脐静脉血胰岛素和C肽水平与妊娠期糖尿病患者子代新生儿体格发育的相关性

Correlation of umbilical cord insulin and C-peptide levels with growth of the neonates born from gestational diabetes mellitus mothers

目的探讨妊娠期糖尿病(GDM)孕妇子代新生儿脐静脉血胰岛素和C肽水平对新生儿体格发育的影响。方法纳入2014年7月至2015年1月于我院行剖宫产的GDM孕妇51例和糖耐量正常(NGT)孕妇49例。收集孕妇一般资料,测定孕妇分娩前空腹外周血血糖和血脂水平,测定新生儿脐静脉血血糖、血脂、胰岛素和C肽水平,测量新生儿出生后24 h内的体格发育指标。采用logistic回归和多元线性回归分析新生儿脐静脉血胰岛素和C肽与巨大儿发生风险和新生儿体格发育的相关性。结果 1 GDM组新生儿脐静脉血胰岛素、C肽水平高于NGT组(P<0.05),两组新生儿血糖、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白-胆固醇(HDL-C)和低密度脂蛋白-胆固醇(LDL-C)水平差异无统计学意义(P>0.05)。2与NGT组相比,GDM组新生儿巨大儿发生率高,新生儿上臂周径、胸围、腹围、肩宽和总皮褶厚度显著增加(P<0.01,P<0.05),头围/肩宽比值、头围/胸围比值显著下降(P<0.01),但两组新生儿出生体重、身长和头围差异无统计学意义(P>0.05)。3 Logistic回归分析显示,新生儿脐静脉血胰岛素水平、C肽水平与巨大儿发生率呈正相关;多元线性回归分析显示,新生儿脐静脉血胰岛素水平、C肽水平与新生儿出生体重、身长、胸围、腹围、上臂周径、肩宽以及总皮褶厚度均呈正相关,与头围/肩宽比值、头围/胸围比值呈负相关(P<0.01)。结论 GDM孕妇子代脐静脉血胰岛素和C肽水平升高可增加巨大儿发生风险,并与新生儿体格发育各项指标具有显著相关性。

Objective To compare the umbilical cord insulin and C-peptide levels in the neonates born from gestational diabetes mellitus（GDM）women with that from normal glucose tolerance（NGT）women,and to investigate the impacts on neonatal growth. Methods A total of 51 GDM women and 49 NGT women, who all had cesarean delivery in our hospital from July 2014 to January 2015, were enrolled in this study. Their maternal plasma glucose and serum lipids were obtained before delivery, and the umbilical cord glucose, lipids, C-peptide and insulin levels were collected at birth. The neonatal anthropometrics were measured within 24 hours of birth. The logistic regression analysis and multiple linear regression analysis were performed. Results ①The cord blood insulin levels, C-peptide levels of GDM group were higher than those in NGT group（P〈0.05）, while the neonatal blood glucose, serum TG, TC, HDL-C and LDL-C levels between twogroups had no significant difference（P〉0.05）. ②Compared with NGT group, neonates of GDM group had increased risk of macrosomia, larger chest circumference, abdomen circumference, shoulder width, total skinfold and upper arm circumference（P〈0.01, P〈0.05）. Their head circumference/shoulder width and head circumference/chest circumference were lower（P0.01）. No difference in birth weight, body length, head circumferences were observed（P〉0.05）. ③Logistic regression analysis showed that higher cord blood insulin and C-peptide levels were associated with increased risk of macrosomia. Multiple linear regression analysis showed that cord blood insulin and C-peptide levels were significantly associated with neonatal birth weight, body length, chest circumference, abdomen circumference, upper arm circumference, shoulder width, total skinfold, while they were associated with reduced head circumference/shoulder width and head circumference/chest circumference（P〈0.01）. Conclusion The cord blood insulin and C-peptide levels in GDM patients are higher than those in NGT patients. Both higher neonatal insulin and C-peptide levels may increase macrosomia incidence and affect neonatal growth.