妊娠期糖耐量降低对新生儿的影响

目的：探讨妊娠期糖耐量降低(GIGT)对新生儿的影响。方法：对GIGT孕妇52例(GIGT组)、正常孕妇40例(对照组)的新生儿进行比较。结果：GIGT组巨大儿发生率明显高于对照组(21.2%vs 5.0%)，(P<0.05)，生后2 h血糖均值低于对照组［(1.52±0.66) mmol/Lvs(2.58±0.57) mmol/L］(P<0.01)，低血糖、高胆红素血症、红细胞增多症等并发症发病率高于对照组，但差异无显著性。结论：GIGT对新生儿的预后有一定影响，应引起重视。     

妊娠期糖耐量损伤与新生儿结局分析

目的探讨妊娠期糖耐量损伤与新生儿结局的关系。方法统计2000年10月-2002年10月在我院进行糖耐量筛查，年龄在20-30岁间，分娩孕周≥34周和孕妇中确诊为妊娠期糖尿病(GDM)的170例，妊娠期糖耐量损伤(GIGT)的185例和随机选取同期糖耐量筛查阴性的180例，对比其新生儿的发病率。结果GIGT组其新生儿的发病率与对照组相比显著增加，而GIGT组与GDM组的新生儿发病率差异无显著性。结论糖耐量损伤的孕妇也应受到临床医生的足够重视，早发现、早诊断、早治疗才能有效减少新生儿的发病率。     

母体高尿酸血症对妊娠结局和新生儿合并症影响的回顾性巢式病例对照研究

背景：高尿酸血症（HUA）患病率逐年增高,不仅与痛风、尿酸盐肾病和肾结石有关,还与内分泌代谢、心脑血管等系统疾病的发生和发展有关。 目的：探讨孕母妊娠晚期血尿酸水平与不良妊娠结局、新生儿尿酸水平及新生儿合并症的关系。 设计：回顾性巢式病例对照研究。 方法：以2020年1~12月在北京大学人民医院产检的孕母为队列人群,根据孕母妊娠晚期血尿酸水平分为HUA组和非HUA组,比较两组妊娠结局和新生儿临床结局。根据孕母妊娠晚期血尿酸水平（μmol·L-1）分为低浓度（<360）、中浓度（~420）和高浓度（>420）,采用线性回归和Logistic 回归模型分析孕母血尿酸水平与早产、低出生体重、小于胎龄儿的关系。孕母妊娠晚期尿酸值及新生儿生后24 h尿酸值相关性分析采用Spearman秩相关分析。 主要结局指标：孕母血尿酸水平与早产、低出生体重和小于胎龄儿的关系。 结果：共纳入孕母2 397例（新生儿2 581例）,HUA组216例（9.0%）,非HUA组2 181例。HUA组孕母所生新生儿出生体重低于非HUA组（2 925 g vs 3 260 g,P<0.001）,差异均有统计学意义;而早产（18.5% vs 8.9%）、低出生体重（23.1% vs 7.1%）、小于胎龄儿（29.2% vs 10.6%）和转儿科比例（19.9% vs 11.1%）均高于非HUA组,差异均有统计学意义（P<0.001）。尿酸水平高浓度组孕母分娩的新生儿出生体重较低浓度组低54.0 g（95%CI：-106.5~-1.6,P=0.043）,发生早产的风险增加74%（OR=1.74,95%CI：1.08~2.8,P=0.023）,发生小于胎龄儿的风险增加85%（OR=1.85,95%CI：1.26~2.73,P=0.002）。新生儿生后24 h内尿酸水平与孕母妊娠晚期尿酸水平呈中等相关（r=0.613,P=0.000）。两组早产儿合并症差异无统计学意义。 结论：母体妊娠晚期HUA与早产、低出生体重、小于胎龄儿的发生相关。     

妊娠期母亲糖耐量减低对其新生儿血清脂联素水平的影响

目的探讨妊娠期孕妇糖耐量减低(GIGT)对其新生儿脐血血清脂联素(APN)水平的影响。方法采用放射免疫方法测定并比较18例GIGT孕妇的新生儿及50例糖耐量正常(NGT)孕妇的新生儿脐静脉血血清APN水平,二组新生儿于娩出后1h测末梢血糖。结果GIGT组新生儿脐血血清APN水平显著高于NGT组[(61.06±16.85)mg/Lvs(48.04±15.47)mg/L,t=2.38P<0.05],而其生后1h血糖显著低于NGT组[(2.31±0.71)mmol/Lvs(3.18±0.52)mmol/L,t=-4.46P<0.001]。GIGT组新生儿脐血血清APN水平与其生后1h血糖不存在相关性(r=-0.125P>0.05)。结论GIGT孕妇的新生儿脐血血清APN水平升高,GIGT孕母和新生儿的代谢状况应受到更多关注。     

妊娠期糖尿病治疗与新生儿预后的关系

目的　探讨妊娠期糖尿病 (GDM)治疗与新生儿预后的关系。方法　将 30例GDM孕妇按开始治疗时间分为孕 32周前及孕 32周后各 15例 ,分析比较新生儿预后。结果　孕 32周前开始治疗组巨大儿发生率及剖宫产率均明显低于孕 32周后开始治疗组 ,有显著性差异 (P <0 .0 5 ) ;两组新生儿低血糖、窒息、肺炎、呼吸窘迫综合征等并发症发生率无显著差异 (P >0 .5 ) ;两组均无围生儿死亡。结论　早期发现和治疗GDM可减少巨大儿的发生率及剖宫产率 ;GDM孕妇孕期严格控制血糖可降低围生儿死亡率 ;GDM孕妇 36～ 39周终止妊娠对母儿较安全     

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。     

胎龄联合出生体重对新生儿遗传代谢病相关代谢物的影响

目的 探讨胎龄联合出生体重对遗传代谢病（IMD）相关代谢物的影响。方法 从2014~2016年间参加IMD筛查的38 931名新生儿中,随机抽取3381例经随访排除IMD疾病的新生儿样本,按胎龄联合出生体重分为极早产适于胎龄儿组（n=12）、早产小于胎龄儿组（n=18）、早产适于胎龄儿组（n=219）、早产大于胎龄儿组（n=18）、足月小于胎龄儿组（n=206）、足月适于胎龄儿组（n=2 677）、足月大于胎龄儿组（n=231）。采集各组新生儿出生3~7 d充分哺乳后的足跟血,采用串联质谱检测干血斑中17种IMD关键代谢指标水平。利用Spearman秩相关分析各影响因素与代谢指标的相关性,采用协方差分析各组代谢指标水平差异。结果 在控制了新生儿生理及病理状态等相关因素后,与足月适于胎龄儿组相比,亮氨酸\异亮氨酸\羟基脯氨酸、缬氨酸在极早产适于胎龄儿、早产小于胎龄儿、早产适于胎龄儿组,鸟氨酸在早产适于胎龄儿组,脯氨酸在极早产、早产适于胎龄儿组中水平明显下降（P < 0.05）;苯丙氨酸在极早产、早产适于胎龄儿组,甲硫氨酸在早产小于胎龄儿组,酪氨酸在早产适于胎龄儿组中水平则明显升高（P < 0.05）;游离肉碱、乙酰肉碱、丙酰肉碱在早产小于胎龄儿、早产适于胎龄儿组,十八碳烯酰肉碱在早产小于胎龄儿组中水平明显升高（P < 0.05）。大部分肉碱指标在早产和足月的小于胎龄儿分别与适于胎龄儿、大于胎龄儿组间比较中差异有统计学意义（P < 0.05）。结论 胎龄不足和低出生体重均会造成IMD筛查指标异常,故在判读IMD筛查指标异常时应结合胎龄和体重情况综合判断。     

小于胎龄儿发病情况分析

目的　评估正常孕产妇分娩的小于胎龄儿 (SGA)的患病率及死亡率。方法　回顾分析 1998年～2 0 0 2年在我院分娩胎龄为 3 7～ 41周的SGA ,依据新生儿出生体重的百分位数将SGA分为大于第 5百分位 ,但小于第 10百分位SGA(SGA1) ;小于第 5百分位SGA(SGA2 )。将孕母患妊娠合并症及胎儿畸形者予以剔除。将同期正常孕产妇分娩的适于胎龄儿 (AGA)作为对照组。比较 3组胎龄、出生体重、身长 ,入新生儿重症监护病房 (NICU)率、低血糖、肺透明膜病 (RDS)、吸入性肺炎、机械通气、红细胞增多症、高胆红素血症、败血症及 1minApgar评分≤ 7分、发生率等指标。 结果　观察对象共 4546例 (AGA组 43 2 3例 ,SGA1组 13 0例 ,SGA2组 93例 )。 3组胎龄相似 (P均 >0 .0 5) ;SGA组出生体重、身长均明显低于AGA组 (P均 <0 .0 0 1) ;低血糖、RDS、吸入性肺炎、机械通气、高胆红素血症和败血症 3组之间无统计学差异 (P均 >0 .0 5)。SGA入新生儿重症监护病房率、红细胞增多症和新生儿窒息的发生率显著高于AGA组 ,且存在出生体重越低危险越大趋势。结论　与AGA相比 ,正常孕产妇分娩足月SGA某些新生儿疾病的发生率显著增加     

早产儿和小于胎龄儿发生的危险因素的比较分析

目的 比较早产儿和小于胎龄儿发生的危险因素.方法 选择1 270例排除明确孕母疾病和产科危险因素的新生儿,自制调查问卷调查母亲身高、体重、被动吸烟和不良孕产史等因素,将研究对象分类为早产儿和足月儿、小于胎龄儿和适于胎龄儿,采用多因素logistic 回归分析比较早产儿和小于胎龄儿发生的危险因素.结果 孕期增重<9 kg使早产(OR=1.63,95%CI:1.12~2.07)和小于胎龄儿(OR=1.92,95%CI:1.56~2.58)发生的危险性均增高;母亲既往流产史(OR=1.46,95%CI:1.09~1.93)和早产史(OR=2.63,95%CI:1.81~3.92)是早产儿发生的的独立危险因素;孕母身高<1.55 m(OR=2.46,95%CI:1.78~3.48)、孕前BMI<18.5(OR=2.16,95%CI:1.53~3.16)、被动吸烟(OR=2.24,95%CI:1.65~2.98)是小于胎龄儿发生的的独立危险因素.结论 早产儿和小于胎龄儿的危险因素不同,针对两类特征孕妇应采取不同的预防措施,有针对性地减少两类不良妊娠结局的发生.     

小于胎龄儿生长激素水平测定及生长发育随访

研究目的 探讨小于胎龄儿、适于胎龄儿及孕母血生长激素水平和生后10～56月小于胎龄儿的生长发育情况。 研究方法 病例对照研究。用放射免疫分析法测定孕母及新生儿脐血生长激素水平。观察小于胎龄儿生后10～56月的生长发育情况。 研究结果 平均生长激素水平,新生儿为15.87±13.42ng/ml,孕母3.85±2.18ng/ml。小于胎龄儿16.13±13.71ng/ml(服可乐定前),24.80 ±17.50ng/ml(服可乐定后);适于胎龄儿16.47±17.47ng/ml(服可乐定前),22.30±19.11ng/ml(服可乐定后)。生后第1、3、 5天生长激素分别为17.00±14.84,19.40±18.08和11.87±10.58ng/ml。出院56例小于胎龄儿随访,41.07％(身长)、35.71％(体重)、26.79％(头围)仍小于第十百分位数;而对照组仅14.28％,1.79％和16.07％在第十百分位数以下。 结论 新生儿生长激素浓度呈高水平,明显高于孕母水平。出生后前5天血中生长激素持续呈高水平。小于胎龄儿和适于胎龄儿生长激素水平无差异。小于胎龄儿生长发育落后于适于胎龄儿。     

Disorders in Glucidic Metabolism and Congenital Heart Diseases: Detection and Prevention

The identification of gestational diabetes (GDM) through appropriate screening and its subsequent treatment have not been demonstrated to limit neonatal malformations to date. This study aimed to detect congenital heart diseases in newborns of mothers with GDM by evaluating the existence of a correlation with maternal glycemic control. This observational prospective study investigated newborns of mothers with GDM enrolled during a period of 9 months. Four subgroups were considered according to the type of maternal glucidic alteration during pregnancy and the home treatment: impaired glucose tolerance, insulin-dependent gestational diabetes mellitus (IDDM), non-insulin-dependent gestational diabetes mellitus (NIDDM), and gestational diabetes not controlled (NC: untreated diabetes). Student’s t test was used to compare the subgroups. The study enrolled 65 newborns (30 boys) born to 82 of mothers with impaired glucidic metabolism. Patent ductus arteriosus was observed in 11 patients (16.9 %), pulmonary stenosis of mild grade in 4 patients ( 6.2 %), and hypertrophy of the ventricular septum in 22 patients (33.8 %). A total of 14 patients had increased thickness in the left ventricle posterior wall, and 17 patients had an abnormal electrocardiogram. Hyperglycemia can influence the development of the fetal heart, affecting both its structure and its function. A treatment with insulin for women with GDM is supported by the study data.     

Glucose disappearance in infants of diabetic mothers I. Relationship to maternal glucose tolerance and insulin production

Glucose disappearance and insulin response were determined in mother--infant pairs of normal, gestational diabetic and diabetic pregnancies following an intravenous glucose load. Mothers were studied in the third trimester of pregnancy and at least 6 wk postpartum. Significant differences were present in glucose disappearance and insulin response in both gestational diabetic and diabetic mothers during pregnancy compared with the control group. Infants were studied within 4 h of birth while fasting, and glucose and insulin levels followed through the first 3 days of life. Neonatal hypoglycemia did not occur and glucose disappearance (KT) was not different among the three groups. There was no correlation between maternal glucose tolerance or insulin production and that of their infants. The only distinguishing factor among the infants was higher insulin production in infants of diabetic mothers during the 60-min intravenous glucose tolerance test which persisted up to 4 h following the infusion. It is concluded that factors other than the degree of maternal glucose tolerance are responsible for the development of neonatal hypoglycemia in infants of diabetic mothers, most notably control of maternal diabetes, the amount of glucose infused immediately before delivery and neonatal glucose production.     

Gastric emptying in premature newborns with acute respiratory distress

OBJECTIVES: The authors hypothesized that acute respiratory distress (ARD) delays gastric emptying. The objective was to test this hypothesis by assessing gastric emptying on the second and seventh days of life in premature infants with ARD resulting from pulmonary disease. METHODS: Thirty-nine newborns with ARD starting on the first day of life were selected and paired with 39 healthy control newborns matched by weight (within 250 g). Gestational age was 相似文献   

测定脐血脑钠肽对血糖异常孕妇的胎儿心功能评价

目的：探讨脐血脑钠肽（BNP）评价血糖异常孕妇胎儿心功能的可行性及高血糖对胎儿心功能的影响。方法：妊娠期血糖异常孕妇24例,包括妊娠期糖尿病18例和糖耐量受损6例,按分娩前血糖值的高低分为控制欠佳组（7例）和控制较好组（17例）,孕末期行胎儿超声心动图测量心脏相关指标;正常妊娠孕妇25例为对照组。于胎儿分娩时留脐血,测定BNP浓度。结果：血糖异常组胎儿脐血BNP值明显高于对照组,分别为（114.0±39.0）和（80.6±13.7） pg/mL（P<0.01）,其中血糖控制欠佳组高于控制较好组（142.1±44.1 pg/mL vs 102.4±31.2 pg/mL;P<0.01）。脐血BNP在妊娠期糖尿病和糖耐量受损两组间差异无显著性,与孕末期胎儿左室壁厚度呈正相关,与二尖瓣A峰、E/A比值分别呈正、负相关（r值分别为0.715,0.491和-0.507,P<0.05）。结论：妊娠期高血糖时脐血BNP水平明显升高,与孕妇血糖控制情况及胎儿心功能变化相关联,可反映胎儿心功能的潜在损害。良好血糖控制可能减轻这一影响。［中国当代儿科杂志,2009,11（10）：805-808］     

Glucose or sucrose as an analgesic for newborns: a randomised controlled blind trial

BACKGROUND: To evaluate the effect of different oral glucose or sucrose solutions on the pain response to heelstick in newborns. METHODS: DESIGN: randomised double blind placebo controlled trial of water (control) versus one of three solutions of glucose - namely 5, 33 and 50% - or one of two solutions of sucrose (33% and 50%) or nothing. SETTING: postnatal ward. PATIENTS: seven groups of 20 healthy newborns (gestational age 38-41, weighing over 2500 g) were randomised to receive 2 ml of one of the six solutions on the tongue inmediately before heelstick procedure. Main outcome measure: heart rate before, during and three minutes after the procedure. RESULTS: Even if the trend of the cardiac rates did not reach statistic significance, glucose solution 33 and 50% proved to be the most effective in reducing pain response. CONCLUSIONS: Sweet solutions may be an easy, useful, safe and cheap analgesic for minor invasive procedures in newborns.     

Newborns' sleep-wake patterns: the role of maternal,delivery and infant factors

Objective: The purpose of this study was to assess the sleep-wake patterns of fullterm (≥37 weeks) newborns and to evaluate the effects of specific factors including maternal gestational diabetes, infant size and anthropometric measures, gender, gestational age and delivery variables. Methods: Two-hundred twenty newborns were studied in the hospital nursery for a continuous 24-h period with miniature activity monitors attached to the infants' ankles. The sample consisted of 102 infants of gestational diabetic mothers (IGDM) and 118 controls. Anthropometric measurements were obtained and maternal and infant characteristics were recorded. Results: The newborns had a discernible diurnal steep pattern and slept twice as much during the nighttime as daytime hours (P < 0.001). Higher skinfold measurements correlated significantly with increased quiet and motionless sleep (P < 0.05) for the IGDM but not for controls. Sleep of infants born at later gestational ages was characterized by increased percent of quiet and motionless sleep (P < 0.0001). No direct gender effects were identified. Conclusions: Multiple factors were associated with the sleep-wake patterns of the newborns on our study cohort including maternal glucose values during pregnancy, increased measures of adiposity in IGDM, increased gestational age, mode of delivery and delivery Sequence. Investigation of the sleep-wake characteristics of neonates using activity monitors is a noninvasive method for gaining new understanding of the relationships between sleep wake activity patterns and infant characteristics.     

Glycohemoglobin (HbAIc): a predictor of birth weight in infants of diabetic mothers

Hemoglobins AIa-c (fast Hb), minor variants of HbA, are elevated in patients with diabetes mellitus. Recent studies indicate a relationship of fast hemoglobins, especially HbAIc (glycosylated form), to chronic hyperglycemia. Since infant oversize has been attributed to maternal hyperglycemia and fetal hyperinsulinemia, the hemoglobin HbAIc fraction was compared to birth weight (actual and relative to gestational age) and to maternal glucose tolerance. Normal (13), probably normal (8), gestational diabetic (10), and insulin-dependent women (14) were studied in the third trimester; women with advanced diabetic vascular disease were excluded. When corrected for gestational age, relative birth weights correlated in a significant linear regression with HbAIc (n = 45, r = 0.57, P less than 0.001). Third trimester maternal glucose tolerance (Kt) of women, not insulin dependent, correlated in a signigicant manner with both HbAIc (P less than 0.05) and birth weight for gestational age (P less than 0.01).     

Gastrointestinal enhanced insulin release in response to glucose in newborn infants

The purpose of this investigation was to determine whether or not gastrointestinal (GI) enhanced insulin response occurs in newborn infants soon after birth. Glucose infusion by intravenous or orogastric routes was given to infants during the first 4 days of life, aiming at achieving similar plasma glucose concentrations. Their plasma insulin responses were then compared. Thirty term, newborn infants (10 appropriate for gestational age, 8 small for gestational age, 6 large for gestational age, and 6 infants of diabetic mothers) were studied. With intravenous glucose infusions of 8 mg/kg/min or orogastric infusion of 16 mg/kg/min, the plasma glucose concentrations achieved were similar and approximated 110 mg/dl. Plasma insulin responses were greater in infants receiving glucose via the GI route. The finding was in contrast to our previous data, in which no GI enhancement of insulin response was demonstrated. The present data suggest that in the term newborn infant, GI enhanced insulin release occurs only when a threshold of plasma glucose concentration has been exceeded. It appears that the enteroinsular axis is functional in newborns soon after birth.     

宫内发育迟缓与胰岛素样生长因子及其结合蛋白的关系

目的 检测宫内发育迟缓(IUGR)儿脐血胰岛素样生长因子-1(IGF-1)、胰岛素样生长因子结合蛋白-3(IGFBP-3)水平,分析这些指标的变化程度与胎儿期生长的关系。方法 将86例脐血标本分为IUGR(即小于胎龄儿)组和适于胎龄儿(AGA)组。采用竞争性放射免疫分析法(RIA)测定IGF-1水平,非竞争性免疫放射分析法测定IGFBP-3水平。两组间比较用t检验,两变量之间的关系采用相关回归分析。结果 与AGA组相比,IUGR组脐血IGF-1和IGFBP-3水平显著降低(P均<0.01);IGF-1、IGFBP-3均随胎龄及出生体重增加而增加(P均<0.01);IGFBP-3与IGF-1呈正相关(P<0.01)。结论 脐血IGF-1和IGFBP-3的含量可作为判断新生儿生长发育程度的一项客观生化指标。