妊娠期糖耐量异常对新生儿的影响

目的：妊娠期糖代谢异常可引起新生儿多种并发症。该文通过回顾性分析,探讨妊娠期不同程度糖代谢异常对新生儿的影响。方法：根据孕妇在孕24～28周时50 g葡萄糖筛查试验(GCT)及75 g葡萄糖耐量试验(OGTT)的结果,将其所分娩新生儿分为4组：妊娠期糖尿病组(GDM,182例)、妊娠期糖耐量减低(GIGT)1 h组(57例)、GIGT (2~3 h)组(156例)、GCT异常而OGTT正常(仅GCT异常组, 38例),并以糖代谢正常孕妇所分娩新生儿1 025例作为对照,对妊娠期不同程度糖代谢异常孕母的围产儿结局进行比较。结果：GIGT（1 h）组巨大儿、大于胎龄儿及小于胎龄儿发生率,以及低血糖、早产发生率明显高于对照组,与GDM组类似。GIGT（2~3 h）组和仅GCT异常组巨大儿、小于胎龄儿以及低血糖和早产的发生率明显低于GDM组,差异均有显著性意义,与对照组比较差异无显著性意义。GIGT(1 h)组新生儿低血糖和早产发生率明显高于GIGT (2~3 h) 组和仅GCT异常组, 差异有显著性意义。结论：母亲妊娠期糖代谢异常程度不同对新生儿的影响不同。孕母OGTT 试验1 h 单项血糖升高的糖耐量减低与妊娠糖尿病一样对新生儿具有危险性,可导致巨大儿、大于胎龄儿、小于胎龄儿及低血糖、早产的发生率增加。［中国当代儿科杂志,2009,11（3）：177-180］     

母亲妊娠期糖尿病对新生儿左心功能的影响

目的：评估妊娠期糖尿病（GDM）母亲的新生儿左心功能状况。方法：GDM母亲娩出的新生儿40例（GDM组）及正常新生儿40例（对照组）作为研究对象,应用超声二维斑点追踪成像技术检测室间隔厚度、左室后壁厚度、射血分数,并计算左室旋转和扭转参数。结果：GDM组新生儿室间隔舒张厚度（0.45±0.06 mm）较对照组（0.34±0.05 mm）增大;GDM组左室后壁舒张厚度（0.45±0.17 mm）亦较对照组（0.31±0.02 mm）增大,差异均有统计学意义（P0.05）。GDM组新生儿内膜旋转峰值、外膜旋转峰值、平面旋转峰值、跨壁扭转峰值均较对照组升高,差异有统计学意义（P<0.05）。结论：GDM母亲的新生儿左心室的形态和旋转及扭转运动发生变化,心功能虽受到损害,但处于代偿状态,能维持正常的射血功能。超声二维斑点追踪成像技术可作为早期检测新生儿左心功能的良好手段。     

母亲糖尿病对新生儿神经系统的影响

糖尿病在人群中的发病率日趋增多,妊娠期糖尿病近年来更是为人们所关注.妊娠期糖尿病不但会造成孕妇一系列代谢紊乱,也会造成胎儿、新生儿,甚至在儿童期、青春期各类疾病的发生.人们在注意母亲孕期内分泌代谢异常和新生儿早期疾病的同时,十分关注糖尿病母亲后代遗留的长远问题,除与糖代谢紊乱相关的疾病外,也很注意神经系统的异常,并积极寻找在胎儿期和围生期的发病根源.     

妊娠期糖尿病母亲所生新生儿肾功能的变化

目的 探讨妊娠期糖尿病(GDM)母亲所生新生儿肾功能的变化,加强对GDM母亲所生新生儿并发症的认识,从而提高GDM母亲所生新生儿的生活质量.方法 选取2009年3月-2010年9月山东大学附属省立医院新生儿科收治的GDM母亲所生新生儿45例作为观察组.男23例,女22例;早产儿25例,足月儿20例;巨大儿20例,非巨大儿25例.选取同期出生的非GDM母亲所生新生儿45例作为对照组.男21例,女24例;早产儿18例,足月儿27例;巨大儿22例,非巨大儿23例.研究对象均于出生72 h内采集空腹外周静脉血,应用广州OLYMPUS-AU5400全自动生化分析仪检测血清胱抑素C(Cys-C)、β2微球蛋白(β2-MG)、BUN、肌酐(CREA)水平,观察各检测指标变化.结果 观察组BUN、CREA水平与对照组比较均无统计学差异(Pa＞0.05),血清Cys-C、β2-MG均较对照组升高(Pa＜0.05);观察组早产儿、足月儿Cys-C、β2-MG水平均较对照组显著升高(Pa＜0.05),而观察组早产儿和足月儿间Cys-C、β2-MG水平比较均无统计学差异(Pa＞0.05);观察组巨大儿和非巨大儿Cys-C、β2-MG水平均较对照组升高(Pa＜0.05),观察组巨大儿与非巨大儿间Cys-C、β2-MG水平均无统计学差异(Pa＞0.05).结论 GDM母亲所生新生儿较非GDM母亲所生新生儿血清Cys-C与β2-MG水平升高,GDM母亲所生新生儿可能存在早期肾功能损害,且不受胎龄、体质量影响.     

母亲糖尿病对新生儿神经系统的影响

糖尿病在人群中的发病率日趋增多，妊娠期糖尿病近年来更是为人们所关注。妊娠期糖尿病不但会造成孕妇一系列代谢紊乱，也会造成胎儿、新生儿，甚至在儿童期、青春期各类疾病的发生。人们在注意母亲孕期内分泌代谢异常和新生儿早期疾病的同时，十分关注糖尿病母亲后代遗留的长远问题，除与糖代谢紊乱相关的疾病外，也很注意神经系统的异常，并积极寻找在胎儿期和围生期的发病根源。     

糖尿病母亲婴儿的白细胞分类计数

本研究的目的在于检验糖尿病母亲的婴儿(IDMs)是否有白细胞增多和核左移,并以非糖尿病母亲的婴儿(INMs)做对照。病人和方法研究组中,第1组为115例其母为糖尿病的适于胎龄儿(IDMs-AGA),第2组16例为糖尿病母亲的大于胎龄儿(IDMs-LGA)。对照     

妊娠期糖尿病母亲脐血visfatin水平与新生儿出生体重的关系

妊娠期糖尿病(gestational diabetes mellitus,GDM)指妊娠期首次发现或发生的糖代谢异常,若未及时治疗,可严重危害孕妇及其子代健康.近年许多研究认为,脂肪组织可分泌多种多肽因子,如抵抗素、瘦素等,均可能在胰岛素抵抗(IR)、代谢紊乱、2型糖尿病(T2DM)的发病中起重要作用.     

辅助生殖技术与妊娠期糖尿病孕产妇肠道菌群的特异表达

目的 通过检测和比较不同受孕方式及是否并发妊娠期糖尿病(gestational diabetes mellitus,GDM)孕产妇的肠道菌群,明确辅助生殖技术(assisted reproductive technology,ART)及GDM孕产妇肠道菌群的特异性表达,分析其机制,为今后预防干预、促进ART妊娠母婴健康...     

母乳喂养对妊娠期糖尿病母亲子代儿童期超重的影响

目的：通过对妊娠期糖尿病（GDM）母亲子代的随访,探讨母乳喂养是否可以降低GDM子代发生超重的风险性。方法：对2003年1月至2009年12月GDM母亲子代1189例进行随访,采用logistic回归分析出生后0～3月母乳喂养方式及母乳喂养持续时间对GDM子代超重发生风险的影响。结果：在对孕前BMI、孕期增重、孕期血糖水平、性别、出生体重、年龄及父亲体重等混杂因素进行校正后,0～3月纯母乳喂养组GDM子代儿童期超重发生风险低于人工喂养组（OR：0.479,95%CI：0.256～0.897）;接受0～3月母乳喂养、4～6月母乳喂养及大于6月母乳喂养GDM子代儿童期超重发生风险均低于人工喂养组（分别OR：0.456,95%CI：0.233～0.827;OR：0.29,95%CI：0.103～0.817;OR：0.534,95%CI：0.280～0.970）;接受4～6月母乳喂养GDM子代儿童期超重发生风险低于0～3月母乳喂养组（OR：0.372,95%CI：0.129～0.874）;而接受母乳喂养时间<6月与接受母乳喂养时间≥6月与GDM子代儿童期超重发生风险无相关性（OR：0.769,95%CI：0.4701～1.258）。结论：出生后0～3月母乳喂养,尤其是纯母乳喂养可以降低GDM子代发生超重的风险,且在出生后6月内,随着母乳喂养时间的增加,GDM子代超重发生风险降低,而出生6月以后,延长母乳喂养时间可能并不能降低超重的发生风险。     

母亲妊娠期糖尿病对胎儿结局影响的研究进展北大核心CSCD

妊娠期糖尿病(GDM)是妊娠期最常见的代谢紊乱性疾病,严重影响胎儿的正常发育。妊娠期血糖控制情况不仅与早产、巨大儿、低血糖、新生儿呼吸窘迫综合征、电解质紊乱、心脏发育畸形和肠道菌群紊乱等近期不良结局有关,而且与持续的糖耐量受损、肥胖、代谢综合征、神经精神疾病及眼科疾病等远期结局相关。正确认识GDM对新生儿近期与远期造成的不良影响及其相关机制,及时采取相应的防治措施,可显著改善妊娠结局。本文将对此作一综述。     

Neonatal Macrosomia and Hypoglycaemia in Children of Mothers with Insulin-Treated Gestational Diabetes Mellitus

ABSTRACT. All newborn children to mothers with gestational diabetes mellitus (GDM) in the county of Örebro were investigated during a one year prospective study. Neonatal macrosomia (birthweight > 3 SD) was observed in 27% of children of mothers with GDM and was significantly correlated to the cord C-peptide concentration. Hypoglycaemia (B-glucose <1.5 mmol/l) was observed in 38% of the children, most frequently two hours after delivery. Hypoglycaemia was not more common in macrosomic children and could not be predicted by the blood glucose concentration of the mother at delivery or by the cord C-peptide level. It is concluded that mothers with GDM must be intensively treated in order to avoid the occurrence of macrosomia in their infants and that the newborn child must be carefully observed and treated in order to avoid neonatal hypoglycaemia.     

Neonatal macrosomia and hypoglycaemia in children of mothers with insulin-treated gestational diabetes mellitus.

All newborn children to mothers with gestational diabetes mellitus (GDM) in the county of Orebro were investigated during a one year prospective study. Neonatal macrosomia (birthweight greater than 3 SD) was observed in 27% of children of mothers with GDM and was significantly correlated to the cord C-peptide concentration. Hypoglycaemia (B-glucose less than 1.5 mmol/l) was observed in 38% of the children, most frequently two hours after delivery. Hypoglycaemia was not more common in macrosomic children and could not be predicted by the blood glucose concentration of the mother at delivery or by the cord C-peptide level. It is concluded that mothers with GDM must be intensively treated in order to avoid the occurrence of macrosomia in their infants and that the newborn child must be carefully observed and treated in order to avoid neonatal hypoglycaemia.     

Recognizing a child at increased risk of abuse.

Data from two studies are presented. Both highlight characteristics which help identify children at increased risk of child abuse. The first study demonstrates that the abused child when compared with unharmed children in the same family is more likely to have been the product of an abnormal pregnancy, labor, delivery and neonatal period. He is more likely to have been separated from his mother and to have been ill in the first year of life. His mother too is more likely to have been sick during that year. The second study shows that it is possible to identify 'at risk' families around the time the baby is born. When compared with controls, five factors are more common: mother aged under 20 at birth of first child, evidence of emotional disturbance, referral to the social worker, admission of baby to special care nursery, and early concern over mothering.     

Obesity, gestational diabetes and pregnancy outcome

The prevalence of both obesity and gestational diabetes mellitus (GDM) is rising worldwide. The complications of diabetes affecting the mother and fetus are well known. Maternal complications include preterm labor, pre-eclampsia, nephropathy, birth trauma, cesarean section, and postoperative wound complications, among others. Fetal complications include fetal wastage from early pregnancy loss or congenital anomalies, macrosomia, shoulder dystocia, stillbirth, growth restriction, and hypoglycemia, among others. The presence of obesity among diabetic patients compounds these complications. The above-mentioned short-term complications can be mediated by achieving the desired level of glycemic control during pregnancy. However, GDM during pregnancy is associated with increased risk of early obesity, type 2 diabetes during adolescence and the development of metabolic syndrome in early childhood. Additionally, GDM is a marker for the development of overt type 2 diabetes and metabolic syndrome for the mother in the early future.     

Effect of a low glycaemic index diet in gestational diabetes mellitus on post‐natal outcomes after 3 months of birth: a pilot follow‐up study

A low glycaemic index (LGI) diet during pregnancy complicated by gestational diabetes mellitus (GDM) may offer benefits to the mother and infant pair beyond those during pregnancy. We aimed to investigate the effect of an LGI diet during pregnancy complicated with GDM on early post‐natal outcomes. Fifty‐eight women (age: 23–41 years; mean ± SD pre‐pregnancy body mass index: 24.5 ± 5.6 kg m^?2) who had GDM and followed either an LGI diet (n = 33) or a conventional high‐fibre diet (HF; n = 25) during pregnancy had a 75‐g oral glucose tolerance test and blood lipid tests at 3 months post‐partum. Anthropometric assessments were conducted for 55 mother–infant pairs. The glycaemic index of the antenatal diets differed modestly (mean ± SD: 46.8 ± 5.4 vs. 52.4 ± 4.4; P < 0.001), but there were no significant differences in any of the post‐natal outcomes. In conclusion, an LGI diet during pregnancy complicated by GDM has outcomes similar to those of a conventional healthy diet. Adequately powered studies should explore the potential beneficial effects of LGI diet on risk factors for chronic disease.     

Beta Testing of a Gestational Diabetes Risk Reduction Intervention for American Indian and Alaska Native Teens

IntroductionAmerican Indian and Alaska Native (AIAN) girls have double the risk of obesity, pregnancy, and gestational diabetes mellitus (GDM) than the general U.S. population. The purpose of this study was to beta test Stopping GDM (SGDM), a GDM risk reduction intervention for at-risk AIAN teens, before beginning a randomized controlled trial.MethodA sample of 11 AIAN mothers and daughters were recruited through an urban Indian health program. Daughters were at risk of GDM as assessed by a BMI ≥ 85th percentile. Pre- and posttest online questionnaires evaluated the online intervention (e-book and video).ResultsMean pre- to posttest knowledge increased for mothers and daughters on diabetes prevention, reproductive health, and GDM knowledge. Daughters demonstrated an increased self-efficacy for healthy living and pregnancy planning. Satisfaction for the e-book, video, and online survey was moderately high to very high.DiscussionThe SGDM intervention is feasible and acceptable in AIAN mother–daughter dyads. These findings informed the SGDM intervention and the randomized controlled trial evaluation protocol.     

Weight concerns and weight control behaviors of adolescents and their mothers

OBJECTIVE: To assess the association between weight concerns and weight control practices of adolescents and their mothers. DESIGN AND PARTICIPANTS: Cross-sectional study of 5331 adolescent girls and 3881 adolescent boys (age range, 11.8-18.4 years) in an ongoing cohort study and their mothers. Participants were included in the analysis if both the adolescent and his or her mother returned a questionnaire mailed in 1999 and provided information on weight, height, and weight concerns. RESULTS: More adolescent girls (33.0%) than boys (8.1%) thought frequently about wanting to be thinner. Compared with adolescent girls who accurately perceived that their thinness was not important to their mother, girls who misperceived (odds ratio [OR] = 1.9; 95% confidence interval [CI], 1.3-2.8) or accurately perceived (OR = 2.85; 95% CI, 1.0-8.4) that it was important to their mother that they be thin were significantly more likely to think frequently about wanting to be thinner. Among the adolescent boys, only those who accurately perceived that it was important to their mother that they not be fat were more likely than their peers to think frequently about wanting to be thinner (OR = 3.8; 95% CI, 2.3-6.2). Adolescents who accurately perceived that it was important to their mother to be thin or not fat were significantly more likely to be frequent dieters than their peers who accurately perceived that their weight was not important to their mother. CONCLUSION: Among adolescents, an accurate perception that weight status is important to their mother is associated with thinking frequently about wanting to be thinner and about frequent dieting.     

Exploring the work of donald meltzer: A festschrift

This paper gives an account of some of the themes in the development of a three-year-old child, Bella, observed for one year in a toddler group and occasionally at home. Her mother led the toddler group and had a number of responsibilities which meant the little girl had to share her mother with her work and with other mothers and toddlers as well as her own baby sister of 15 months. The paper considers the impact on Bella's development of sharing her mother with so many others; she often seemed to be in identification with her mother, looking after or playing with her little sister or standing with her mother and other adults. She struggled to feel sufficient confidence and internal strength to move away in order to play with her own peers which might have reflected in interaction with her sister into whom she projected some of her more infantile needs and emotions. The theme of the struggle with being with and separate from mother, which all toddlers face, is discussed, as is the role and emotional response of the observer.     

Release of GI hormones in mother and infant by sensory stimulation

It is well established that sensory stimulation is of great importance for the growth of and for the physiological and psychological development of infants. Supplementary sensory stimulation such as non-nutritive sucking and tactile stimulation has been shown to increase the growth rate and the maturation of premature infants. In human neonates non-nutritive sucking has a vagally mediated influence on the levels of some gastrointestinal hormones. In animal experiments afferent electrical stimulations of the sciatic nerves at low intensity leads to an activation of the vagal nerves and to a consequent release of vagally controlled gastrointestinal hormones such as gastrin and cholecystokinin. We therefore assume that both non-nutritive sucking and tactile stimulation trigger the activity of sensory nerves which leads to a release of vagally regulated gut hormones. Since gut hormones stimulate gastrointestinal motor and secretory activity and the growth of the gastrointestinal tract, and enhance the glucose-induced insulin release, they may contribute to the beneficial effects on maturation and growth caused by sensory stimulation. In the breast-feeding situation, the sucking of the child elicits similar reflexes in the mother leading to an activation of the maternal gut endocrine system and a consequent increase in energy uptake. These data indicate that many types of neurogenic reflexes induced in mother-infant interactions are of importance for the energy economy of both mother and child.     

Release of GI Hormones in Mother and Infant by Sensory Stimulation

ABSTRACT. It is well established that sensory stimulation is of great importance for the growth of and for the physiological and psychological development of infants. Supplementary sensory stimulation such as non-nutritive sucking and tactile stimulation has been shown to increase the growth rate and the maturation of premature infants. In human neonates non-nutritive sucking has a vagally mediated influence on the levels of some gastrointestinal hormones. In animal experiments afferent electrical stimulations of the sciatic nerves at low intensity leads to an activation of the vagal nerves and to a consequent release of vagally controlled gastrointestinal hormones such as gastrin and cholecystokinin. We therefore assume that both nonnutritive sucking and tactile stimulation trigger the activity of sensory nerves which leads to a release of vagally regulated gut hormones. Since gut hormones stimulate gastrointestinal motor and secretory activity and the growth of the gastrointestinal tract, and enhance the glucose-induced insulin release, they may contribute to the beneficial effects on maturation and growth caused by sensory stimulation. In the breast-feeding situation, the sucking of the child elicits similar reflexes in the mother leading to an activation of the maternal gut endocrine system and a consequent increase in energy uptake. These data indicate that many types of neurogenic reflexes induced in mother-infant interactions are of importance for the energy economy of both mother and child.