Correlation of insulin management during pregnancy and childbirth with neonatal hypoglycemia in pregnant women with diabetes
-
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。
Abstract:ObjectiveTo 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.
MethodsClinical 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.
ResultsHypoglycemia (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).
ConclusionMaternal 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.
-
Keywords:
- insulin /
- diabetes management /
- pregnancy /
- neonatal hypoglycemia /
- glycated hemoglobin /
- hyperinsulinemia
-
-
表 1 新生儿低血糖结局[n(%)]
新生儿结局 全组(n=100) 1型糖尿病(n=59) 2型糖尿病(n=41) P 新生儿血糖 < 2.2 mmol/L 65(65.0) 42(71.2) 23(56.1) 0.120 新生儿静脉注射葡萄糖 46(46.0) 35(59.3) 11(26.8) 0.001 新生儿低血糖转至新生儿科 53(53.0) 39(66.1) 14(34.1) 0.001 
下载: 导出CSV
表 2 母体血糖控制与新生儿低血糖结局的关系
时期 分类 n 新生儿低血糖 新生儿接受静脉注射葡萄糖 低血糖转新生儿科 孕晚期 HbA1c≤6.5% 71 45(63.4) 24(33.8) 30(42.3) HbA1c>6.5% 29 22(75.9) 18(62.1) 20(69.0) P 0.232 0.028 0.018 OR (95%CI) 1.82(0.68~4.86) 3.21(1.31~7.86) 3.04(1.21~7.60) 产程中 CBG≤7.0 mmol/L 64 37(57.8) 24(37.5) 30(46.9) CBG>7.0 mmol/L 36 28(77.8) 19(52.8) 23(63.9) P 0.034 0.141 0.104 OR (95%CI) 2.84(1.08~7.44) 1.86(0.82~4.26) 2.01(0.87~4.64)
下载: 导出CSV
表 3 新生儿低血糖结局相关因素的Logistic回归分析
变量 新生儿结局 OR 95%CI P 孕妇产程中CBG>7.0 mmol/L CBG < 2.2 mmol/L 2.40 0.92~6.71 0.070 需要静脉注射葡萄糖 1.86 0.74~4.69 0.190 低血糖转至新生儿科 1.76 0.71~4.34 0.220 孕妇孕晚期HbA1c>6.5% CBG < 2.2 mmol/L 2.89 1.09~7.67 0.033 需要静脉注射葡萄糖 3.43 1.29~9.20 0.014 低血糖转至新生儿科 3.89 1.42~10.68 0.008
下载: 导出CSV
-
[1] CAO Y, YANG Y, LIU L, et al. Analysis of risk factors of neonatal hypoglycemia and its correlation with blood glucose control of gestational diabetes mellitus: a retrospective study[J]. Medicine, 2023, 102(35): e34619.
[2] US Preventive Services Task Force, DAVIDSON K W, BARRY M J, et al. Screening for gestational diabetes: us preventive services task force recommendation statement[J]. JAMA, 2021, 326(6): 531-538.
[3] YAMAMOTO J M, DONOVAN L E, MOHAMMAD K, et al. Severe neonatal hypoglycaemia and intrapartum glycaemic control in pregnancies complicated by type 1, type 2 and gestational diabetes[J]. Diabet Med, 2020, 37(1): 138-146.
[4] THEVARAJAH A, SIMMONS D. Risk factors and outcomes for neonatal hypoglycaemia and neonatal hyperbilirubinaemia in pregnancies complicated by gestational diabetes mellitus: a single centre retrospective 3-year review[J]. Diabet Med, 2019, 36(9): 1109-1117.
[5] FERRARA A, WEISS N S, HEDDERSON M M, et al. Pregnancy plasma glucose levels exceeding the American Diabetes Association thresholds, but below the National Diabetes Data Group thresholds for gestational diabetes mellitus, are related to the risk of neonatal macrosomia, hypoglycaemia and hyperbilirubinaemia[J]. Diabetologia, 2007, 50(2): 298-306.
[6] WEST T E, LOWY C. Control of blood glucose during labour in diabetic women with combined glucose and low-dose insulin infusion[J]. Br Med J, 1977, 1(6071): 1252-1254.
[7] ELSAYED N A, ALEPPO G, ARODA V R, et al. 15. management of diabetes in pregnancy: standards of care in diabetes-2023[J]. Diabetes Care, 2023, 46(Suppl 1): S254-S266.
[8] DASHORA U, MURPHY H R, TEMPLE R C, et al. Managing hyperglycaemia during antenatal steroid administration, labour and birth in pregnant women with diabetes[J]. Diabet Med, 2018, 35(8): 1005-1010.
[9] 黄国英, 王天有. 儿科学[M]. 2版. 北京: 人民卫生出版社, 2022: 134-134. [10] EDWARDS T, ALSWEILER J M, GAMBLE G D, et al. Neurocognitive outcomes at age 2 years after neonatal hypoglycemia in a cohort of participants from the hPOD randomized trial[J]. JAMA Netw Open, 2022, 5(10): e2235989.
[11] BUCHANAN T A, XIANG A H, PAGE K A. Gestational diabetes mellitus: risks and management during and after pregnancy[J]. Nat Rev Endocrinol, 2012, 8(11): 639-649.
[12] JOVANOVIC L. Glucose and insulin requirements during labor and delivery: the case for normoglycemia in pregnancies complicated by diabetes[J]. Endocr Pract, 2004, 10(Suppl 2): 40-45.
[13] TASCHETTO A P D, ZIMATH P L, SILVÉRIO R, et al. Reduced insulin sensitivity and increased β/α cell mass is associated with reduced hepatic insulin-degrading enzyme activity in pregnant rats[J]. Life Sci, 2021, 277: 119509.
[14] Group of Neonatology P S. Expert consensus on standard clinical management of neonatal hypoglycemia in China (2021)[J]. Zhongguo Dang Dai Er Ke Za Zhi, 2022, 24(1): 1-13.
[15] HOERMANN H, MOKWA A, ROEPER M, et al. Reliability and observer dependence of signs of neonatal hypoglycemia[J]. J Pediatr, 2022, 245: 22-29, e2.
[16] MITANCHEZ D, YZYDORCZYK C, SIDDEEK B, et al. The offspring of the diabetic mother: short- and long-term implications[J]. Best Pract Res Clin Obstet Gynaecol, 2015, 29(2): 256-269.
[17] DUDE A M, DREXLER K, YEE L M. Glycosylated hemoglobin A1c prior to delivery and neonatal hypoglycemia in pregnancies complicated by diabetes[J]. Am J Obstet Gynecol MFM, 2022, 4(5): 100670.
[18] MATHIESEN E R, RINGHOLM L, DAMM P. Pregnancy management of women with pregestational diabetes[J]. Endocrinol Metab Clin North Am, 2011, 40(4): 727-738.
[19] ALEXOPOULOS A S, BLAIR R, PETERS A L. Management of preexisting diabetes in pregnancy: a review[J]. JAMA, 2019, 321(18): 1811-1819.
-
期刊类型引用(10)
1. 张伟. NT-proBNP、D-D、CRP检测在中老年急性脑梗死患者中的临床诊断价值分析. 中国实用医药. 2024(10): 81-84 . 
百度学术
2. 杨光，毛婷婷，陈红蕾，张海燕. 间质性肺疾病急性加重期患者外周血D-二聚体、B型钠尿肽的检测应用. 锦州医科大学学报. 2024(03): 61-65 . 百度学术
3. 刘爱平. 动态检测D-二聚体浓度在急性脑梗死患者溶栓治疗中的意义. 中国实用医药. 2023(05): 89-91 . 百度学术
4. 孙培丽，孙贵祥，许秀兰. 急性脑梗死静脉溶栓短期预后的影响因素分析. 北京医学. 2022(03): 209-212 . 百度学术
5. 张洁菁，余小萍，沈捷玉. cTnⅠ、Mb、D-D、Hcy水平变化与急性脑梗死患者预后的相关性研究. 黑龙江医药. 2021(02): 447-449 . 百度学术
6. 李海燕，肖瑾，刘兵荣，吴婷. 凝血酶原时间、活化部分凝血酶原时间、纤维蛋白原、C反应蛋白、脑钠肽检测对急性脑梗死诊断价值研究. 临床军医杂志. 2020(02): 219-221 . 百度学术
7. 刘芳卉. 急性大面积脑梗死患者的临床急救护理措施探讨. 心理月刊. 2020(07): 123 . 百度学术
8. 林梓波. 血清指标因子在急性脑梗死治疗前后的评估意义. 黑龙江医药. 2020(04): 933-934 . 百度学术
9. 俞峰，郑毅敏，张帅，吴峰. 血清可溶性肿瘤坏死因子样弱凋亡诱导因子、B型利钠肽、基质金属蛋白酶1水平与扩张型心肌病患者左心室重构的关系. 中国基层医药. 2020(12): 1472-1476 . 百度学术
10. 王珏，孙杰，徐乾治. 急性脑梗死患者的血浆D-二聚体和N末端B型钠尿肽前体水平及其意义分析. 内科. 2020(05): 592-593+610 . 百度学术
其他类型引用(1)
计量
- 文章访问数: 0
- HTML全文浏览量: 0
- PDF下载量: 0
- 被引次数: 11
苏公网安备 32100302010246号