糖、早产儿、LGA、SGA、高胆红素血症、肺炎的发生率均高于GDM1组(P<0.05)。3组的盖泽尔智能评分均随时间的延长而增高(P<0.05),而各时间点对照组的评分高于其他两组(P<0.05),但GDM1组与GDM2组间比较,差异无统计学意义(P>0.05)。结论 GDM对子代各种病理并发症的发生和早期智能行为发育均可能有影响。
Objective To explore the influence of gestational diabetes mellitus( GDM) on postnatal complications and neurobehavioral development of infants. Methods The clinical data of 108 infants whose mothers suffering GDM( GDM group) and 110 infants of healthy mothers( control group) were collected. The GDM group was divided into well-controlled blood glucose group( GDM1 group,n =87) and poorly-controlled blood glucose group( GDM2 group,n = 21) according to the results of blood glucose control of the mothers. The incidence of complications after birth was compared between the GDM group and the control group,also between the GDM1 group and the GDM2 group. A follow-up was performed in all infants,and the scores of Gesell Development Scale were compared among the control group,the GDM1 group and the GDM2 group at 42 days,three months and six months after birth. Results The incidence rates of hypoglycemia,hyperbilirubinemia,premature delivery,asphyxia,large-for-gestational-age( LGA) infant,small-for-gestational-age( SGA) infant,polycythemia,congenital malformation and pneumonia were higher in the GDM group compared to the control group( P < 0. 05). The incidence rates of hypoglycemia,premature delivery,LGA infant,SGA infant,hyperbilirubinemia and pneumonia were higher in the GDM2 group compared to the GDM1 group( P < 0. 05).The scores of Gesell development scale increased over time in the three groups( P < 0. 05). At each time point,the scores of the control group were higher than those of other two groups( P < 0. 05),but there was no significant difference between the GDM1 group and the GDM2 group( P > 0. 05). Conclusion GDM might affect the incidence of pathological complications and early neurobehavioral development of offspring.
Objective To explore the influence of gestational diabetes mellitus( GDM) on postnatal complications and neurobehavioral development of infants. Methods The clinical data of 108 infants whose mothers suffering GDM( GDM group) and 110 infants of healthy mothers( control group) were collected. The GDM group was divided into well-controlled blood glucose group( GDM1 group,n =87) and poorly-controlled blood glucose group( GDM2 group,n = 21) according to the results of blood glucose control of the mothers. The incidence of complications after birth was compared between the GDM group and the control group,also between the GDM1 group and the GDM2 group. A follow-up was performed in all infants,and the scores of Gesell Development Scale were compared among the control group,the GDM1 group and the GDM2 group at 42 days,three months and six months after birth. Results The incidence rates of hypoglycemia,hyperbilirubinemia,premature delivery,asphyxia,large-for-gestational-age( LGA) infant,small-for-gestational-age( SGA) infant,polycythemia,congenital malformation and pneumonia were higher in the GDM group compared to the control group( P < 0. 05). The incidence rates of hypoglycemia,premature delivery,LGA infant,SGA infant,hyperbilirubinemia and pneumonia were higher in the GDM2 group compared to the GDM1 group( P < 0. 05).The scores of Gesell development scale increased over time in the three groups( P < 0. 05). At each time point,the scores of the control group were higher than those of other two groups( P < 0. 05),but there was no significant difference between the GDM1 group and the GDM2 group( P > 0. 05). Conclusion GDM might affect the incidence of pathological complications and early neurobehavioral development of offspring.
引文
[1]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.
[2]Anna V,van der Ploeg HP,Cheung NW,et al.Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005[J].Diabetes Care,2008,31(12):2 288-2 293.
[3]Simeoni U,Barker DJ.Offspring of diabetic pregnancy:longterm outcomes[J].Semin Fetal Neonatal Med,2009,14(2):119-124.
[4]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[J].4版.北京:人民卫生出版社,2011:页码209-698.
[5]中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿高胆红素血症诊断和治疗专家共识[J].中华儿科杂志,2014,52(10):745-748.
[6]张春一,龙芳,叶秀桢,等.妊娠期糖尿病对新生儿并发症及神经行为发育的影响[J].暨南大学学报(自然科学与医学版),2014,35(6):547-550.
[7]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.
[8]H Nagy K,Pomucz J,Varga R,et al.Anthropometric data,fetal and neonatal complications in infants of diabetic mothers.Results of a 10-year retrospective study[J].Orv Hetil,2013,154(5):172-177.
[9]Radaelli T,Lepercq J,Varastehpour A,et al.Differential regulation of genes for fetoplacental lipid pathways in pregnancy with gestational and type 1 diabetes mellitus[J].Am J Obstet Gynecol,2009,201(2):209-201.
[10]Mitanchez D.Foetal and neonatal complications in gestational diabetes:perinatal mortality,congenital malformations,macrosomia,shoulder dystocia,birth injuries,neonatal complications[J].Diabetes Metab,2010,36(6 Pt 2):617-627.
[11]Balsells M,García-Patterson A,Gich I,et al.Major congenital malformations in women with gestational diabetes mellitus:a systematic review and meta-analysis[J].Diabetes Metab Res Rev,2012,28(3):252-257.
[12]Schneider DJ,Moore JW.Patent ductus arteriosus[J].Circulation,2006,114(17):1 873-1 882.
[13]Chang TI,Horal M,Jain SK,et al.Oxidant regulation of gene expression and neural tube development:Insights gained from diabetic pregnancy on molecular causes of neural tube defects[J].Diabetologia,2003,46(4):538-545.
[14]Zhao Z,Yang P,Eckert RL,et al.Caspase-8:a key role in the pathogenesis of diabetic embryopathy[J].Birth Defects Res B Dev Reprod Toxicol,2009,86(1):72-77.
[15]甘斌,杨树杰,易海英,等.糖尿病母亲婴儿脑损伤高危因素分析[J].中华实用诊断与治疗杂志,2014,28(12):1 246-1 248.
[16]Ornoy A.Growth and neurodevelopmental outcome of children born to mothers with pregestational and gestational diabetes[J].Pediatr Endocrinol Rev,2005,3(2):104-113.
[17]Camprubi Robles M,Campoy C,Garcia Fernandez L,et al.Maternal diabetes and cognitive performance in the offspring:A systematic review and meta-analysis[J].PLo S One,2015,10(11):e0142583.
[2]Anna V,van der Ploeg HP,Cheung NW,et al.Sociodemographic correlates of the increasing trend in prevalence of gestational diabetes mellitus in a large population of women between 1995 and 2005[J].Diabetes Care,2008,31(12):2 288-2 293.
[3]Simeoni U,Barker DJ.Offspring of diabetic pregnancy:longterm outcomes[J].Semin Fetal Neonatal Med,2009,14(2):119-124.
[4]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[J].4版.北京:人民卫生出版社,2011:页码209-698.
[5]中华医学会儿科学分会新生儿学组,《中华儿科杂志》编辑委员会.新生儿高胆红素血症诊断和治疗专家共识[J].中华儿科杂志,2014,52(10):745-748.
[6]张春一,龙芳,叶秀桢,等.妊娠期糖尿病对新生儿并发症及神经行为发育的影响[J].暨南大学学报(自然科学与医学版),2014,35(6):547-550.
[7]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.
[8]H Nagy K,Pomucz J,Varga R,et al.Anthropometric data,fetal and neonatal complications in infants of diabetic mothers.Results of a 10-year retrospective study[J].Orv Hetil,2013,154(5):172-177.
[9]Radaelli T,Lepercq J,Varastehpour A,et al.Differential regulation of genes for fetoplacental lipid pathways in pregnancy with gestational and type 1 diabetes mellitus[J].Am J Obstet Gynecol,2009,201(2):209-201.
[10]Mitanchez D.Foetal and neonatal complications in gestational diabetes:perinatal mortality,congenital malformations,macrosomia,shoulder dystocia,birth injuries,neonatal complications[J].Diabetes Metab,2010,36(6 Pt 2):617-627.
[11]Balsells M,García-Patterson A,Gich I,et al.Major congenital malformations in women with gestational diabetes mellitus:a systematic review and meta-analysis[J].Diabetes Metab Res Rev,2012,28(3):252-257.
[12]Schneider DJ,Moore JW.Patent ductus arteriosus[J].Circulation,2006,114(17):1 873-1 882.
[13]Chang TI,Horal M,Jain SK,et al.Oxidant regulation of gene expression and neural tube development:Insights gained from diabetic pregnancy on molecular causes of neural tube defects[J].Diabetologia,2003,46(4):538-545.
[14]Zhao Z,Yang P,Eckert RL,et al.Caspase-8:a key role in the pathogenesis of diabetic embryopathy[J].Birth Defects Res B Dev Reprod Toxicol,2009,86(1):72-77.
[15]甘斌,杨树杰,易海英,等.糖尿病母亲婴儿脑损伤高危因素分析[J].中华实用诊断与治疗杂志,2014,28(12):1 246-1 248.
[16]Ornoy A.Growth and neurodevelopmental outcome of children born to mothers with pregestational and gestational diabetes[J].Pediatr Endocrinol Rev,2005,3(2):104-113.
[17]Camprubi Robles M,Campoy C,Garcia Fernandez L,et al.Maternal diabetes and cognitive performance in the offspring:A systematic review and meta-analysis[J].PLo S One,2015,10(11):e0142583.