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中国循证儿科杂志

中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (5): 342-346.

• 论著 • 上一篇    下一篇

妊娠期糖尿病母亲的新生儿出生48小时内血糖的动态变化及低血糖的影响因素

黄欣欣,江秀敏,林艳,周衔玲   

  1. 福建省妇幼保健院,福建医科大学附属医院 福州，350001
  • 收稿日期:2017-07-27 修回日期:2017-11-30 出版日期:2017-10-25 发布日期:2017-10-25
  • 通讯作者: 江秀敏

Dynamic changes of blood glucose in newborns with gestational diabetes mellitus within 48 hours after birth and the influencing factors of hypoglycemia

HUANG Xin-xin, JIANG Xiu-min, LIN Yan, ZHOU Xian-ling   

  1. Fujian Provincial Maternity and Children Hospital，Affiliated Hospital of Fujian Medical University,Fuzhou 350001, China
  • Received:2017-07-27 Revised:2017-11-30 Online:2017-10-25 Published:2017-10-25
  • Contact: JIANG Xiu-min

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摘要： 摘要目的：探讨糖尿病母亲婴儿（IDMS）出生后血糖的变化情况，分析IDMS发生低血糖的可能影响因素。方法：回顾性横断面调查，纳入2014年1月1日至12月31日在福建省妇幼保健院（我院)定期产检和分娩、单胎活产的全部妊娠期糖尿病（GDM）产妇，收集产妇和新生儿的一般临床资料、母亲孕产期血糖值和IDMS出生后48 h内各时点的血糖值。血糖值＜2.2 、~2.6 mmol·L-1 为低血糖和临界低血糖。多因素Logistic回归分析IDMS低血糖、临界低血糖的影响因素。结果：共1 083份病志进入本文分析。①GDM产妇年龄(30.2±4.2)岁，(39.1±1.4)孕周，初产妇66.8%，阴道分娩82.4%，孕前BMI＜18.5者4.5%、≥25者9.8%。1 083例IDMS中，早产儿3.8%，男52.5%，Apgar评分均≥8分，出生体重(3 303.7±428.2)g。②IDMS出生0.5 h时平均血糖明显下降，2~48 h呈上升趋势。母亲孕前BMI 18.5~24.9、阴道分娩、足月儿、总产程时间≥7 h、傍晚至夜间分娩、正常体重儿的IDMS出生时和生后某些时点的平均末梢血糖相对较高。③1 083例IDMS中，低血糖7例(0.65%)，6例发生在出生时，1例发生在生后48 h；临界低血糖29例(2.68%)，26例发生在出生时，生后12、24和48 h各1例。④多因素非条件Logistic回归显示，孕末期静脉血糖水平高是新生儿低血糖、临界低血糖的保护因素。结论：IDMS生后48 h内发生低血糖的时间以出生时最多，但生后48 h都有发生低血糖的可能，应密切监测。GDM孕妇孕末期静脉血糖水平高可能是新生儿低血糖和临界低血糖的保护因素。

Abstract: AbstractObjective：To investigate the changes of blood glucose after birth in infants of diabetic mothers (IDMS), and to analyze the possible influencing factors of hypoglycemia in IDMS, in order to standardize the IDMS monitoring pathway and reduce the incidence of hypoglycemia. Methods：A retrospective cross-sectional study was conducted to examine all GDM parturients who underwent regular birth examination and delivery during the period from January 1st, 2014 to December 31st, 2014 in Fujian Provincial Maternity and Child Care Center (our hospital), maternal and neonatal general clinical data, maternal blood glucose values and blood glucose values at each time point within 48 h after birth were collected in IDMS. The blood sugar value < 2.2 mmol·L-1was considered as neonatal hypoglycemia, and ~2.6 mmol·L-1 critical hypoglycemia. The influencing factors of low blood glucose and critical hypoglycemia of IDMS were analyzed by multifactor non-conditional logistic regression. Results：A total of 1,083 patients were analyzed in this study. ①Among the 1,083 cases of GDM, the maternal age was(30.2 ± 4.2), gestational week (39.1±1.4), 66.8% of the first parturition, 82.4% of the vaginal delivery, and the prepregnancy BMI< 18.5, 4.5%, or 25, 9.8%.Among the 1,083 cases of IDMS, 3.8% of premature infants, 52.5% of men, and Apgar scores were all equal to 8 points and birth weight (3 303.7 + 428.2) g. ②When IDMS were born 0.5 h, average blood glucose decreased significantly, and 2 h rose to 48 h. Maternal prepregnancy BMI18.5~ 24.9, vaginal delivery, full moon, total delivery time of 7 h, evening to night delivery, normal weight of IDMS, and the average peripheral blood glucose at some points of time after birth were relatively high. ③Of the 1 083 cases of IDMS, 7 were hypoglycemic (0.65%), 6 occurred at birth, and 1 occurred at 48 h after birth. The critical hypoglycemia was 29 cases (2.68%), and the 26 cases occurred at the birth and one case each 12, 24 and 48 h after birth respectively. ④Multifactor nonconditional logistic regression showed that high blood glucose level was the protective factor for hypoglycemia and critical hypoglycemia in neonates.Conclusion：The time of hypoglycemia occurred at 48 h after the birth of IDMS, but it could occur any time within 48 h and should be closely monitored. The high blood glucose level of GDM in the end of pregnancy may be a protective factor for hypoglycemia and hypoglycemia in newborns.