妊娠期糖尿病孕妇分娩新生儿血糖水平变化情况及其低血糖的影响因素分析

Changes in blood glucose and influencing factors of hypoglycemia in neonates born to pregnant women with gestational diabetes mellitus

目的调查分析妊娠期糖尿病孕妇分娩新生儿血糖水平变化情况及其低血糖的影响因素。方法采用方便抽样方法抽取2019年1月到2022年10月在廊坊市某医院建立产科档案并分娩的妊娠期糖尿病孕妇及其新生儿作为调查对象,采用自制信息收集表于孕妇分娩后收集孕妇及其新生儿资料,分娩前对孕妇血清空腹血糖、餐后2 h血糖、空腹胰岛素、糖化血红蛋白及尿微量白蛋白水平进行检测,并对新生儿娩出后15 min、24 h及48 h血糖水平进行检测。采用描述性分析方法对新生儿低血糖发生情况进行分析,并对其相关因素进行单、多因素分析。结果共纳入1054对妊娠期糖尿病孕妇及其分娩新生儿,新生儿发生低血糖238例,发生率为22.58%。新生儿出生后15 min、24 h及48 h血糖水平变化呈逐渐升高趋势(P<0.05)。多因素分析结果显示孕妇血糖控制欠佳(OR=1.872)、孕前超重或肥胖(OR=2.418)、合并妊娠期高血压(OR=1.570)、泌乳量不足(OR=3.330)及新生儿早产(OR=3.196)、低体重出生(OR=1.970)、低体温(OR=4.246)、窒息(OR=2.724)均为妊娠期糖尿病孕妇分娩新生儿低血糖发生的独立危险因素。结论妊娠期糖尿病孕妇分娩新生儿娩出后15 min、24 h及48 h血糖水平逐渐升高,其低血糖发生的危险因素包括孕妇血糖控制欠佳、孕前超重或肥胖、合并妊娠期高血压、泌乳量不足及新生儿早产、低体重出生、低体温、窒息。

Objective To investigate and analyze the changes in blood glucose and the influencing factors of hypoglycemia in neonates born to pregnant women with gestational diabetes mellitus(GDM).Methods Pregnant women with GDM who had established obstetric records and delivered in a hospital in Langfang City from January 2019 to October 2022 and their neonates were selected by convenient sampling method.The data of pregnant women and their neonates were collected after delivery using a self-made information collection table.The levels of serum fasting blood glucose,2 hours postprandial blood glucose,fasting insulin,glycosylated hemoglobin,and urinary microalbumin of pregnant women were measured before delivery,and the blood glucose levels of neonates were measured at 15 min,24 hours,and 48 hours after delivery.The descriptive analysis method was used to analyze the incidence of hypoglycemia in neonates,and univariate and multivariate analyses were conducted on its related factors.Results A total of 1054 pairs of pregnant women with CDM and their neonates were included,238 neonates suffered from hypoglycemia,with an incidence rate of 22.58%.The changes in blood glucose levels of neonates at 15 minutes,24 hours,and 48 hours after delivery showed a gradual upward trend(P<0.05).Multivariate analysis showed that poor blood glucose control of pregnant women(OR=1.872),overweight or obesity before pregnancy(OR=2.418),gestational hypertension(OR=1.570),insufficient lactation(OR=3.330),premature birth(OR=3.196),low birth weight(OR=1.970),low body temperature(OR=4.246),and asphyxia(OR=2.724)were all independent risk factors for hypoglycemia in neonates born to pregnant women with GDM.Conclusions The blood glucose level of neonates born to pregnant women with GDM gradually increased at 15 minutes,24 hours,and 48 hours after delivery.The risk factors for hypoglycemia include poor blood glucose control of pregnant women,overweight or obesity before pregnancy,gestational hypertension,insufficient lactation,premature birth,low birth weight,low body temperature,and asphyxia.