摘要
目的探讨母亲妊娠期糖尿病(gestational diabetes mellitus,GDM)对新生儿心脏发育的影响.方法本研究为回顾性分析,选择2016年1~12月首都医科大学附属北京妇产医院新生儿科收治的母亲符合国际糖尿病与妊娠研究组GDM诊断标准的足月新生儿为GDM组;同期收治的非GDM母亲分娩的足月新生儿为对照组.比较两组新生儿出生体重、身长、胎盘重量、出生体重/胎盘重量比值、出生1周内超声心动心脏测量值、先天性心脏病发生率,并对影响GDM组新生儿室间隔肥厚的相关因素进行多元线性回归分析.结果GDM组共纳入104例,对照组共纳入107例.GDM组出生体重、身长和胎盘重量大于对照组,差异有统计学意义(P<0.05);两组性别、胎龄和出生体重/胎盘重量比值差异无统计学意义(P>0.05).GDM组主动脉和主肺动脉宽度,左心房、左心室和右心室大小,室间隔厚度均大于对照组,差异有统计学意义(P<0.05);两组在体重无差异条件下,GDM组室间隔厚度大于对照组[≥3500 g:(3.6±0.5)mm比(3.3±0.3)mm,<3500 g:(3.5±1.0)mm比(3.1±0.4)mm],差异有统计学意义(P<0.05).GDM组先天性心脏病发生率为4.8%(5/104),对照组为0%,两组差异有统计学意义(P<0.05).多元线性回归分析结果显示,GDM组室间隔厚度与母亲孕期糖化血红蛋白、糖化白蛋白、胰岛素水平及新生儿出生体重成正相关(P<0.05).结论母亲GDM对新生儿心肌发育有明显的不良影响,对于其发生机制及如何监控仍需进一步研究.
Objective To study the effects of maternal gestational diabetes mellitus(GDM)on neonatal cardiac development.Method From January to December in 2016,full-term neonates of GDM mothers admitted to the neonatal department of our hospital were retrospectively included as the GDM group,and full-term neonates with non-GDM mothers during the same period as the control group.Their birth weight,length,placenta weight,birth weight/placenta weight ratio,echocardiographic cardiac measurements within the first week,and the incidence of congenital heart disease were compared between the two groups.Multivariate linear regression analysis was used to analyse the possible factors causing neonatal ventricular septal hypertrophy in GDM group.Result A total of 104 cases in the GDM group and 107 cases in the control group were included.Significant differences existed in birth weight,length and placental weight between the two groups(P<0.05).No significant differences in gender,gestational age and birth weight/placental weight ratio between the two groups(P>0.05).The width of the aorta and main pulmonary artery,the size of the left atrium,the left ventricle and the right ventricle,and the thickness of the ventricular septum in the GDM group were greater than the control group,the differences were statistically significant(P<0.05).The ventricular septal thickness of the GDM group was greater than the control group[≥3500g:(3.6±0.5)mmvs.(3.3±0.3)mm,<3500g:(3.5±1.0)mmvs.(3.1±0.4)mm],the difference was statistically significant(P<0.05).The incidence of congenital heart disease was 4.8%(5/104)in the GDM group and 0%in the control group.The difference between the two groups was statistically significant(P<0.05).Multivariate linear regression analysis showed that the interventricular septal thickness of the GDM group was positively correlated with the levels of HbA1c,HbA1 c,insulin of their mothers during pregnancy and birth weight of the newborn(P<0.05).Conclusion GDM mother may pose adverse effects on neonatal myocardial development.F
作者
邢继伟
张巍
焦颖
Xing Jiwei;Zhang Wei;Jiao Ying(Department of Neonatology,Capital Medical Uninersity Capital University of Beijing Obstries&Gynecology Hopital,Beijing 100026,China)
关键词
糖尿病
妊娠
心肌病
肥厚性
先天性心脏病
婴儿
新生
Diabetes,gestational
Cardiomyopathy,hypertrophic
Congenital heart disease
Infant,newborn