妊娠期糖尿病孕妇口服75g葡萄糖耐量试验不同时点血糖异常对新生儿并发症及神经行为发育的影响

目的分析妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇75g葡萄糖耐量试验(oral glucose tolerance test,OGTT)不同时点血糖异常对新生儿并发症及神经行为发育的影响。方法选取2015年10月至2016年4月在华北理工大学附属医院规律产检并住院分娩的GDM孕妇所生144例新生儿作为研究对象,其中孕妇75g OGTT 1项时点血糖异常为GDMⅠ组、2项时点血糖异常为GDMⅡ组、3项时点血糖均异常为GDMⅢ组;分别对3组孕妇的新生儿进行新生儿行为神经测定(neonatal behavioral neurological assessment,NABA)评分。结果①3组NABA评分相比较,GDMⅢ组低于GDMⅡ组和GDMⅠ组,且两两比较差异有统计学意义(P0.05)。②3组新生儿低血糖的发生率分别为5.2%、6.2%、23.0%;巨大儿的发生率分别为5.2%、18.7%、33.3%,组间比较差异均有统计学意义(P0.05)。③3组中,新生儿低血糖者NABA低于血糖正常者;巨大儿NABA评分低于非巨大儿。结论 75g OGTT异常时点越多,新生儿神经行为发育损伤及新生儿低血糖、巨大儿的发生率也越高。因此对不同层次的高危孕妇及新生儿应尽早采取不同的措施以改善不良预后。

The effects of abnormal blood glucose of 75 g OGTT in pregnant women with gestational diabetes mellitus on neonatal complications and neurobehavioral development

Objective To analyze the effects of abnormal blood glucose of 75g oral glucose tolerance test ( OGTT) in pregnant women with gestational diabetes mellitus ( GDM) on neonatal complications and neurobehavioral development .Methods A total of 144 newborns were selected as the observation group , whose mothers were diagnosed as GDM and received prenatal examination and delivered in North China University of Science and Technology Affiliated Hospital from October 2015 to April 2016.The pregnant women were divided into 3 groups on the basis of each time point blood glucose results in 75g OGTT.Group GDMⅠ:one abnormal blood glucose of OGTT result .Group GDMⅡ:two abnormal blood glucose of OGTT results and Group GDMⅢ:three abnormal blood glucose results.The neonatal behavioral neurological assessment ( NABA) score of newborns of the 3 groups of pregnant women were analyzed respectively.Results ①Comparison of NABA scores in the 3 groups,GDMⅢ was lower than GDMⅡand GDMⅠ,and pairwise comparison were different significantly (P<0.05);②The incidence of neonatal hypoglycemia in the 3 groups were 5.2%, 6.2%and 23.0%.The incidence of macrosomia were 5.2%,18.7%and 33.3%.The differences were statistically significant ( P<0.05) .③In the 3 groups, the NABA score of neonatal hypoglycemia was lower than that of the normal blood glucose .The NABA score of macrosomia was lower than that of normal .Conclusion The more OGTT abnormal points ,the higher the incidence rate of neonatal neurological behavioral development injury , neonatal hypoglycemia and macrosomia .Therefore, different levels of high -risk pregnant women and newborns should take different measures as early as possible to prevent the poor prognosis .