初产经产和是否患妊娠期糖尿病产妇的新生儿出生体质量、血糖、脐动脉血气对比观察分析

Comparative analysis of birth weight,blood glucose,umbilical arterial blood gas of newborns in nulliparous or multiparous mothers with or without gestational diabetes mellitus

目的对比观察初产经产和是否患妊娠期糖尿病(GDM)产妇的新生儿出生体质量、血糖、脐动脉血气。方法单胎妊娠产妇及其新生儿共87对,根据生产史不同分为初产妇组和经产妇组,根据是否诊断为GDM分为GDM组和无GDM组。胎儿出生后称重,根据胎龄别出生体质量将新生儿分为小于胎龄儿(SGA)、适于胎龄儿(AGA)、大于胎龄儿(LGA),对比分析各组新生儿出生体质量。在产后未开奶前检测新生儿末梢血糖,对比分析各组新生儿低血糖检出率。胎儿娩出后取脐动脉血,采用血气分析仪进行脐动脉血气分析,记录pH、血氧分压(PO_(2))、二氧化碳分压(PCO_(2))、实际碳酸氢盐(AB)、标准碳酸氢盐(SB)、全血剩余碱[BE(B)]、细胞外液剩余碱[BE(ecf)]数值,对比分析各组新生儿脐动脉血气指标。将新生儿胎龄别出生体质量、低血糖检出率和脐动脉血气作为结局指标,采用二分类Logistic回归法探讨GDM对新生儿胎龄别出生体质量、低血糖检出率的影响,采用广义线性回归法分析初产经产对脐动脉血气指标的影响。结果初产妇组SGA、AGA、LGA、低血糖检出率与经产妇组相比,P均>0.05。与无GDM组新生儿相比,GDM组新生儿中SGA占比降低、LGA占比升高、低血糖检出率升高(P均<0.05)。初产妇组新生儿脐动脉血pH、AB、SB、BE(B)、BE(ecf)值均低于经产妇组(P均<0.05)。GDM组、无GDM组新生儿脐动脉血pH、PCO_(2)、PO_(2)、AB、SB、BE(B)、BE(ecf)值差异无统计学意义(P均>0.05)。经产是新生儿脐动脉血pH、AB、SB、BE(B)值的保护性因素。未发现GDM对新生儿出生体质量、低血糖检出率产生影响。结论经产是新生儿脐动脉血pH、AB、SB、BE(B)值的保护性因素,但不影响新生儿出生体质量、血糖。GDM对新生儿出生体质量、血糖和脐动脉血气均不产生影响。

Objective To compare the birth weight,blood glucose,and umbilical arterial blood gas of newborns in nulliparous or multiparous mothers with or without gestational diabetes mellitus(GDM).Methods Information from 87 pairs of singleton pregnancies and newborns were collected.Pregnancies were grouped according to their production history(primipara and multipara groups)and the OGTT(GDM and non-GDM groups).According to the birth weight for gestational age,newborns were divided into small for gestational age(SGA),appropriate for gestational age(AGA),and large for gestational age(LGA).We compared the birth weight and the incidence of neonatal hypoglycemia in different groups before suckling.We collected the umbilical arterial blood,and we recorded and compared the potential of hydrogen(pH),partial pressure of oxygen(PO_(2)),partial pressure of carbon dioxide(PCO_(2)),actual bicarbonate(AB),standard bicarbonate(SB),blood base excess[BE(B)],and base excess extracellular fluid[BE(ecf)]values.We analyzed the effect of GDM on gestational age specific birth weight and neonatal hypoglycemia by binary Logistic regression models,and the generalized linear regression model was used to analyze the impact of parity on the umbilical arterial blood gas value.Results The prevalence of SGA,AGA,LGA,and hypoglycemia had no difference between nulliparous and multiparous mothers(all P>0.05).Compared with the non-GDM group,the proportion of SGA in the GDM group decreased,the proportion of LGA and the hypoglycemia detection rate increased(all P<0.05).The pH,AB,SB,BE(B),and BE(ecf)values of umbilical arterial blood were significantly lower in nulliparous mothers than in multiparous mothers(all P<0.05),while there was no significant difference between the GDM group and non-GDM group for these values(all P>0.05).Multiparity was the protective factor of umbilical arterial blood pH,AB,SB,BE(B).GDM did not affect birth weight and the incidence of neonatal hypoglycemia.Conclusions Multiparity is a protective factor for umbilical arterial blood pH,AB,SB,and BE(B)values,but does not affect the birth weight and neonatal blood glucose.GDM has no effect on birth weight,neonatal blood glucose,and umbilical arterial blood gas.