妊娠期糖尿病新生儿脐血血气分析影响的研究
|
摘要
目的:探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)新生儿脐血血气分析情况及可能影响因素。方法:选择2015年6—8月同济大学附属第一妇婴保健院分娩的单胎GDM孕妇(GDM组)152例和单胎正常孕妇(对照组)152例。152例GDM孕妇中,阴道分娩组69例,剖宫产组83例;非胰岛素治疗组141例,胰岛素治疗组11例。比较2组新生儿脐血血气分析和结局,以及不同分娩方式和治疗方式对GDM新生儿各项指标的影响。结果:GDM组脐静脉血碱剩余(BE)值较正常对照组低,差异有统计学意义(t=2.702,P=0.007)。不同分娩方式GDM新生儿脐动脉血p H值、脐静脉血p H值、脐动脉血BE值、脐静脉血BE值、脐静脉二氧化碳分压[p(CO_2)]比较,差异有统计学意义(均P<0.05);但2组新生儿结局差异无统计学意义(均P>0.05)。是否采用胰岛素治疗的GDM新生儿脐血血气分析和结局比较差异无统计学意义(均P>0.05)。结论:血糖控制良好的GDM新生儿脐血血气分析与正常妊娠者类似,分娩方式及是否采用胰岛素治疗均不影响GDM新生儿结局。
Objective:We analyzed the umbilical blood gas and investigated its possible influencing factors in neonates of women with gestational diabetes mellitus(GDM). Methods:This study included 152 singleton pregnant women with GDM and152 women with normal glucose tolerance(normal glucose tolerance, NGT) who delivered in Shanghai First Maternity and Infant Hospital from June to August 2015. Of 152 women with GDM, 69 were delivered vaginally, and 83 underwent cesarean delivery;and 11 required insulin therapy. Umbilical blood gases were measured. Results:The umbilical venous BE in the GDM group was lower than that in the NGT group( t=2.702,P=0.007). There were statistic differences in umbilical artery p H, umbilical venous p H, umbilical artery BE, umbilical venous BE and umbilical venous p( CO_2), while neonatal outcomes showed no differences(P >0.05), when compared with different delivery mode in women with GDM(P<0.05). Insulin therapy showed no difference in umbilical blood gas analysis and outcomes(P>0.05). Conclusions:The umbilical blood gas in neonates of women with GDM, who controls her blood glucose well, is similar to that of women with NGT. The mode of delivery and insulin therapy did not significantly affect neonatal-outcome.
Objective:We analyzed the umbilical blood gas and investigated its possible influencing factors in neonates of women with gestational diabetes mellitus(GDM). Methods:This study included 152 singleton pregnant women with GDM and152 women with normal glucose tolerance(normal glucose tolerance, NGT) who delivered in Shanghai First Maternity and Infant Hospital from June to August 2015. Of 152 women with GDM, 69 were delivered vaginally, and 83 underwent cesarean delivery;and 11 required insulin therapy. Umbilical blood gases were measured. Results:The umbilical venous BE in the GDM group was lower than that in the NGT group( t=2.702,P=0.007). There were statistic differences in umbilical artery p H, umbilical venous p H, umbilical artery BE, umbilical venous BE and umbilical venous p( CO_2), while neonatal outcomes showed no differences(P >0.05), when compared with different delivery mode in women with GDM(P<0.05). Insulin therapy showed no difference in umbilical blood gas analysis and outcomes(P>0.05). Conclusions:The umbilical blood gas in neonates of women with GDM, who controls her blood glucose well, is similar to that of women with NGT. The mode of delivery and insulin therapy did not significantly affect neonatal-outcome.
引文
[1]中华医学会围产医学分会.电子胎心监护应用专家共识[J].中华围产医学杂志,2015,18(7):486-490.
[2]中华医学会围产医学分会新生儿复苏学组.新生儿窒息诊断的专家共识[J].中华围产医学杂志,2016,19(1):3-6.
[3]Adamkin DH,Committee on fetus and newborn.Clinical Report—Postnatal Glucose Homeostasis in Late-Preterm and Term Infants[J].Pediatrics,2011,127(3):575-579.
[4]Queensland Clinical Guidelines.Newborn hypoglycaemia[R/OL].[2013-08].https://www.health.qld.gov.au/__data/assets/pdf_file/0019/142156/g-hypogly.pdf.
[5]Li HP,Chen X,Li MQ.Gestational diabetes induces chronic hypoxia stress and excessive inflammatory response in murine placenta[J].Int J Clin Exp Pathol,2013,6(4):650-659.
[6]Gabbay-Benziv R,Baschat AA.Gestational diabetes as one of the"great obstetrical syndromes"—the maternal,placental,and fetal dialog[J].Best Pract Res Clin Obstet Gynaecol,2015,29(2):150-155.
[7]Madazli R,Tuten A,Calay Z,et al.The incidence of placental abnormalities,maternal and cord plasma malondialdehyde and vascular endothelial growth factor levels in women with gestational diabetes mellitus and nondiabetic controls[J].Gynecol Obstet Invest,2008,65(4):227-232.
[8]Jarmuzek P,Wielgos M,Bomba-Opon D.Placental pathologic changes in gestational diabetes mellitus[J].Neuro Endocrinol Lett,2015,36(2):101-105.
[9]朱东波,孙香玲,申屠飞兰,等.脐血血气分析评价围生期窒息及新生儿预后的相关研究[J].中国小儿急救医学,2006,13(1):51-52.
[10]Thorp JA,Rushing RS.Umbilical cord blood gas analysis[J].Obstet Gynecol Clin North Am,1999,26(4):695-709.
[11]Yan Y,Liu Z,Liu D.Heterogeneity of glycometabolism in patients with gestational diabetes mellitus:Retrospective study of 1,683pregnant women[J].J Diabetes Investig,2017,8(4):554-559.
[12]Al-Aissa Z,Hadarits O,Rosta K,et al.A brief of gestational diabetes mellitus,risk factors and current criteria of diagnosis[J].Orv Hetil,2017,158(8):283-290.
[13]潘玥,刘巧,朱绍密.妊娠期糖尿病胰岛素治疗的临床分析[J].中国计划生育和妇产科,2011,3(6):57-60.
[14]Bogdanet D,Egan AM,Reddin C,et al.ATLANTIC DIP:Insulin Therapy for Women With IADPSG-Diagnosed Gestational Diabetes Mellitus.Does It Work?[J].J Clin Endocrinol Metab,2017,102(3):849-857.
[15]黎小兰,王艳丽,邹文霞,等.新生儿脐血p H和BE影响因素的研究[J].中国新生儿科杂志,2014,29(1):27-31.
[16]Kotaska K,Urinovska R,Klapkova E,et al.Re-evaluation of cord blood arterial and venous reference ranges for p H,p O(2),p CO(2),according to spontaneous or cesarean delivery[J].J Clin Lab Anal,2010,24(5):300-304.
[2]中华医学会围产医学分会新生儿复苏学组.新生儿窒息诊断的专家共识[J].中华围产医学杂志,2016,19(1):3-6.
[3]Adamkin DH,Committee on fetus and newborn.Clinical Report—Postnatal Glucose Homeostasis in Late-Preterm and Term Infants[J].Pediatrics,2011,127(3):575-579.
[4]Queensland Clinical Guidelines.Newborn hypoglycaemia[R/OL].[2013-08].https://www.health.qld.gov.au/__data/assets/pdf_file/0019/142156/g-hypogly.pdf.
[5]Li HP,Chen X,Li MQ.Gestational diabetes induces chronic hypoxia stress and excessive inflammatory response in murine placenta[J].Int J Clin Exp Pathol,2013,6(4):650-659.
[6]Gabbay-Benziv R,Baschat AA.Gestational diabetes as one of the"great obstetrical syndromes"—the maternal,placental,and fetal dialog[J].Best Pract Res Clin Obstet Gynaecol,2015,29(2):150-155.
[7]Madazli R,Tuten A,Calay Z,et al.The incidence of placental abnormalities,maternal and cord plasma malondialdehyde and vascular endothelial growth factor levels in women with gestational diabetes mellitus and nondiabetic controls[J].Gynecol Obstet Invest,2008,65(4):227-232.
[8]Jarmuzek P,Wielgos M,Bomba-Opon D.Placental pathologic changes in gestational diabetes mellitus[J].Neuro Endocrinol Lett,2015,36(2):101-105.
[9]朱东波,孙香玲,申屠飞兰,等.脐血血气分析评价围生期窒息及新生儿预后的相关研究[J].中国小儿急救医学,2006,13(1):51-52.
[10]Thorp JA,Rushing RS.Umbilical cord blood gas analysis[J].Obstet Gynecol Clin North Am,1999,26(4):695-709.
[11]Yan Y,Liu Z,Liu D.Heterogeneity of glycometabolism in patients with gestational diabetes mellitus:Retrospective study of 1,683pregnant women[J].J Diabetes Investig,2017,8(4):554-559.
[12]Al-Aissa Z,Hadarits O,Rosta K,et al.A brief of gestational diabetes mellitus,risk factors and current criteria of diagnosis[J].Orv Hetil,2017,158(8):283-290.
[13]潘玥,刘巧,朱绍密.妊娠期糖尿病胰岛素治疗的临床分析[J].中国计划生育和妇产科,2011,3(6):57-60.
[14]Bogdanet D,Egan AM,Reddin C,et al.ATLANTIC DIP:Insulin Therapy for Women With IADPSG-Diagnosed Gestational Diabetes Mellitus.Does It Work?[J].J Clin Endocrinol Metab,2017,102(3):849-857.
[15]黎小兰,王艳丽,邹文霞,等.新生儿脐血p H和BE影响因素的研究[J].中国新生儿科杂志,2014,29(1):27-31.
[16]Kotaska K,Urinovska R,Klapkova E,et al.Re-evaluation of cord blood arterial and venous reference ranges for p H,p O(2),p CO(2),according to spontaneous or cesarean delivery[J].J Clin Lab Anal,2010,24(5):300-304.