妊娠期糖尿病患者孕晚期血糖和新生儿脐血激素水平与新生儿呼吸窘迫综合征的关系

Association between advanced gestational blood glucose in patients with gestational diabetes and neonatal cord blood hormone levels and neonatal respiratory distress syndrome

目的了解妊娠期糖尿病患者孕晚期血糖水平、新生儿脐血激素水平对新生儿呼吸窘迫综合征(NRDS)发生的影响。方法选取2017年11月—2021年11月树兰(杭州)医院收治的符合入选标准的妊娠期糖尿病患者及其分娩新生儿为研究对象,回顾性分析其临床资料,收集产妇产前最后一次糖化血红蛋白(HbA1c)、产前末梢血糖、产前是否应用糖皮质激素等信息,新生儿性别、胎龄、体质量、脐血皮质醇、甲状腺激素水平等信息,追踪新生儿是否发生NRDS。结果纳入新生儿74例,男44例、女30例,早产儿26例、足月儿48例,母亲孕周34~41.1周,平均(37.3±1.6)周。74例新生儿中未发生NRDS 50例为非NRDS组,发生NRDS 24例为NRDS组,产前应用糖皮质激素23例,均符合产前应用糖皮质激素应用指征,13例为≥34周且<35周7 d内早产高风险者;10例为≥35周存在或可疑胎肺不成熟可能。74例妊娠期糖尿病母亲孕早期TSH均值为(2.114±0.924)mIU/L。两组新生儿性别、母亲产前末梢血糖值及新生儿出生体质量比较,差异均无统计学意义(均P>0.05)。两组新生儿母亲产前HbA1c水平[NRDS组(6.325±0.872)%,非NRDS组(5.004±0.234)%]、孕周[NRDS组(36.078±1.531)周,非NRDS组(37.959±1.263)周]比较,差异均有统计学意义(t=9.772、-5.592,均P<0.05)。两组新生儿脐血皮质醇、游离T3(FT_(3))及游离T4(FT_(4))水平比较,差异均无统计学意义(均P>0.05);两组新生儿TSH水平比较,差异有统计学意义(P<0.05)。母亲产前HbA1c与脐血TSH值呈负相关关系,HbA1c越高,脐血TSH越低;胎龄与TSH值呈正相关关系,胎龄越小、脐血TSH越低;NRDS与母亲产前HbA1c呈正相关关系,与脐血TSH呈负相关关系(均P<0.05)。结论妊娠期糖尿病母亲孕晚期血糖控制不良、新生儿脐血低TSH水平对NRDS发生具有一定的警示意义。

Objective To understand the effects of advanced pregnancy blood glucose in patients with gestational diabetes and neonatal umbilical cord blood hormone level on the occurrence of neonatal respiratory distress syndrome(NRDS).Methods Gestational diabetic mothers and their newborns admitted to Shulan(Hangzhou)Hospital from November 2017 to November 2021 were selected as the study ob⁃jects,The clinical data were retrospectively analyzed to collect the last prenatal glybated hemoglobin(HbA1c),prenatal peripheral blood glucose,prenatal glucocorticoid,gender,gestational age,body quality,umbilical cord blood cortisol,thyroid hormone level,to track whether the newborn had NRDS.Results 74 newborns,44 males,30 females,26 preterm and 48 term infants,maternal gestational age 34 to 41.1 weeks,with an average(37.3±1.6)weeks.Among 74 neonates,no NRDS 50 was non-NRDS,group,NRDS 24 was NRDS group;23 were antenatal glucocorticoid application,all met the indication of antenatal glucocorticoid application,13 were 34 weeks and high risk of premature birth within<35 weeks;10 were 35 weeks present or suspected of fetal lung immaturity.TSH for early gestational in 74 gestational diabetic mothers,with a mean value of(2.114±0.924)mIU/L.There were no significant differences between the neonatal gen⁃der,maternal prenatal peripheral blood glucose values and neonatal body mass between the two groups(all P>0.05).There were statistically sig⁃nificant differences comparing maternal prenatal HbA1c levels[NRDS(6.325±0.872)%,non-NRDS(5.004±0.0234)%],gestational age[NRDS(36.078±1.531)and non-NRDS(37.959±1.263)weeks](t=9.772,-5.992,all P<0.05).TSH levels in cord blood were different between the two groups(P<0.05).Maternal prenatal HbA1c and cord blood TSH value negative correlation,the higher HbA1c,the lower cord blood TSH;gestational age was a positive relationship with TSH,the younger gestational age,the lower cord blood TSH;the positive relationship between NRDS and maternal prenatal HbA1c,a negative relationship with cord blood TSH(all P<0.05).Conclusion For mothers with gestational diabetes mellitus,poor control of blood glucose in late pregnancy and low TSH level in umbilical cord blood of newborns have certain warning significance for the occurrence of NRDS.