妊娠期糖耐量异常对新生儿的影响

Effect of impaired glucose tolerance during pregnancy on newborns

摘要:

目的：妊娠期糖代谢异常可引起新生儿多种并发症。该文通过回顾性分析，探讨妊娠期不同程度糖代谢异常对新生儿的影响。方法：根据孕妇在孕24～28周时50 g葡萄糖筛查试验(GCT)及75 g葡萄糖耐量试验(OGTT)的结果，将其所分娩新生儿分为4组：妊娠期糖尿病组(GDM，182例)、妊娠期糖耐量减低(GIGT)1 h组(57例)、GIGT (2~3 h)组(156例)、GCT异常而OGTT正常(仅GCT异常组, 38例)，并以糖代谢正常孕妇所分娩新生儿1 025例作为对照，对妊娠期不同程度糖代谢异常孕母的围产儿结局进行比较。结果：GIGT（1 h）组巨大儿、大于胎龄儿及小于胎龄儿发生率，以及低血糖、早产发生率明显高于对照组，与GDM组类似。GIGT（2~3 h）组和仅GCT异常组巨大儿、小于胎龄儿以及低血糖和早产的发生率明显低于GDM组，差异均有显著性意义，与对照组比较差异无显著性意义。GIGT(1 h)组新生儿低血糖和早产发生率明显高于GIGT (2~3 h) 组和仅GCT异常组, 差异有显著性意义。结论：母亲妊娠期糖代谢异常程度不同对新生儿的影响不同。孕母OGTT 试验1 h 单项血糖升高的糖耐量减低与妊娠糖尿病一样对新生儿具有危险性，可导致巨大儿、大于胎龄儿、小于胎龄儿及低血糖、早产的发生率增加。［中国当代儿科杂志，2009，11（3）：177-180］

Abstract:

OBJECTIVE: Abnormal glucose metabolism during pregnancy can result in significant adverse outcomes for newborns. This study was designed to investigate the effect of different degrees of impaired glucose tolerance on newborns. METHODS: Glucose challenge test (GCT) and oral glucose tolerance test (OGTT) were performed in pregnant women at 24-28 weeks of gestation. Based on the results of the two tests, their newborn infants were classified into five groups: gestational diabetes mellitus (GDM, n=182), gestational impaired oral glucose tolerance ［GIGT, subdividing into GIGT 1 h (n=57) and GIGT 2-3 h groups (n=156)based on the occurrence time of abnormal blood glucose after glucose load］, GCT abnormal but OGTT normal (only GCT abnormal, n=38) and normal glucose tolerance (control, n=1 025). The perinatal outcomes were compared among the five groups. RESULTS: The incidences of macrosomia, large for gestational age (LGA), small for gestational age (SGA), neonatal hypoglycemia and premature birth in the GIGT (1 h) group were significantly higher than those in the control group, but similar to those in the GDM group. The incidences of macrosomia, SGA, neonatal hypoglycemia and premature birth in the GIGT (2-3 h) and the only GCT abnormal groups significantly decreased as compared with those in the GDM group, and similar to those in the control group. GIGT (1 h ) group showed higher incidence of neonatal hypoglycemia and premature birth than the GIGT (2-3 h) and the only GCT abnormal groups. CONCLUSIONS: Different degrees of maternal impaired glucose tolerance have different effects on newborns. As maternal GDM, maternal GIGT (1 h) may increase the risk of macrosomia, LGA, SGA, neonatal hypoglycemia and premature birth.［Chin J Contemp Pediatr, 2009, 11 (3):177-180］