妊娠期糖耐量降低对胎儿及新生儿的影响

目的：探讨妊娠期糖耐量降低（ＧＩＧＴ）对胎儿及新生儿的影响。方法：对ＧＩＧＴ孕妇５２例（ＧＩＧＴ组），妊娠期糖尿病（ＧＤＭ）孕妇３４例（ＧＤＭ组），正常孕妇４４例（对照组）的围产儿结局进行比较。结果：ＧＩＧＴ组巨大儿发生率高于对照组（Ｐ＜０．０２５），生后２小时的血糖均值在３组中最低（Ｐ＜０．０５），低血糖、红细胞增多症等并发症高于对照组。结论：ＧＩＧＴ与ＧＤＭ均是影响胎儿及新生儿预后的重要因素。     

妊娠期糖尿病新生儿脐血血气分析影响的研究

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pH值、脐静脉血pH值、脐动脉血BE值、脐静脉血BE值、脐静脉二氧化碳分压[p（CO2）]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。     

妊高征患者左心功能和房室结构的变化

目的 :探讨妊高征患者血流动力学改变对心脏结构和心功能的影响。方法 :用彩色多普勒超声心动图对正常妊娠和妊高征孕妇的房室结构、心功能和产后恢复情况进行比较。结果 :正常妊娠者左房轻度增大 ,二尖瓣血流舒张早期最大血流峰值 (E)升高 ,妊高征患者左房扩大明显 (P <0 .0 1) ,二尖瓣血流频谱的舒张早期最大血流峰值 舒张晚期最大血流峰值 (E A)比值明显减少 ,其舒张功能异常与正常妊娠差异有显著性 (P <0 .0 5) ,产后恢复较慢。结论 :妊高征患者心脏舒张功能受损出现在收缩功能前 ,左房扩大比正常妊娠出现早 ,可用于监测妊高征患者的心功能 ,早期发现心衰     

妊娠期糖尿病发病机制及对母婴的影响

年龄、肥胖、种族、不良孕育史和糖尿病家族史是影响妊娠期糖尿病(gestational diabetes mellitus,GDM)的主要因素.胰岛索抵抗是其主要发病机制.GDM对母儿影响的严重程度与病情及血糖控制情况密切相关,主要表现为妊娠期高血压、羊水过多、巨大儿、早产、难产及软产道损伤、剖宫产等发生率明显增高,还可...     

妊娠期糖尿病患者子代3～4岁的随访研究

目的 探讨妊娠期糖尿病(gestional diabetes mellitus,GDM)对子代远期发育的影响.方法 研究对象为2006年6月14日至2007年12月31日于北京大学第一医院分娩的单胎妊娠GDM孕妇124例(GDM组)和本院同期分娩的糖代谢正常的单胎妊娠妇女98例(对照组).于2010年11月6日至2011年1月30日对以上人群的子代进行随访.将这2组的子代分为GDM巨大儿(15例)、GDM非巨大儿(109例)、对照组巨大儿(6例)和对照组非巨大儿(92例)4个亚组.儿童测量指标包括身高、体重、腰围、血压及皮下脂肪厚度.以2006年世界卫生组织发布的5岁以下儿童生长发育参考值作为评价标准,具体评价指标包括年龄别身高z值(length/height for age z-score,HAZ)、年龄别体重z值(weight for age z-score,WAZ)、身高别体重z值(weight for length/height z-score,WHZ)、年龄别体重指数(body mass index,BMI)z值(BMI for age z-score,BAZ)、年龄别肱三头肌皮褶厚度z值(triceps skin folds for age z-score,TSFZ)和年龄别肩胛下角皮褶厚度z值(sub-scapular skin folds for z-score,SSFZ)等6项.分别采用x2检验、t检验和方差分析对数据进行统计.结果 (1)GDM组与对照组子代年龄、出生体重和性别比例、身高、体重、体重指数、腰围、血压、TSF和SSF的差异均无统计学意义(均P＞0.05).(2)GDM巨大儿、GDM非巨大儿、对照组巨大儿和对照组非巨大儿4个亚组间比较,体重、BMI、腰围、WHZ、WAZ、HAZ、WAZ、BAZ差异均有统计学意义[体重:(19.8±3.9)、(17.0±1.9)、(17.7±1.7)与(17.2±2.7) kg,F=6.238,P＜0.001;BMI:(17.6±2.6)、(16.0±1.2)、(16.6±1.1)与(16.2±1.4),F=5.901,P＜0.001；腰围:(53.6±5.3)、(49.9±2.7)、(50.9±3.3)与(50.4±3.6) cm,F=5.307,P＜0.001;WHZ:(1.40±1.44)、(0.45±0.81)、(0.88±0.75)与(0.60±0.87),F=5.269,P=0.002; HAZ:(1.22±0.78)、(0.47±0.82)、(0.98±0.74)与(0.50±1.00),F=3.668,P=0.013;WAZ:(1.68±1.23)、(0.58±0.79)、(1.15±0.85)与(0.71±0.93),F=7.361,P＜0.001;BAZ:(1.41±1.52)、(0.42±0.84)、(0.81±0.76)与(0.60±0.90),F=5.210,P=0.002].两两比较发现,GDM巨大儿亚组与GDM非巨大儿亚组和对照非巨大儿亚组均存在明显差异,而对照巨大儿亚组与另外3个亚组的差异无统计学意义.(3)GDM巨大儿和GDM非巨大儿分别与对照组[体重(17.2±2.5) kg、BMI(16.2±1.4)、腰围(50.5±3.6) cm、舒张压(55.2±6.9)mm Hg(1 mm Hg=0.133 kPa)、SSF(6.1±1.8) mm、WHZ(0.62±0.87) 、HAZ(0.53±0.99)、WAZ(0.73±0.92)、BAZ (0.61±0.89)]相比,体重(F=9.283,P＜0.001) 、BMI(F=8.707,P＜0.001)、腰围(F=7.934,P＜0.001)、舒张压(F=3.123,P=0.046)和SSF(F=3.499,P=0.032)均明显升高,WHZ(F=7.639,P＜0.001)、HAZ(F=4.709,P=0.010)、WAZ(F=10.302,P＜0.001)和BAZ(F=7.689,P＜0.001)均明显增大.(4)GDM巨大儿组的超重比例及肥胖比例明显高于GDM非巨大儿组及对照组[超重:9/15、24.8％ (27/109)与24.5％(24/98),x2 =8.870,P=0.012；肥胖:5/15、7.3％(8/109)与9.2％(9/98),x2=10.083,P=0.006].如仅根据出生体重分为巨大儿和非巨大儿组,则巨大儿组超重比例及肥胖比例将显著高于非巨大儿组[超重:52.4％ (11/21)与24.4％ (49/201),x2=7.560,P=0.006；肥胖:28.6％(6/21)与7.9％(16/201),x2=9.047,P=0.003].结论 与GDM分娩的非巨大儿和非GDM孕妇分娩的子代相比,GDM孕妇分娩的巨大儿的远期发育受到显著影响,其在3～4岁时更多发生肥胖和血压升高.     

母亲妊娠期高血压疾病对新生儿脑发育的影响

目的　探讨母亲妊娠期高血压疾病对新生儿脑发育的影响. 方法　采用颅脑超声测量56例妊娠期高血压疾病母亲的新生儿脑岛面积、周长及新生儿脑回宽度,并与53例同胎龄对照组新生儿相比较. 结果 对照组足月儿脑回宽度低于早产儿,脑岛面积与周长大于早产儿,差异有统计学意义(P<0.01).妊娠期高血压疾病组胎龄34周以上新生儿脑岛周长[胎龄≥37周:(87.43±10.21)mm;胎龄34～37周:(72.59±7.50)mm]与面积[胎龄≥37周:(413.60±90.05)mm2;胎龄34～37周:(285.71±48.62)mm2]明显小于对照组同胎龄新生儿脑岛周长[胎龄≥37周:(102.14±9.97)mm;胎龄34～37周:(78.42±10.14)mm]和面积[胎龄≥37周:(557.08±98.89)mm2;胎龄34～37周:(356.01±93.07)mm2],差异有统计学意义(P<0.05或0.01).妊娠期高血压疾病组小于胎龄儿发生率为30.36%(17/56),其脑回宽度宽于适于胎龄儿,脑岛面积与周长明显减小,差异均有统计学意义.妊娠期高血压疾病组新生儿均有肌张力增高,在新生儿行为神经测定评分时,主动、被动肌张力共8项都未扣分,但行为能力扣分较多,分值明显低于对照组(P<0.01). 结论 母亲妊娠期高血压疾病可造成新生儿脑发育欠佳,可通过颅脑超声测量新生儿脑岛面积、周长及脑回宽度予以评价.     

糖尿病母亲婴儿脑发育状况的研究

目的探讨糖尿病母亲婴儿脑发育情况。方法通过颅脑超声及应用医学图像分析软件对64例糖尿病母亲婴儿脑灰、白质发育的评价,101例非糖尿病母亲婴儿作对照。另配合新生儿脑反应性功能测定及新生儿期后神经发育的研究。结果糖尿病母亲婴儿脑成熟欠佳,足月糖尿病母亲婴儿丘脑基底核平均灰度值(76.92±6.60)、额叶白质平均灰度值(62.68±5.21)、枕叶白质平均灰度值(73.39±5.67)与非糖尿病母亲婴儿[丘脑基底核平均灰度值(84.72±6.35)、额叶白质平均灰度值(67.60±4.09)、枕叶白质平均灰度值(78.61±2.95)]比较,差异有显著性(P<0.01);部分不同程度脑室大,64例糖尿病母亲婴儿脑室大20例(31.25%),母亲糖尿病未控制组异常发生率(40%)高于控制组(23.5%)。新生儿脑反应性功能检测显示糖尿病母亲未控制组婴儿脑组织局部氧饱和度(rSO2)基础值(57.83±3.34)%、脑组织rSO2反应潜伏期(240.50±16.69s)、rSO2最大反应值(2.31±0.84)%,与母亲糖尿病控制组[分别为:(59.33±4.56)%、(194.00±25.03)s、(4.00±2·24)%]及非糖尿病母亲婴儿[分别为:(60.20±4.15)%、(155.71±16.23)s、(4.89±1.47)%]比较,差异有统计学意义(P<0.01)。新生儿期后仍存在不同程度的脑成熟度欠佳及神经发育落后。结论母亲孕期糖尿病可能造成子代脑成熟障碍,可通过对新生儿脑灰、白质发育,早期脑反应性功能及新生儿期后神经发育的随访予以评价。     

妊娠期糖代谢异常母亲之子代的早期生长模式

目的 了解不同糖代谢状态孕妇后代在婴儿早期的生长模式.方法 选择2007年1月1日至2009年12月31日在北京大学第一医院分娩,且在生后6～12周完成随访的7600例单胎新生儿作为研究对象,其中母亲妊娠期糖代谢正常者6955例,糖代谢异常者645例.以母亲糖代谢情况和新生儿是否为巨大胎儿为分层因素将婴儿分为4组:糖代谢正常非巨大儿组6432例,糖代谢正常巨大儿组523例,糖代谢异常非巨大儿组588例,糖代谢异常巨大儿组57例.比较4组婴儿出生体重、复查时体重及日增长体重情况.采用t检验、单因素方差分析、LSD法进行统计学分析.为校正随访时天数对婴儿体重增长的影响,以随访天数为协变量,比较4组出生后体重增长情况的差别.结果 糖代谢正常组与糖代谢异常组比较,2组婴儿出生体重差异无统计学意义[(3367.0±420.3)g与(3368.2±475.1)g,t=-0.061,P＞0.05];糖代谢异常组复查时体重及日增长体重均低于糖代谢正常组,差异均有统计学意义[复查时体重:(5393.9±647.2)g与(5459.3±625.2)g;日增长体重:(42.9±9.5)g与(44.0±9.5)g,t=2.464和2.874,P均＜0.05].糖代谢正常非巨大儿、糖代谢异常非巨大儿、糖代谢正常巨大儿和糖代谢异常巨大儿组婴儿出生体重分别为(3300.6±359.2)g、(3282.1±397.0)g、(4183.8±203.8)g和(4256.8±248.8)g;复查时体重分别为(5400.5±590.7)g、(5325.8±618.8)g、(6182.7±584.7)g和(6096.5±502.4)g;日增长体重分别为(44.1±9.4)g、(43.2±9.4)g、(42.4±10.9)g和(39.6±10.0)g.4组间各指标比较,差异均有统计学意义(F值分别为1140.471、313.376、10.830,P均＜0.001).4组间体重日增长协方差分析比较发现,糖代谢正常非巨大儿组分别高于糖代谢异常非巨大儿、糖代谢正常巨大儿组和糖代谢异常巨大儿组,糖代谢正常巨大儿组高于糖代谢异常巨大儿组,糖代谢异常非巨大儿组高于糖代谢异常巨大儿组(P均＜0.05或0.01).结论 在脱离母体高血糖影响后,妊娠期高血糖孕妇子代在婴儿早期的生长速度可能呈现暂时减慢.     

妊娠糖尿病母亲新生儿和健康孕妇巨大儿的血糖、胰岛素、皮质醇和并发症的观察

目的探讨妊娠糖尿病(GDM)母亲新生儿和健康孕妇巨大儿的血糖、胰岛素、皮质醇和并发症的特点。方法 2014年1月至2015年6月廉江市人民医院新生儿科出生的单胎、足月新生儿107例,分为GDM新生儿组(GDM孕妇所产)38例,巨大儿组(健康孕妇所产)34例和健康新生儿组(健康孕妇所产)35例。检测3组的血糖、胰岛素和皮质醇的水平,同时记录3组窒息、低血糖、高胆红素血症、低血钙、红细胞增多症的发病情况。结果 GDM新生儿和巨大儿的血糖均明显比健康新生儿低,而胰岛素和皮质醇水平均比健康新生儿高,差异有统计学意义(P0.05)。血糖、胰岛素和皮质醇水平在GDM新生儿和巨大儿之间比较差异无统计学意义(P0.05)。低血糖在GDM新生儿组的发病率明显高于健康新生儿组,差异有统计学意义(P0.017)。结论 GDM新生儿和巨大儿的血糖、胰岛素和皮质醇水平存在异常的比率高,GDM新生儿要注意低血糖并发症。     

妊娠期高血糖患者产后糖代谢和脂代谢转归及其影响因素

目的 了解妊娠期不同程度高血糖患者产后6～12周糖代谢及脂代谢转归;分析影响妊娠期高血糖患者产后转归的相关因素;初步探讨国际妊娠合并糖尿病研究组近期提出的新的妊娠期糖尿病诊断标准对产后近期随访结果的影响.方法 通过对我院2007年1月1日至2009年12月31日分娩且于产后6～12周进行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)的262例妊娠期高血糖患者的临床资料进行分析,根据产后糖代谢及脂代谢状态进行分组,采用多因素Logistic回归模型对糖代谢及脂代谢影响因素进行分析,了解妊娠期高血糖患者产后6～12周糖代谢及脂代谢转归及相关因素.结果 (1)产后6～12周糖代谢异常检出率为35.1%(92/262),其中空腹血糖受损1例(0.4%),糖耐量受损81例(30.9%),空腹血糖受损+糖耐量受损4例(1.5%),糖尿病6例(2.3%).(2)Logistic回归模型分析显示,妊娠期高血糖诊断孕周,早孕期OGTT 2 h及3 h血糖值高均为产后6～12周发生糖代谢异常的危险因素,产后母乳喂养为保护因素,OR值及95%CI分别为0.824(0.724～0.941)、1.521(1.196～1.934)、1.272(1.047～1.547)、0.408(0.181～0.918).(3)250例妊娠期高血糖患者在产后6～12周进行血脂检测,产后脂代谢异常的发生率为63.2%(158/250),在血脂异常的患者中,最常见的是高胆固醇血症126例(50.4%),其次分别为高低密度脂蛋白胆固醇血症,共102例(40.8%),高甘油三酯血症60例(24.0%),低高密度脂蛋白胆固醇血症11例(4.4%).(4)Logistic回归模型分析显示,孕期OGTT 2 h血糖水平高为产后发生脂代谢异常的危险因素,OR=1.364(95%CI:1.063～1.751);孕期高密度脂蛋白胆固醇水平高为保护因素,OR=0.379(95%CI:0.169～0.851).结论 妊娠期高血糖患者产后6～12周存在糖、脂代谢异常.妊娠期高血糖发现孕周早以及孕期OGTT 2 h及3 h血糖值高均为产后发生糖代谢异常的危险因素,产后母乳喂养为保护因素.孕期OGTT 2 h血糖值高为产后发生脂代谢异常的危险因素,孕期高密度脂蛋白胆固醇水平高为保护因素.

Abstract：

Objective (1) To investigate the glucose and lipid metabolism 6-12 weeks after delivery in women with hyperglycemia during pregnancy. (2) To find out factors associated with the prognosis of women with hyperglycemia during pregnancy. (3) To investigate the feasibility of the diagnostic criteria set by the International Association of Diabetes and Pregnancy Study Group according to the follow-up data of women with hyperglycemia in pregnancy. Methods Clinical data of 262 women with hyperglycemia during pregnancy delivered in our hospital from January 1, 2007 to December 31, 2009 were collected. All patients underwent oral glucose tolerance test (OGTT) at 6-12weeks after delivery. They were divided into two groups according to the postnatal status of glucose and lipid metabolism. Multivariate Logistic regression model was used to analyze the factors affected glucose and lipid metabolism after 6-12 weeks of delivery. Results (1) Among the 262 women, 92(35.1%) were reported with abnormal glucose metabolism at 6-12 weeks of delivery, including one (0. 4 % ) woman with impaired fasting glucose, 81 (30. 9 % ) with impaired glucose tolerance, 4( 1.5 % )with impaired fasting glucose+impaired glucose tolerance and 6 (2. 3%) with diabetes mellitus.glucose levels in OGTT (OGTT 2hPG and the OGTT 3hPG) were risk factors for postpartum 0. 181-0. 918)]. (3) All markers of lipid metabolism were detected in 250 women with hyperglycemia during pregnancy at 6-12 weeks after delivery, the rate of abnormal postnatal lipid metabolism was 63.2%(158/250). In the abnormal group (n= 174), the most common abnormal marker was hypercholesterolemia (n = 126, 50. 4 % ), followed by high levels of low-density lipoprotein-cholesterol (n = 102, 40. 8 %), hypertriglyceridemia (n= 60, 24. 0 %) and low levels of high-density lipoproteincholesterol (n= 11, 4. 4 %). (4) Logistic regression model showed that elevated OGTT 2hPG was the risk factor for postpartum abnormal glucose metabolism [OR= 1. 364 (95%CI: 1. 063-1. 751)], while 0. 169-0. 851)]. Conclusions Women with hyperglycemia during pregnancy are more likely to present with abnormal glucose and lipid metabolism which commonly coexisted with insulin resistance.The risk factors for the postpartum abnormal glucose metabolism in mothers with hyperglycemia during pregnancy include early diagnosis, OGTT 2hPG and OGTT 3hPG, while the protective factor is breastfeeding. The risk factor for the postpartum dyslipidaemia in mothers with hyperglycemia during pregnancy is OGTT 2hPG, while the protective factor is high-density lipoprotein-cholesterol level in pregnancy.     

血清内脏脂肪素浓度与妊娠期糖尿病的关系

目的 观察不同程度糖代谢异常孕妇血清内脏脂肪素(visfatin,VF)浓度的变化并探讨其与胰岛素抵抗(insulin resistance,IR)、代谢参数及新生儿出生体重(birth weight,BW)的关系. 方法 根据50g糖筛查(glucose challenge test,GCT)及75g口服葡萄糖耐量试验(oral glucose tolerance teat,OGTT)结果将120名孕妇(妊娠36～40周)分为三组:妊娠期糖尿病葡萄组(n=45)、50g GET(+)组(n=20)、正常糖耐量(normal goucose tolerance,NGT)组(n=55),检测血清VF浓度、空腹血糖,空腹胰岛索、总胆固醇、甘油三酯水平及记录新生儿出生体重. 结果 GDM组血清VF浓度明显高于NGT组[(374.9±23.1)ng/ml和(308.9±16.8)ng/ml,P＜0.05],但GCT(+)组血清VF浓度[346.5±23.1)ng/ml]与GDM组及NGT组差异无统计学意义.血清VF浓度与空腹血糖、胰岛素、总胆固醇、甘油三酯水平、IR及新生儿出牛体重无关(P均＞0.05). 结论 GDM孕妇血VF水平是升高的,与GDM有密切联系,但其与IR、代谢参数及新生儿出生体重无关.     

不同胎龄和日龄早产儿心功能变化

目的 探讨不同胎龄早产儿出生后心功能的变化特点及影响因素.方法 早产儿111例,根据胎龄分为28～31+6、32～33+6和34～36+6周组.以足月儿作为对照组(n=50),胎龄为37～41+6周.在生后1周内,平均(4.8±1.4)d,应用SonoSite 180 PLUS彩色多普勒超声仪测定心功能,测量指标包括主动脉瓣峰流速、肺动脉瓣峰流速、心输出量、每搏输出量、左室舒张末期容积、左室收缩末期容积、二、三尖瓣口舒张早期与舒张晚期血流充盈速度比(二尖瓣E/A、三尖瓣E/A)和心率,比较不同胎龄新生儿心功能的变化.另外162例早产儿根据心功能检查日龄分为12 h～,24 h～,72 h～和1周～28 d组,比较不同日龄早产儿心功能变化.采用多元线性回归分析探讨影响心功能的因素.结果 (1)不同胎龄新生儿心功能变化:主动脉瓣峰流速、肺动脉瓣峰流速、左室舒张末期容积、左室收缩末期容积、每搏输出量和心输出量随胎龄增加而增加;在28～31+6、32～33+6和34～36+6周组,二尖瓣E/A分别为1.13±0.17、1.14±0.18和1.13±0.18,三尖瓣E/A分别为0.90±0.16、0.90±0.13和0.90±0.15,均高于胎龄37～41+6周的足月儿(分别为1.28±0.17和1.04±0.20),差异均有统计学意义(P均＜0.05).(2)不同日龄早产儿心功能变化:72 h～和1周～28 d组肺动脉瓣峰流速分别为(79.60±11.22)cm/s和(78.86±13.64)cm/s,高于12 h～组[(72.61±8.56)cm/s];1周～28 d组心率快于其他3组,差异均有统计学意义(P均＜0.05).(3)影响心功能的因素:心输出量与体重和胎龄正相关,r分别=0.55和0.36,P均＜0.05.每搏输出量与体重和胎龄正相关,r分别=0.61和0.52,P均＜0.05.结论 早产儿随胎龄增大,左心室泵功能渐增强,左右心室舒张功能无明显变化.出生72 h后,肺动脉瓣血流速度显著加快.体重和胎龄是影响早产儿心功能的主要因素.

Abstract：

Objective To investigate the features and influence factors of cardiac function in preterm infants.Methods One hundred and eleven preterm infants were divided into three groups according to the gestational age which was 28-31+6,32-33+6 and 34-36+6 weeks respectively.Fifty term-birth infants at gestational age of 37-41+6 weeks were taken as control group.The cardiac function was examined by SonoSite 180 PLUS color Doppler ultrasonic diagnostic apparatus.The parameters of cardiac function included heart rate,peak flow rate of aorta valve orifice (AV),peak flow rate of pulmonary artery valve orifice (PV),cardiac output (CO),stroke volume (SV),left ventricular end diastolic volume (LVEDV),left ventricular end systolic volume (LVESV),the ratio of early (E) and late (A) diastolic velocities of mitral and tricuspid valves (MVE/A,TVE/A).Within one week after delivery,the cardiac function was examined,and the cardiac function of preterm infants with different gestational age were compared.Another 162 preterm infants were divided into four groups according to the time at examination as 12 h-,24 h-,72 h-and 1 week-28 d.The influence factors of cardiac function were determined by multi-factor linear regression analysis.Results The AV,PV,CO,LVEDV,LVESV and SV increased with the increasing of gestational age.MVE/A (1.13±0.17,1.14±0.18,1.13±0.18) and TVE/A (0.90±0.16,0.90±0.13,0.90±0.15) of 28-31+6,32-33+6 and 34-36+6 weeks group were higher than those of control group (1.28±0.17 and 1.04±0.20),respectively (P＜0.05).PV of 72 h-group and 1 week-28 d group were higher than that of 12 h-group [(79.60±11.22) cm/s and (78.86±13.64) cm/s vs (72.61±8.56) cm/s](P＜0.05).The heart rate of 1 week-28 d group was higher than that of other three groups (P＜0.05).Both CO and SV were positively related to body weight and gestational age (r=0.55 and 0.36,0.61and 0.52,respectively,P＜0.05).Conclusions The left ventricular pump function increases with the increasing of gestational age,while the diastolic function of left and right ventricle of preterm infants does not change significantly in the first month of life.The PV of preterm infants significantly increases 72 h after delivery.The body weight and gestational age are important influence factors of cardiac function in preterm infants.     

Long-term endocrine outcome of small for gestational age infants born to mothers with and without gestational diabetes mellitus

Abstract

Small for gestational age (SGA) infants and infants born to mothers with gestational diabetes mellitus (GDM) are at an increased risk for significant morbidity and mortality, mainly metabolic disorders. We aimed to question the long-term endocrine morbidity of SGA infants born to mothers with GDM compared to SGA infants born to non- diabetic mothers. A population-based cohort study was performed to assess the risk for endocrine morbidity among children born SGA to mothers with and without GDM. The main outcome evaluated was endocrine morbidity of the offspring up to the age of 18 years, predefined in a set of ICD-9 codes. Endocrine morbidity included thyroid disease, insulin and non-insulin dependent diabetes mellitus, hypoglycemia, childhood obesity, parathyroid hormone disease, adrenal disease, and sex hormone disease. All SGA infants born between the years 1991 and 2014 and discharged alive from the hospital were included in the study. Multiple pregnancies, infants with congenital malformations or chromosomal abnormalities and mothers lacking prenatal care were excluded from the analysis. Kaplan–Meier survival curve was constructed to compare cumulative endocrine morbidity. A Cox proportional hazards model was conducted to control for confounders. During the study period, 9312 newborn infants met the inclusion criteria, of them 259 SGA infants were born to mothers with GDM and 9053 SGA infants were born to mother without GDM. No significant differences in long-term endocrine morbidity were noted between the groups (0.8% in children born to mothers with GDM vs. 0.5% in children born to non-diabetic mothers, p?=?.62). Likewise, the Kaplan–Meier survival curve did not demonstrate a significantly higher cumulative incidence of endocrine morbidity in offspring of women with GDM (log rank test p=.67). In a Cox regression model, while controlling for ethnicity, hypertensive disorders, preterm birth, and maternal age, delivery of an SGA neonate to mother with GDM was not associated with long-term endocrine morbidity of the offspring (adjusted HR 1.2, 95% confidence interval 0.27–5.00, p=.82). SGA infants born to mothers with GDM are not at an increased risk for long-term endocrine morbidity as compared with SGA infants born to non-diabetic mothers.     

妊娠期糖尿病患者的分娩时机及方式

妊娠期糖尿病(gestational diabetes mellitus,GDM)的发病率逐年上升,已成为妊娠期最常见的合并症之一,严重影响了围产期母儿的妊娠结局.合适的分娩时机及分娩方式,能有效降低GDM围产期并发症的发生率,有利于改善孕妇和新生儿不良结局.本文主要就近年来关于GDM的分娩时机、分娩方式及其影响因素研...     

妊娠合并糖尿病患者新生儿的管理

妊娠合并糖尿病发病率在全球范围内呈急剧增高的趋势.宫内高糖环境通过胎盘、血管、代谢、表观遗传等方面对新生儿器官功能发育产生影响,导致各个系统出现相应的异常,而且这种影响可延续到成年期.为此临床医生需要提高认识,做好新生儿期的系统管理,对高危病例给予提前干预和规范随访,以达到良好的防治效果.     

妊娠期糖尿病不同诊断标准适宜性的比较

目的 比较妊娠期糖尿病(GDM)不同诊断标准的适宜性.方法 通过对北京大学第一医院产科2005年1月至2009年12月期间分娩的、孕周≥28周且接受规范的GDM筛查和诊断的非孕前糖尿病产妇14 593例的病历资料进行回顾性分析,比较按照美国国家糖尿病数据组(NDDG)和国际糖尿病与妊娠研究组(IADPSG)诊断标准计算的妊娠期高血糖的发生率及对妊娠结局的影响;并比较对妊娠期高血糖进行管理后不良妊娠结局的改善情况,以同期妊娠分娩的12 403例糖代谢正常孕妇为对照.结果 (1)妊娠期高血糖的发生率:分别按照NDDG、IADPSG标准,需要干预的妊娠期高血糖的发生率分别为8.9%(1293/14 593)和14.7%(2138/14 593),两种标准诊断的需要干预的妊娠期高血糖发生率比较,差异有统计学意义(P＜0.05).(2)妊娠并发症发生情况:不同标准诊断的妊娠期高血糖均将增加巨大儿、大于胎龄儿(LGA)、剖宫产、早产、新生儿低血糖等不良结局的发生率.NDDG、IADPSG标准诊断的妊娠期高血糖和糖代谢正常孕妇巨大儿的发生率分别为8.4%(108/1293)、11.3%(241/2138)和6.7%(835/12 403);LGA的发生率分别为9.7%(125/1293)、11.7%(250/2138)和5.5%(687/12 403);剖宫产率分别为59.0%(763/1293)、60.4%(1291/2138)和51.6%(6397/12 403);早产率分别为11.4%(147/1293)、9.5%(203/2138)和6.3%(777/12 403);新生儿低血糖发生率分别为2.6%(33/1293)、2.2%(46/2138)和0.7%(89/12 403).(3)血糖控制方法:按NDDG标准诊断的妊娠期高血糖孕妇中71.3%(922/1293)可以通过单纯饮食控制达到血糖控制满意.结论 与NDDG标准比较,IADPSG标准诊断的妊娠期高血糖发生率将明显增加,如果未进行管理其围产期并发症也明显增加;提示在我国采用IADPSG标准更适宜.

Abstract：

Objective To investigate the relationship between gestational hyperglycemia and adverse pregnancy outcomes and find out the optimum diagnostic criteria of gestational diabetes mellitus in China. Methods A retrospective population-based study of 14 593 pregnant women, who delivered between Jan. 2005 and Dec. 2009 and accepted the gestational diabetes mellitus ( GDM ) screening and diagnosis was performed. The prevalence of gestational hyperglycemia according to different criteria was calculated, and the incidence of adverse pregnant outcomes relation to gestational hyperglycemia according to different criteria was analyzed. Results ( 1 ) According to National Diabetes Data Group (NDDG) criteria and International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, the prevalence of gestational hyperglycemia that intervention required was 8.9% (1293/14 593 ) and 14.7% (2138/14 593 )respectively; the prevalence of gestational hyperglycemia differed significantly between NDDG and IADPSG criteria ( P ＜ 0. 05 ). ( 2 ) The prevalence of macrosomia, large for gestational ages ( LGA), cesarean section,preterm birth and neonatal hypoglycemia etc would increase in gestational glucose metabolic disorders according to any criteria. The prevalence of the complications in gestational hyperglycemia according to NDDG criteria, IADPSG criteria and the patients with normal glucose metabolism is as follows, macrosomia:8.4% ( 108/1293), 11.3% (241/2138) and 6. 7% ( 835/12 403 ); LGA: 9. 7% ( 125/1293 ), 11.7% (250/2138) and 5.5% (687/12 403); cesarean section: 59. 0% (763/1293), 60. 4% ( 1291/2138 ) and 51.6%(6397/12403); preterm birth: 11.4% (147/1293), 9.5% (203/2138) and 6.3% (777/12 403); neonatal hypoglycemia: 2. 6% ( 33/1293 ), 2. 2% (46/2138) and 0. 7% ( 89/12 403 ). ( 3 )About 71.3% (922/1293) of the gestational hyperglycemia according to NDDG criteria could be well control only by diet control. Conclusion The prevalence of perinatal complications would increase in gestational hyperglycemia that achieved IADPSG criteria without intervention, so IADPSG criteria is reasonable in China.     

葡萄糖激酶基因与妊娠糖尿病的关系

目的 探讨葡萄糖激酶（ＧＣＫ）基因与妊娠糖尿病（ＧＤＭ）易感性的关系。方法 采用群体关联研究的方法,应用聚合酶链反应－变性聚丙烯酰胺凝胶电泳技术,对４０例ＧＤＭ患者（ＧＤＭ组）及４３例正常对照（对照组）ＧＣＫ基因３＇和５＇端的微卫星ＤＮＡ多态标记（ＧＣＫ１、ＧＣＫ２）,进行基因分型,并比较其等位基因、基因型和单倍型在两组中的频率分布。结果 （１）ＧＣＫ１的等位基因频率及基因型频率在两组间无差异。（     

自噬在妊娠期糖尿病中的作用

自噬广泛存在于机体细胞中,能够保护细胞,维持正常的细胞功能和组织结构。过度自噬会引起细胞死亡,导致组织出现病理性损伤。胎盘通过自噬维持正常生理功能。在妊娠期糖尿病孕妇的胎盘中,高血糖能够诱导滋养细胞过度自噬,抑制胎盘血管生成,导致组织缺血、缺氧及细胞活性氧水平升高,出现胎盘功能障碍,增加早产、巨大儿等不良妊娠结局的发生风险。     

糖化血红蛋白在妊娠期糖尿病诊治中的应用

目的 探讨糖化血红蛋白(glyeosylated hemoglobin,HbAlc)在妊娠期糖尿病(gestational diabetes mellitus,GDM)病情程度评价、胰岛素使用及新生儿出生体重预测方面的指导价值. 方法 收集2005年1月1日至2011年8月31日于北京大学第一医院分娩的GDM孕妇中测定HbAlc者1074例的资料,75 g口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)空腹、1和2h血糖诊断界值分别为5.1、10.0及8.5 mmol/L,3点中任何1点血糖达到或者超过界值即诊断为GDM.采用Pearson相关分析探讨HbAlc与OGTT空腹、1和2h血糖水平之间的关系;采用受试者工作特性(receiver operating characteristic,ROC)曲线及Logistic回归分析HbAlc预测GDM孕妇需要使用胰岛素治疗及新生儿出生体重的效力. 结果 1074例GDM孕妇平均年龄为(31.8±4.0)岁,均于妊娠中、晚期行OGTT,平均孕周为(27.6±3.4)周,其中,空腹、1和2h平均血糖分别为(5.2±0.7)、(10.9±1.4)及(9.4±1.5) mmol/L.初次检测HbAlc的孕周为(31.8±4.3)周,HbAlc为(5.57±0.48)％.(1)HbAlc与OGTT血糖水平的关系:726例孕妇在OGTT后1个月内进行了HbAlc检测,HbAlc为(5.54±0.47)％.1点血糖异常者159例,HbAlc为(5.34±0.41)％,低于2点血糖异常者[293例,HbAlc为(5.47±0.41)％](t=3.025,P＜0.01);2点血糖异常者HbAlc低于3点血糖异常者[228例,HbAlc为(5.71±0.46)％](t=6.399,P＜0.01).(2)HbAlc与需要胰岛素治疗的相关性:使用胰岛素治疗的299例孕妇HbAlc为(5.78±0.58)％,显著高于不需要胰岛素治疗者[775例,HbAlc为(5.42±0.37)％](t=9.431,P＜0.01).HbAlc水平预测GDM需要胰岛素治疗的ROC曲线下面积为0.713,当HbAlc为5.67％时,预测GDM需要胰岛素治疗的敏感性与特异性分别为57.8％及75.5％.两因素Logistic回归分析示OR＝6.847,95％CI:4.588～10.218,P＜0.01.(3)妊娠晚期HbAlc与新生儿出生体重的关系:大于胎龄儿组(290例,344次)HbAlc为(5.75±0.52)％,高于非大于胎龄儿组[763例,814次,HbAlc为(5.54±0.42)％](t=6.845,P＜0.01).HbAlc预测大于胎龄儿的ROC曲线下面积为0.626.当HbAlc为5.75％时,预测大于胎龄儿的敏感性与特异性分别为44.8％及73.8％.两因素Logistic回归分析示OR=2.187,95％CI:2.097～3.783,P＜0.01.巨大儿组(93例,117次)HbAlc为(5.88±0.53)％,高于非巨大儿组[960例,1041次,HbAlc为(5.57±0.45)％](t＝5.990,P＜0.01).HbAlc预测巨大儿的ROC曲线下面积为0.675.当HbAlc为5.85％时,预测巨大儿的敏感性与特异性分别为50.4％及79.8％.两因素Logistic回归分析示OR＝3.299,95％CI:2.237～4.865,P＜0.01.结论 诊断GDM时HbAlc水平与GDM的病情程度相关,对胰岛素的使用有预测价值.妊娠晚期HbAlc水平对大于胎龄儿及巨大儿的发生有预测价值.