糖尿病母亲新生儿大于胎龄儿的危险因素及近期结局

目的 分析糖尿病母亲新生儿大于胎龄儿的相关围产因素及其近期不良结局的情况,为大于胎龄儿新生儿期的临床管理提供科学依据。方法 收集2019 年1—5 月马鞍山市妇幼保健院产科817例妊娠期糖尿病孕妇及其所分娩的新生儿临床资料,采用多因素Logistic二元回归模型对糖尿病母亲新生儿发生大于胎龄儿相关围产因素进行分析;用χ²检验分析大于胎龄儿与适于胎龄儿近期不良结局的关系。结果 糖尿病母亲新生儿发生大于胎龄儿危险因素是母亲孕晚期体重指数 (BMI>23.9 kg/m²,OR=1.139,95%CI:1.082~1.198,P<0.001),甘油三酯 (TG≥2.3 mmol/L,OR=1.115,95%CI:1.020～1.219,P=0.016)、男性婴儿(OR=1.089,95%CI:1.050～1.129,P＜0.001)及新生儿胎龄(OR=1.403,95%CI:1.205～1.634,P＜0.001);大于胎龄儿与适于胎龄儿转入新生儿科的发生率,差异无统计学意义(11.2% vs. 12.4%,χ²=0.239,P>0.05)。结论 应积极控制妊娠期糖尿病孕妇孕晚期的BMI及TG水平,对胎龄大以及男性婴儿需警惕大于胎龄儿的发生,促进母婴健康;大于胎龄儿近期结局与适于胎龄儿无明显差别,应着重于其日后远期不良结局的监测。

perinatal factors and the short-term adverse outcomes larger gestational age infants and gestational diabetes mellitus mothers

Objective To analyze the perinatal factors and the short-term adverse outcomes of large gestational age (LGA) infants delivered by gestational diabetes mellitus (GDM) mothers, so as to provide scientific reference for clinical management of LGA. Methods The clinical data of 817 cases in the obstetrical department of Ma'anshan Maternal and Child Health Hospital from January to May 2019 were collected. Logistic regression was used to analyze the association between perinatal factors and LGA infants in mothers with GDM. The relationship of short outcome between LGA infants and appropriate for gestational age (AGA) infants was analyzed by χ² test. Results Multivariate analysis of LGA infants revealed the following risk factors: Maternal body mass index (BMI)>23.9 kg/m²(OR=1.139, 95%CI:1.082—1.198, P＜0.001), maternal triglyceride(TG)≥2.3 mmol/L (OR=1.115, 95%CI: 1.020-1.219, P=0.016), male neonates (OR=1.089, 95%CI: 1.050-1.129,P＜0.001) and neonatal gestational age (OR=1.403,95%CI:1.205-1.634, P＜0.001) were the risk factors for LGA infants. There was no significant difference of hospitalization between LGA infants and AGA infants (11.2% vs. 12.4%, χ²=0.239, P＞0.05). Conclusions It is supposed to strictly control maternal BMI and TG levels of GDM, and to pay more attention to the long-term adverse of LGA infants in order to promoting mother-infant health. The short-term outcomes of LGA and AGA infants are not distinctly different, so the long-term outcome should be further monitored.