妊娠糖尿病筛查与妊娠糖尿病母儿结局的分析研究

目的:分析妊娠糖尿病筛查对妊娠糖尿病母儿结局的影响.方法:抽选2019年1月至2019年12月在本所建卡、已分娩的妊娠期糖尿病产妇作为病例组(64例);另选择同期在本所建卡、已分娩的健康产妇作为对照组(64例)进行回顾性研究,两组在孕期均使用妊娠期糖尿病筛查,比较两组新生儿评分、不良妊娠结局以及并发症发生率.结果:对照...     

妊娠期糖尿病孕妇糖化血红蛋白水平与不良母婴结局的相关性

目的:通过分析妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇分娩前糖化血红蛋白(glycosylated hemoglobin,HbA1c)水平与不良母婴结局的关系,探讨HbAlc在血糖监测及预判母婴结局中的价值。方法:回顾性分析2019年1月至6月在安徽医科大学附属妇幼保健院住院分娩的593例GDM孕妇的临床资料。根据分娩前HbAlc水平将其分为3组:229例孕妇HbAlc<5.5%为A组,284例孕妇HbAlc 5.5%~6.0%为B组,80例HbAlc>6.0%为C组。比较3组母婴结局情况,采用二分类logistic回归分析不良母婴结局的高危因素,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析HbAlc水平预测不良母婴结局的价值。结果:1)C组孕妇妊娠期高血压疾病、巨大儿发生率及新生儿体重指数(body mass index,BMI)高于A组、B组(均P<0.05),A组与B组间差异无统计学意义(P>0.05)。C组羊水过多、胎膜早破、胎儿窘迫发生率最高,与A组比较差异有统计学意义(P<0.05),与B组比较差异无统计学意义(P>0.05)。C组早产发生率最高,与B组比较差异有统计学意义(P<0.05),与A组比较差异无统计学意义(P>0.05)。3组剖宫产、产后出血、新生儿窒息及胎死宫内发生率比较,差异均无统计学意义(均P>0.05)。Pearson积矩相关分析显示新生儿BMI与HbAlc水平呈正相关(r=0.167,P<0.05)。2)二分类logistic回归分析显示HbAlc水平升高是不良母婴结局的危险因素(B组OR=1.477,95%CI:1.011~2.158,P<0.05;C组OR=1.848,95%CI:1.022~3.344,P<0.05)。HbAlc水平有预测不良母婴结局的价值,曲线下面积(area under curve,AUC)为0.601(P<0.001)。结论:分娩前HbAlc水平可作为GDM孕妇孕期血糖监测及预测不良母婴结局的辅助指标。     

妊娠期糖尿病患者网膜素-1与新生儿体质量的相关性研究

目的探讨妊娠期糖尿病（gestational diabetes mellitus,GDM）足月妊娠患者血清网膜素-1水平变化及其与新生儿体质量的相关性。方法采用ELISA法检测60例GDM孕妇（GDM组）,60例糖耐量试验正常孕妇（对照组）血清网膜素-1以及分娩后脐静脉血清中网膜素-1水平;测量新生儿体质量及身高,分析网膜素-1与新生儿体质量、身高的相关性。结果GDM组母体及脐带血清网膜素-1水平低于对照组（P〈0．05）;GDM组新生儿体质量高于对照组（P〈0．05）,2组新生儿身高比较差异无统计学意义（P〉0．05）;脐带血清网膜素-1水平与新生儿体质量呈负相关（r=-0．213,P=0．033）。结论血清网膜素-1降低可能是GDM发生、发展的重要环节,脐带血清网膜素-1水平是影响新生儿体质量的因素之一。     

二甲双胍和胰岛素在妊娠糖尿病患者中的疗效对比观察及对新生儿的影响研究

目的观察二甲双胍和胰岛素在妊娠糖尿病患者的临床治疗效果及对新生儿的影响。方法取2012年8月至2016年10月医院收治妊娠期糖尿病患者60例,采用随机数字方法分为对照组(n=30)和观察组(n=30)。对照组采用胰岛素治疗,观察组在对照组基础上联合二甲双胍治疗,比较2组临床疗效及对新生儿的影响。结果观察组治疗后空腹血糖、餐后2h血糖、餐后4h血糖水平,低于对照组,差异有统计学意义(P0.05);观察组平均糖化血红蛋白水平,高于对照组,差异有统计学意义(P0.05);观察组治疗后新生儿窒息、胎儿窘迫、呼吸窘迫、巨大胎儿及早产发生率低于对照组,差异有统计学意义(P0.05);2组治疗前胱抑素C(Cys C)及同型半胱氨酸(Hcy)水平比较差异无统计学意义(P0.05);观察组治疗后CysC及Hcy水平低于对照组,差异有统计学意义(P0.05);观察组治疗后血糖达标所需时间短于对照组,差异有统计学意义(P0.05);观察组胰岛素用量少于对照组,差异有统计学意义(P0.05)。结论与胰岛素治疗相比,妊娠糖尿病患者采用二甲双胍治疗效果理想,能改善新生儿结局,值得推广应用。     

Exercise during pregnancy has a preventative effect on excessive maternal weight gain and gestational diabetes. A randomized controlled trial

Background

Excessive gestational weight gain is associated with several adverse events and pathologies during pregnancy.

糖化血红蛋白控制在妊娠期糖尿病管理中的价值及对母婴健康的影响

目的 探讨糖化血红蛋白(HbA1c)控制在妊娠期糖尿病管理中的价值及对母婴健康的影响.方法 选取2020年1月至10月我院收治的104例妊娠期糖尿病孕妇作为研究对象,根据产前HbA1c将其分为A组和B组,A组HbA1c>6％,B组HbA1c≤6％,每组52例;另选择同期于我院进行体检的51名健康孕妇作为C组.观察并比较...     

妊娠期糖尿病患者脐血成纤维细胞生长因子19、瘦素水平与新生儿出生体重的关系

目的分析妊娠期糖尿病(GDM)患者脐血成纤维细胞生长因子19(FGF19)、瘦素(LP)水平与新生儿出生体重的关系。方法选择2017年2月至2018年11月在我院住院分娩的GDM孕妇44例为GDM组,正常孕妇44例为对照组,检测两组母体血清及胎儿脐血FGF19、LP水平,测量新生儿出生体重。分析新生儿出生体重与脐血FGF19、LP的相关性。结果GDM组母体与脐血FGF19低于对照组(P<0.01),母体与脐血LP、新生儿体重高于对照组(P<0.05);GDM患者脐血FGF19与LP呈负相关(r=-0.553,P<0.01);新生儿体重与脐血FGF19呈负相关,与LP呈正相关(r=-0.513,0.433,P<0.01)。结论GDM患者母儿均存在FGF19水平降低、LP水平升高,且脐血FGF19、LP与新生儿出生体重明显相关,可作为预测GDM新生儿体重及健康的指标。     

Infant feeding, early weight gain, and risk of type 1 diabetes. Childhood Diabetes in Finland (DiMe) Study Group

OBJECTIVE: To evaluate whether the increased risk of type 1 diabetes conferred by an early introduction of cow's milk supplements can be mediated by accelerated growth in formula-fed infants. RESEARCH DESIGN AND METHODS: All children < or = 14 years of age who were diagnosed with type 1 diabetes from September 1986 to April 1989 were invited to participate in the study. Birth date- and sex-matched control children were randomly selected from the Finnish Population Registry. At least three weight measurements from the first year of life were obtained for 435 full-term diabetic subjects and 386 control subjects from well-baby clinics and school health care units. RESULTS: Increase in body weight was greater in the diabetic girls than in the control girls, and the difference increased from 111 g (95% CI 0-218, P = 0.04) at 1 month of age to 286 g (95% CI 123-450, P = 0.0006) at 7 months. For boys, the difference in weight between the diabetic subjects and the control subjects remained stable during infancy (difference 95 g, 95% CI-2-205, P = 0.09). Increased weight was associated on average with a 1.5-fold risk of type 1 diabetes. Early introduction of formula feeding (< 3 vs. > or = 3 months) was also associated with an increased risk of type 1 diabetes after adjustment for the individual weight gain curve (adjusted odds ratio 1.53, 95% CI 1.1-2.2). No evidence for interaction was observed. CONCLUSIONS: These observations indicate that an early exposure to cow's milk formula-feeding and rapid growth in infancy are independent risk factors of childhood type 1 diabetes.     

血清铁、铁蛋白和转铁蛋白与妊娠期糖尿病的相关性研究

目的探讨妊娠期糖尿病(GDM)与血清铁(SI)、血清铁蛋白(SF)和血清转铁蛋白(TRF)水平变化的关系及临床意义。方法选取2017年1-8月江苏省妇幼保健院孕周为24~28周的GDM孕妇121例作为GDM组,血糖正常的孕妇167例作为对照组。分别测定两组孕妇SI、SF、TRF、血红蛋白(Hb)、平均红细胞体积(MCV)、平均红细胞血红蛋白含量(MCH)、平均红细胞血红蛋白浓度(MCHC)水平并进行比较。结果与对照组孕妇比较,GDM组孕妇SI、SF、TRF水平均明显升高,差异均有统计学意义(P<0.05);两组孕妇Hb、MCV、MCH和MCHC水平比较,差异均无统计学意义(P>0.05);SI、SF及TRF水平与空腹血糖、1 h血糖、2 h血糖均呈正相关(P<0.05);单因素Logistic回归分析显示,当显著性水平α=0.05时,SI、SF和TRF水平均是GDM发病的危险因素(P<0.01)。结论孕妇体内铁储存水平的升高与GDM的发生密切相关。     

Pregnancy outcome and infant development following gestational cocaine use by social cocaine users in Toronto, Canada.

To determine the effect of first trimester cocaine use on pregnancy outcome we conducted a prospective cohort study of 30 women admitting to social cocaine use (SCU) during early pregnancy, 20 users of cannabis during the first trimester and 30 matched recreational drug-free control subjects. The groups were of similar age, marital status, and obstetric history and were predominantly white. They were of similar socioeconomic status (SES), however the spouses of the cocaine users were of significantly lower SES than those of both control groups (p less than 0.005). The number of years of education of the cocaine users and the fathers of the SCU-exposed fetuses was significantly lower than that of the recreational drug-free control subjects (p = 0.004), however, female IQ was similar among the three groups (109.1 +/- 12.4 cocaine; 109.1 +/- 25.2 cannabis; 114.1 +/- 11.7 drug-free). Alcohol and cigarette use was greater among the cocaine users than among subjects of the recreational drug-free control group (p less than 0.025). Cocaine and the associated lifestyle were not associated with any adverse obstetric or neonatal endpoint (pregnancy weight gain, incidence of delivery complications, gestational age, birth weight, Apgar scores, and rates of major and minor malformations). There were no differences between groups in attaining developmental milestones. Mental and motor scores on the Bayley Scales of Infant Development and Vineland Adaptive Behavior Scales were identical among the three groups, studied at a mean of 19.7 months of age. We conclude that outcome of pregnancy of social cocaine users and subsequent infant physical and cognitive development are within normal limits at 1.6 years of age.     

三因素三水平正交试验用于运动疗法对妊娠期糖尿病母婴结局的观察

目的：观察正交试验用于运动疗法干预对妊娠期糖尿病（GDM）妊娠母婴结局的影响,为制定科学的运动干预方法提供依据。方法纳入我院妇产科GDM产妇216例（GDM组）,采用正交试验运动疗法干预加糖尿病健康教育,试验开始前再随机分为运动（A）组和非运动（B）组,比较各组糖尿病曲线下面积（AUC）。另选择同期于我院分娩,糖耐量正常产妇220名（NGT组）。比较两组一般实验室检查资料、BMI、羊水指数、产后出血量、新生儿阿氏评分及并发症等差异。结果通过正交试验运动疗法加糖尿病健康教育干预后,A组AUC为（519．69～650．39）mmol/（L·min）,平均（585．65±30．78）mmol/（L·min）,B组为（539．19～692．45）mmol/（L·min）,平均（614．27±35．45）mmol/（L·min）（P＝0．001）。GDM组FPG、2hPG、HbA1c及BMI较干预前均降低（P＜0．05）,与NGT组比较,差异均无显著意义（P＞0．05）。GDM组孕妇羊水过多、早产、胎膜早破、先兆子痫、巨大儿、胎儿窘迫、产后出血发生情况与NGT组比较,差异无显著意义（P＞0．05）;阿氏评分＜7分、剖宫产、妊高症及新生儿黄疸情况与NGT组比较,差异有显著意义（P＜0．05）。结论正交试验用于运动干预加糖尿病健康教育能够改善GDM患者血糖水平,显著改善妊娠结局,并能降低围产儿发病率,对提高护理围产质量具有重要意义。     

双胎妊娠的分娩方式的选择及妊娠结局探讨

目的探讨双胎妊娠的分娩方式的选择及妊娠结局。方法将1996年1月-2006年7月102例双胎妊娠产妇按分娩方式分为阴道分娩组及剖宫产组，对其临床资料进行回顾分析。结果孕龄〈37周时，阴道分娩组显著高于剖宫产组（P〈0．01），孕龄≥37周时，阴道分娩组显著低于剖宫产组（P〈0．01）；产后出血率两组比较无显著性差异（P〉0、05）；剖宫产组新生儿体重≥2500g者显著高于阴道分娩组（P〈0．01）；第一胎儿出生后新生儿窒息率两组比较无显著性差异（P〉0．05），而第二胎儿出生后新生儿窒息率剖宫产组显著低于阴道分娩组（P〈0．01）。结论孕龄≥37周，胎儿体重≥2500g，则以剖宫产为宜。正确选择双胎妊娠的分娩方式，将有助于降低新生儿窒息率。     

Doppler study of the umbilical and fetal middle cerebral arteries in women with gestational diabetes mellitus.

OBJECTIVE: To investigate the correlation between Doppler parameters in the umbilical and fetal middle cerebral arteries and pregnancy outcome in women with gestational diabetes mellitus (GDM). METHODS: A prospective study was performed on 169 singleton GDM pregnancies in a university teaching hospital from January to December 2002. Umbilical artery (UA) pulsatility index (PI) and middle cerebral artery (MCA) PI and peak systolic velocity (Vmax) were measured every 4 weeks until delivery from the time of diagnosis of GDM. The pregnancy outcome was obtained from the hospital database. Using linear or quadratic regression, lines of best fit were drawn to compare the Doppler measurements between the two groups with normal and abnormal pregnancy outcomes. RESULTS: One hundred and thirty-eight women with known pregnancy outcome completed the study. A total of 305 Doppler examinations were performed with one to four examinations for each woman. Thirty-eight women (27.5%) had one or more abnormal pregnancy outcomes: placental abruption, pre-eclampsia, preterm delivery, small-for-gestational age (SGA) infants, low Apgar scores, neonatal jaundice requiring treatment, sepsis, birth trauma, meconium aspiration syndrome, respiratory and neurological complications. There was extensive overlap of the UA-PI, MCA-PI and MCA-Vmax measurements between the two groups. CONCLUSION: A Doppler study of the UA-PI, MCA-PI and MCA-Vmax was not useful in the prediction of abnormal pregnancy outcome in GDM.     

Improved glycemic control reduces the impact of weight gain on cardiovascular risk factors in type 1 diabetes. The Epidemiology of Diabetes Complications Study.

OBJECTIVE: To assess the prevalence and incidence of being overweight in type 1 diabetes, to identify factors associated with weight gain and improved glycemic control, and to examine relationships among weight gain, glycemic control, and cardiovascular risk factors. RESEARCH DESIGN AND METHODS: The prevalence and incidence of being overweight in the Pittsburgh Epidemiology of Diabetes Complications (EDC) cohort (n = 441) were compared with the general population (National Health and Nutrition Examination Survey [NHANES]). Factors associated with weight gain and improved glycemic control were identified, and relationships among weight gain, glycemic control, and cardiovascular risk factors were examined over a 6.9 +/- 2.2-year period. RESULTS: At baseline, the prevalence of being overweight (BMI > 27.8 kg/m2 for men and > 27.3 kg/m2 for women) was 10.4 and 11.4%, respectively, and was lower than the age- and sex-specific estimate for the general population (P < 0.05). The incidence of being overweight was comparable in men (12.6%) and women (11.8%) and did not differ from the general population (P = 0.98). Weight gain correlated with improvements in HbA1c (r = -0.21, P < 0.001). Patients with the highest baseline HbA1c levels gained the most weight and had the greatest improvement in glycemic control. A lower baseline BMI was also associated with a greater improvement in glycemic control. Weight gain favorably influenced the lipid profile in the setting of improved glycemic control, but adversely influenced the lipid profile in the absence of improved glycemic control. Weight change was directly associated with blood pressure change, but the incidence of hypertension was more strongly influenced by the development of nephropathy. CONCLUSIONS: The prevalence of being overweight in type 1 diabetes remains lower than that in the general population. Moderate weight gain did not adversely affect the cardiovascular risk profile in the setting of improved glycemic control.     

运动对妊娠期糖尿病孕妇血糖控制和妊娠结局影响的研究

[目的]评价运动对妊娠期糖尿病孕妇血糖控制和妊娠结局的影响。[方法]计算机检索数据库中关于运动对妊娠期糖尿病孕妇血糖控制和妊娠结局影响的随机对照试验,由2名研究者对文献质量进行严格评价和资料提取,对符合质量标准的随机对照试验(RCT)进行Meta分析。[结果]共纳入4篇英文RCT,4篇RCT均表明运动可以降低使用胰岛素的人数,3篇RCT表明运动可以改善3餐后血糖水平,3篇RCT对运动中不良反应进行追踪,结果发现无论是阻力运动还是有氧运动,未见明显不良反应。[结论]运动训练可以改善妊娠期糖尿病孕妇3餐后2h血糖,降低胰岛素使用率。     

Prediction of insulin-dependent diabetes mellitus in siblings of children with diabetes. A population-based study. The Childhood Diabetes in Finland Study Group.

An unselected population of 755 siblings of children with insulin-dependent diabetes mellitus (IDDM) was studied to evaluate the predictive characteristics of islet cell antibodies (ICA), antibodies to the IA-2 protein (IA-2A), antibodies to the 65-kD isoform of glutamic acid decarboxylase (GADA), insulin autoantibodies (IAA), and combinations of these markers. We also evaluated whether the histochemical ICA test could be replaced by the combined detection of other markers. 32 siblings progressed to IDDM within 7.7 yr of the initial sample taken at or close to the diagnosis of the index case (median follow-up, 9.1 yr). The positive predictive values of ICA, IA-2A, GADA, and IAA were 43, 55, 42, and 29%, and their sensitivities 81, 69, 69, and 25%, respectively. In contrast to the other three antibody specificities, GADA levels were not related to the risk for IDDM. The risk for IDDM in siblings with four, three, two, one, or no antibodies was 40, 70, 25, 2, and 0.8%, respectively. Combined screening for IA-2A and GADA identified 70% of all ICA-positive siblings, and all of the ICA-positive progressors were also positive for at least one of the three other markers. The sensitivity of the combined analysis of IA-2A and GADA was 81%, and the positive predictive value was 41%. In conclusion, combined screening for IA-2A and GADA may replace the ICA assay, giving comparable sensitivity, specificity, and positive predictive value. Accurate assessment of the risk for IDDM in siblings is complicated, as not even all those with four antibody specificities contract the disease, and some with only one or no antibodies initially will progress to IDDM.     

Maternal anthropometry and pregnancy outcomes: a proposal for the monitoring of pregnancy weight gain in outpatient clinics in South Africa

The aim of this review was to develop a framework for the monitoring of pregnancy weight gain in South African outpatient clinics. Studies showed that intrauterine malnutrition have more serious consequences for children than postnatal malnutrition. Undernutrition, as well as overnutrition during pregnancy, was associated with adverse pregnancy outcomes. The IOM published recommended weight gains by pre-pregnancy body mass index (BMI). Wasting in pregnant women can be defined as a mid-upperarm circumference (MUAC) < 22cm. Low prepregnancy BMI is considered a risk factor for preterm birth and intra-uterine growth retardation. Pregnant women in developing countries start to attend antenatal clinics late in pregnancy, so that prepregnancy BMI may be unknown and antenatal care can be based on pregnancy weight gain only. A framework is proposed that identifies the critical points for action during pregnancy to improve birth outcomes. Health care providers should measure height, weight and MUAC and try to classify pregnant women according to weight status, set weight gain goals and monitor gestational weight gain between follow-up visits. Women with short stature (< 145cm), low body weight (< 45kg), and/or MUAC < 22cm are considered to be at risk of adverse pregnancy outcomes. Weekly weight gains should range from 0.3kg for overweight women to 0.5kg or more for underweight women from the second trimester. Genetic background, age, general health, HIV and educational status, cigarette smoking, past nutritional status of the mother, parity, multiple pregnancies, climate, socioeconomic conditions and the availability of health services should be adjusted for in statistical analyses.