妊娠期糖尿病对早产新生儿大脑发育的影响

Influence of gestational diabetes mellitus on brain development of premature newborns

目的探讨妊娠期糖尿病(GDM)对早产新生儿大脑发育的影响。方法采用回顾性研究。选取2017年1月至2020年12月期间广州市第一人民医院新生儿科病房收治的GDM母亲所生早产新生儿为GDM组(45例,男24例,女21例),选择同期出生、母亲无GDM,胎龄、身长及出生体质量等一般情况与GDM组相当的早产新生儿为对照组(45例,男24例,女21例)。采用t检验及χ^(2)检验比较两组新生儿出生后7 d的新生儿行为神经测定(NBNA)评分,并于分娩3 d后行颅脑超声指标记录检测分析,查阅病例获取一般指标情况,分析GDM组新生儿发生大脑整体回声减低的影响因素。结果GDM组新生儿胎龄(34.05±1.70)周,出生体质量(2.29±0.53)kg,身长(45.23±3.25)cm,对照组分别为(34.13±1.41)周、(2.26±0.35)kg、(45.50±2.03)cm,两组新生儿基本情况比较,差异均无统计学意义(均P>0.05)。GDM组新生儿出生后7 d的NBNA总评分为(35.43±1.07)分,显著低于对照组的(36.47±0.62)分(t=4.975,P<0.001);GDM组新生儿脑整体回声减低发生率显著高于对照组[64.44%(29/45)比20.00%(9/45)],差异有统计学意义(χ^(2)=14.930,P<0.001);多元线性回归分析显示,出生体质量与脑整体回声减低呈负相关,母亲GDM程度分级与脑整体回声减低呈正相关(均P<0.05)。结论GDM母亲所生早产新生儿存在不同程度的脑发育不成熟现象,妊娠期高血糖环境对新生儿神经行为发育可能产生不良影响。

Objective To explore the influence of gestational diabetes mellitus(GDM)on the brain development of premature newborns.Methods This was a retrospective study.Forty-five premature newborns born to GDM mothers admitted to the ward at Department of Pediatrics,Guangzhou First People's Hospital from January 2017 to December 2019 were selected as a GDM group,including 24 he-babies and 21 she-babies.Forty-five premature newborns who were born at the same time,whose mothers did not have GDM,and whose gestational age,body length,and birth weight matched with the GDM group were selected as a control group,including 24 he-babies and 21 she-babies.The scores of Neonatal Behavioral Neurological Assessment(NBNA)7 days after birth in the two groups were compared by t test andχ^(2) test.The craniocerebral ultrasound indicators 3 days after delivery were recorded,and the detection indicators were analyzed.The cases were reviewed to obtain their general indicators,so as to analyze the influencing factors of the overall brain echo reduction in the newborns in the GDM group.Results The gestational age,birth weight,and body length were(34.05±1.70)weeks,(2.29±0.53)kg,and(45.23±3.25)cm in the GDM group,and were(34.13±1.41)weeks,(2.26±0.35)kg,and(45.50±2.03)cm in the control group,with no statistical differences(all P>0.05).The total score of NBNA in the GDM group was significantly lower than that of the control group 7 days after birth[(35.43±1.07)vs.(36.47±0.62);t=4.975,P<0.001].The incidence of overall brain echo reduction in the GDM group was significantly higher than that in the control group[64.44%(29/45)vs.20.00%(9/45)],with a statistical difference(χ^(2)=14.930,P<0.001).Multiple linear regression analysis showed that birth weight was negatively correlated with the reduction of overall brain echo(P<0.05),and the maternal GDM degree classification was positively correlated with the reduction of overall brain echo(P<0.05).Conclusion Newborns born to GDM mothers have varied degrees of immature brain development,and the environment of high blood glucose during pregnancy may have adverse effects on their neurobehavioral development.