糖尿病母亲的新生儿早期血糖变化及低血糖的影响因素

Early changes of blood glucose in infants of diabetic mothers after birth and influencing factors of hypoglycemia

目的探讨糖尿病母亲的新生儿(IDMS)早期血糖动态变化及其发生低血糖的可能影响因素。方法回顾性横断面调查,收集2012年1月1日至2017年12月31日在西电集团医院定期产检和分娩、单胎活产的全部妊娠期糖尿病(GDM)产妇及其新生儿的一般临床资料、产妇孕产期血糖值和IDMS出生后48h内各时点的血糖值,并对IDMS出生后各时点血糖值进行比较,用Logistic回归分析IDMS低血糖、临界低血糖的影响因素。结果纳入研究对象358例。①IDMS出生后0.5h平均血糖值明显下降,2h后呈上升趋势。②IDMS生后6h内不同时点血糖的影响因素有:母亲孕前体质量指数(BMI)、胎龄、分娩方式、总产程、分娩时间、出生体重。③358例IDMS中低血糖77例(21.5%),临界低血糖101例(28.2%),均发生于出生后24h内。④Logistic回归分析显示,孕末期静脉血糖值高是新生儿低血糖、临界低血糖的保护因素(Woldχ~2值分别为6.895、18.200,均P<0.05)。结论 IDMS出生后6h内发生低血糖风险较高,应密切监测。GDM孕妇孕末期静脉血糖值高可能降低新生儿低血糖和临界低血糖的风险。

Objective To investigate the early dynamic changes of blood glucose after birth in infants of diabetic mothers (IDMS) and to analyze the possible influencing factors of hypoglycemia in IDMS.Methods A retrospective cross-sectional study was conducted to collect general clinical data of gestational diabetes mellitus (GDM) parturients undergoing regular birth examination and delivery during the period from January 1st,2012 to December 31st,2017 in Xidian Group Hospital and that of their neonates,maternal blood glucose values and blood glucose values of IDMS at each time point within 48h after birth.Blood glucose values at each time point of IDMS were compared,and the influencing factors of hypoglycemia and critical hypoglycemia of IDMS were analyzed by Logistic regression method.Results A total of 358 patients were analyzed in this study.Half an hour after birth,average blood glucose value of IDMS decreased significantly,but rose 2h after birth.The distinction of blood glucose at different time points within 6h after IDMS birth was accounted for maternal pre-pregnancy BMI,gestation age,delivery mode,total stage of labor,time of delivery and birth weight.Hypoglycemia occurred in 77 cases (21.5%) and critical hypoglycemia in 101 cases ( 28.2%) among 358 patients within 24h after birth.Logistic regression analysis showed that high blood glucose level in the third trimester was a protective factor for hypoglycemia and critical hypoglycemia in neonates (χ^2 value was 6.895 and 18.200,respectively,both P <0.05).Conclusion The risk of hypoglycemia occurring within 6h after birth is relatively high in IDMS,and it should be closely monitored.The high blood glucose level of GDM in the end of pregnancy may reduce the risk of hypoglycemia and critical hypoglycemia in newborns.