糖尿病孕妇孕期和产时胰岛素管理与新生儿低血糖的相关性研究  

Correlation of insulin management during pregnancy and childbirth with neonatal hypoglycemia in pregnant women with diabetes

作　　者：高鹰 高雄 GAO Ying;GAO Xiong(Department of Gynecology and Obstetrics,Clinical Medical College of Yangzhou University,Northern Jiangsu People′s Hospital Affiliated to Yangzhou University,Yangzhou,Jiangsu,225001;Department of Gastroenterology and Endocrinology,Yaozhou District People′s Hospital of Tongchuan City in Shaanxi Province,Tongchuan,Shaanxi,727100)

机构地区：[1]扬州大学临床医学院/扬州大学附属苏北人民医院妇产科,江苏扬州225001 [2]陕西省铜川市耀州区人民医院消化内分泌科,陕西铜川727100

出　　处：《实用临床医药杂志》2024年第16期104-108,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省苏北人民医院课题项目(yzucms201713)。

摘　　要：目的探讨糖尿病孕妇产时静脉泵入胰岛素控制血糖的疗效以及孕期和产时糖尿病控制对新生儿低血糖的影响。方法回顾性分析2022年1月—2023年12月在扬州大学附属苏北人民医院妇产科产检的100例糖尿病孕妇的临床资料。结果65例孕妇所娩新生儿血糖<2.2 mmol/L,46例孕妇所娩新生儿需要静脉注射葡萄糖治疗。产妇分娩时血糖>7.0 mmol/L与新生儿血糖<2.2 mmol/L的发生有相关性(P=0.034),但不需要静脉滴注葡萄糖治疗或转至新生儿科住院治疗。糖尿病孕妇孕晚期糖化血红蛋白(HbA1c)>6.5%与新生儿低血糖需要相关干预有相关性[比值比(OR)=3.89,95%CI:1.42~10.68]。结论产妇分娩时血糖>7.0 mmol/L可预测新生儿低血糖,但与新生儿低血糖的严重程度无关;孕妇孕晚期HbA1c升高反映了孕妇高血糖可预测新生儿严重的高胰岛素血症,需要积极干预,孕晚期HbA1c<6.5%对改善新生儿低血糖有重要意义。Objective To investigate the efficacy of intravenous insulin infusion for pregnant women with diabetes during childbirth for blood glucose control and the influence of diabetes management during pregnancy and childbirth on neonatal hypoglycemia.Methods Clinical materials of 100 pregnant women with diabetes receiving antenatal care in the Department of Gynecology and Obstetrics in the Northern Jiangsu People's Hospital Affiliated to Yangzhou University from January 2022 to December 2023 were retrospectively analyzed.Results Hypoglycemia(blood glucose<2.2 mmol/L)was observed in 65 neonates delivered by the pregnant women,and 46 neonates delivered by the pregnant women required intravenous glucose therapy.There was a significant correlation between maternal blood glucose>7.0 mmol/L during childbirth and the occurrence of neonatal hypoglycemia(P=0.034),but these cases did not require intravenous glucose therapy or transferring to the neonatal intensive care unit.Glycated hemoglobin(HbA1c)>6.5%in the third trimester in diabetic pregnant women was correlated with the need for intervention in neonatal hypoglycemia(OR=3.89,95%CI,1.42 to 10.68).Conclusion Maternal blood glucose>7.0 mmol/L during childbirth can predict neonatal hypoglycemia but is not associated with its severity.Elevated HbA1c in the third trimester reflects maternal hyperglycemia and predicts severe neonatal hyperinsulinemia with proactive interventions.Maintaining HbA1c<6.5%in the third trimester is crucial for improving neonatal hypoglycemia.

关 键 词：胰岛素 糖尿病控制 妊娠 新生儿低血糖 糖化血红蛋白 高胰岛素血症 

分 类 号：R722[医药卫生—儿科] R714.25[医药卫生—临床医学] R587.1