本文關(guān)鍵詞：妊娠期糖尿病對嬰兒期體格及智力發(fā)育影響的隊列研究　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 妊娠期糖尿病 嬰兒期 體格發(fā)育 智力發(fā)育

【摘要】：目的:本研究旨在探討妊娠期糖尿病(gestational diabetes mellitus,GDM)孕婦孕期糖脂代謝對其子代嬰兒期體格和1歲智力發(fā)育的影響。方法:采用前瞻性隊列設(shè)計,于2014年5月至2015年5月選取在銅陵市婦幼保健院產(chǎn)前門診做常規(guī)產(chǎn)檢并在此院分娩的孕早期單胎孕婦,按照納入排除標(biāo)準(zhǔn),建立前瞻性觀察隊列。本研究在此基礎(chǔ)上,于2015年7月至2016年5月對632名子代嬰兒期的體格發(fā)育及1歲時智力發(fā)育進(jìn)行隨訪調(diào)查。運用貝利嬰幼兒發(fā)展量表(BSID-CR)(中國城市修訂版)對嬰兒1歲時的運動及智力發(fā)育水平進(jìn)行測定。采用自編調(diào)查問卷,收集嬰兒喂養(yǎng)情況及體格發(fā)育等信息。采用Pearson積矩相關(guān)及逐步多元線性回歸分析模型,分析妊娠期糖尿病孕婦孕期糖脂代謝指標(biāo)與嬰兒期體格發(fā)育、1歲智力發(fā)育的關(guān)系。結(jié)果:(1)本研究共隨訪到555例合格的嬰兒,其中GDM組177例,對照組378例;兩組母親年齡、孕前體質(zhì)指數(shù)(BMI)及嬰兒年齡差異具有統(tǒng)計學(xué)意義(P0.05)。對兩組巨大兒發(fā)生率進(jìn)行比較發(fā)現(xiàn),GDM組發(fā)生率為13.0%,對照組為7.1%,差異具有統(tǒng)計學(xué)意義(P0.05)。GDM組中有87%的嬰兒吃到初乳,對照組有94.2%的嬰兒吃到初乳,兩組差異具有統(tǒng)計學(xué)意義(P0.01)。(3)GDM組母親孕早期的空腹血糖(FPG)、甘油三酯(TG)、總膽固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、孕中期FPG、口服葡萄糖耐量試驗(OGTT)-1h和2h血糖、胰島素、孕晚期FPG及TG、臍血血清胰島素濃度均高于對照組,且差異具有統(tǒng)計學(xué)意義(P0.05);孕中期血清TC、HDL及LDL濃度均低于對照組,且差異具有統(tǒng)計學(xué)意義(P0.001)。(4)在出生時及42天兩個時點,GDM組男嬰年齡別身長(LAZ)、年齡別體重(WAZ)值均高于對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。女嬰各時點LAZ、WAZ和身長別體重(WLZ)均無統(tǒng)計學(xué)差異。智力發(fā)育測定結(jié)果顯示:GDM組嬰兒1歲的智力發(fā)育指數(shù)(MDI)及心理運動發(fā)育指數(shù)(PDI)均低于對照組,差異具有統(tǒng)計學(xué)意義(P0.05)。(5)逐步多元線性回歸分析結(jié)果顯示:孕晚期TC(b=-1.352,P0.001)與42天LAZ呈負(fù)相關(guān);孕晚期母血二十二碳六烯酸(DHA)(b=-0.209,P=0.006)、孕早期FPG(b=-0.197,P=0.050)與42天WAZ呈負(fù)相關(guān),GDM與其呈正相關(guān)(b=0.268,P=0.005);孕中期胰島素與42天WLZ呈負(fù)相關(guān)(b=-0.186,P=0.049),孕晚期胰島素(b=0.222,P=0.016)、臍血HDL(b=0.349,P0.001)與其呈正相關(guān);孕中期胰島素與3月齡LAZ呈正相關(guān)(b=0.179,P=0.043),OGTT-2h血糖(b=-0.205,P=0.024)、孕早期HDL(b=-0.249,P=0.010)與其呈負(fù)相關(guān)性;孕晚期TG(b=0.173,P=0.043)、臍血飽和脂肪酸(SFA)(b=0.190,P=0.017)與12月齡LAZ呈正相關(guān),孕早期FPG與12月齡WAZ呈負(fù)相關(guān)(b=-0.173,P=0.047),孕中期糖化血紅蛋白(Hb A1c)水平與12月齡WLZ呈負(fù)相關(guān)(b=-0.189,P=0.041)。(6)智力發(fā)育多元線性回歸結(jié)果顯示:孕早期TG(b=-0.212,P=0.016)、OGTT-2h血糖(b=-0.161,P=0.044)、孕晚期母血SFA(b=-0.218,P=0.027)與MDI呈負(fù)相關(guān),孕晚期母血DHA與其呈正相關(guān)(b=0.271,P=0.003);孕早期TG(b=-0.186,P=0.045)、孕晚期FPG(b=-0.212,P=0.013)、臍血g-ALA(b=-0.237,P=0.006)與PDI均呈負(fù)相關(guān)。結(jié)論:GDM孕婦同時存在糖代謝異常和脂代謝異常,且GDM孕婦整個孕期血糖水平均高于正常妊娠者,血脂則表現(xiàn)為孕早期、晚期高于對照組,中期低于對照組;GDM對子代嬰兒期體格發(fā)育的影響可能存在性別差異;GDM組嬰兒MDI、PDI值低于對照組,提示GDM可能影響子代嬰兒期的智力發(fā)育;控制好孕期血糖血脂水平、適時添加輔食有助于嬰兒體格及智力發(fā)育。
[Abstract]:Objective: This study aimed to investigate the gestational diabetes mellitus (gestational diabetes mellitus, GDM) of maternal glucose and lipid metabolism on the offspring of infant physical and mental development of 1 years old. Methods: a prospective cohort design, from May 2014 to May 2015 were selected to do regular prenatal antenatal clinics in Tongling maternal and child health hospital and the hospital the first trimester singleton pregnant women, according to the inclusion and exclusion criteria, a prospective observational cohort. On this basis, from July 2015 to May 2016 of the 632 generation name of infant physical growth and mental development at the age of 1 were followed up. Using the Bailey scale of infant development (BSID-CR) (revised edition of Chinese city) the development level of sports and intelligence at the age of 1 infants were determined. By using the questionnaire, collecting the status of infant feeding and physical development and other information. Using Pearson product moment correlation and stepwise multiple Linear regression analysis model, analysis of gestational diabetes in pregnant women with glucose and lipid metabolism of infant physical development, mental development at the age of 1. Results: (1) this study were followed up 555 cases of infants were eligible, including 177 cases of GDM group, 378 cases in the control group; the two groups of maternal age, pre pregnancy body mass index (BMI) with statistical significance and infant age difference (P0.05). The two groups of macrosomia rate were compared, the incidence of group GDM was 13%, 7.1% in the control group, the difference was statistically significant (P0.05) in the.GDM group had 87% babies to eat colostrum, the control group had 94.2% babies to eat colostrum. The two groups have statistical significance difference (P0.01). (3) GDM group maternal fasting blood glucose (FPG), triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), FPG in the period of pregnancy, oral glucose tolerance test (OGTT -1h 2H) and blood glucose, insulin In late pregnancy, FPG and TG, umbilical cord blood serum insulin concentrations were higher than the control group, and the difference was statistically significant (P0.05); second trimester serum TC, HDL and LDL concentrations were lower than the control group, and the difference was statistically significant (P0.001). (4) at birth and 42 days at two time points, GDM group of boys age length (LAZ), weight for age (WAZ) was higher than that of control group, the difference was statistically significant (P0.05). The levels of LAZ WAZ and the baby, body weight (WLZ) were not statistically significant. The results showed that the intelligence development of infants aged 1 GDM mental development index (MDI) and psychomotor development index (PDI) were lower than the control group, the difference was statistically significant (P0.05). (5) analysis results of multiple linear regression: late pregnancy TC (b=-1.352, P0.001) was negatively correlated with LAZ in 42 days; maternal blood twenty-two carbon six acid (DHA) (b=-0.209, P=0.006). Early pregnancy (b=-0.197 P=0, FPG .050) was negatively correlated with the 42 day WAZ, GDM (b=0.268, P=0.005) and positively; second trimester insulin was negatively correlated with the 42 day WLZ (b=-0.186, P=0.049), late pregnancy insulin (b=0.222, P=0.016), HDL (b=0.349, P0.001) of umbilical cord blood were positively correlated with those of the second trimester; insulin was positively correlated with age in March LAZ (b=0.179, P=0.043), OGTT-2h blood glucose (b=-0.205, P=0.024), early pregnancy HDL (b=-0.249, P=0.010) and a negative correlation; late pregnancy TG (b=0.173, P=0.043), umbilical cord blood saturated fatty acid (SFA) (b=0.190, P=0.017) were positively correlated with age in December LAZ, FPG and WAZ in early pregnancy in December age negative correlation (b=-0.173, P=0.047), the second trimester hemoglobin (Hb A1c) was negatively correlated with the age of WLZ (b=-0.189 P=0.041, December). (6) the intelligence development of multiple linear regression showed that early pregnancy TG (b= -0.212 P=0.016), OGTT-2h blood glucose (b=-0.161, P=0.044), maternal blood SFA (b=-0.218, P=0.027) and MDI is Negative correlation, related maternal blood DHA (b=0.271, P=0.003) and positively; early pregnancy TG (b=-0.186, P=0.045), FPG (b=-0.212 P=0.013, late pregnancy), umbilical cord blood g-ALA (b=-0.237, P=0.006) showed a negative correlation with PDI. Conclusion: GDM pregnant women exist abnormal glucose metabolism and lipid metabolism, and GDM pregnant women throughout pregnancy blood glucose levels were higher than those in normal pregnancy, blood lipids showed early pregnancy, late was higher than the control group, the middle lower than the control group; GDM effect on offspring of infant physical development may exist gender differences; GDM group of baby MDI, PDI value is lower than the control group, suggesting that GDM may affect the generation of infant intelligence development; good control of blood glucose and lipid levels during pregnancy, timely add food supplement helps infants physical and mental development.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R714.256

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 張春一;龍芳;葉秀楨;柳國勝;;妊娠期糖尿病對新生兒并發(fā)癥及神經(jīng)行為發(fā)育的影響[J];暨南大學(xué)學(xué)報(自然科學(xué)與醫(yī)學(xué)版);2014年06期

2 朱海燕;姜桂英;吳慶慶;胡江;;不同程度妊娠期糖尿病患者糖代謝異常與脂代謝紊亂關(guān)系的研究[J];中國婦產(chǎn)科臨床雜志;2013年05期

3 孔令英;楊慧霞;;妊娠期糖尿病孕婦血脂變化與胎盤脂質(zhì)轉(zhuǎn)運[J];中華婦幼臨床醫(yī)學(xué)雜志(電子版);2013年01期

4 陳香蘭;郭玉琴;;妊娠期糖尿病對胎兒和嬰兒心血管系統(tǒng)的影響[J];中國婦幼保健;2011年34期

5 Anne Vambergue;Isabelle Fajardy;;Consequences of gestational and pregestational diabetes on placental function and birth weight[J];World Journal of Diabetes;2011年11期

6 王純;牛秀敏;韓姹;;妊娠期糖尿病患者晚期血脂水平與圍產(chǎn)結(jié)局[J];中國婦幼保健;2011年25期

7 李t，

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