本文選題：宮內(nèi)環(huán)境　切入點(diǎn)：BMI　出處：《浙江大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：研究產(chǎn)婦孕前BMI、產(chǎn)婦孕期血糖、孕期危險(xiǎn)因素與胎兒出生情況、新生兒臍血各項(xiàng)生化指標(biāo)之間的關(guān)系,分析并確定孕婦孕期BMI、孕期血糖與胎兒出生體重及新生兒各項(xiàng)生化指標(biāo)的相關(guān)性。 方法：選取2010年1月1日至2011年1月1日在慈溪、義烏、東陽(yáng)、溫嶺四地區(qū)婦幼保健院行產(chǎn)前檢查并在該醫(yī)院分娩的孕36-37周的孕婦1318例,對(duì)其進(jìn)行孕期一般情況調(diào)查及抽血檢驗(yàn),孕婦分娩后,抽取新生兒臍血進(jìn)行檢驗(yàn),并進(jìn)行新生兒出生情況調(diào)查,通過對(duì)新生兒出生體重、新生兒臍血相關(guān)生化指標(biāo)等的統(tǒng)計(jì)分析,了解宮內(nèi)不良環(huán)境對(duì)新生兒出生狀況的影響。 結(jié)果：1318例產(chǎn)婦中,消瘦組共305人；正常組共913人；肥胖組共100人。1318例產(chǎn)婦中,妊娠期糖耐量受損組共90人；妊娠期糖尿病母親組共24人；正常血糖組共1204人。1318例產(chǎn)婦中,對(duì)照組共1170人；高危組共148人。1318例新生兒中,低出生體重兒組共14人；正常出生體重兒組共1229人；高出生體重兒組共75人。1318例新生兒分娩情況,正常順產(chǎn)598例；難產(chǎn)720例。分娩時(shí)無胎盤、臍帶、羊水問題者740例,具胎盤、羊水或臍帶問題者578例。肥胖組所生新生兒出生體重顯著高于消瘦組和正常組(P0.01)。肥胖組難產(chǎn)率最高,消瘦組、正常組的難產(chǎn)率均低于總體的難產(chǎn)率,隨著產(chǎn)婦孕前BMI值的升高而升高。胎盤、羊水、臍帶異常發(fā)生率正常組最高,消瘦組的胎盤、羊水、臍帶異常發(fā)生率均低于總體、正常組和肥胖組的胎盤、羊水、臍帶異常發(fā)生率。產(chǎn)婦孕晚期血樣中,肥胖組甘油三酯水平高于消瘦組、正常組甘油三酯水平,具顯著性差異(P0.05)；肥胖組C肽水平高于消瘦組、正常組C肽水平,具顯著性差異(P0.01)；胰島素、HDL-CH和膽固醇水平任意兩組間均具顯著性差異(P0.01)；消瘦組LDL-CH水平高于正常組和肥胖組,均具顯著性差異(P0.01),正常組LDL-CH水平高于肥胖組LDL-CH水平,具顯著性差異(P0.05)。臍血肥胖組C肽水平高于消瘦組、正常組C肽水平,均具顯著性差異(P0.01)；消瘦組ApoA1水平高于正常組和肥胖組,均具顯著性差異(P0.01),正常組ApoAl水平高于肥胖組,具顯著性差異(P0.05)；消瘦組HDL-CH水平高于正常組和肥胖組,均具顯著性差異(P0.05)；消瘦組膽固醇水平高于正常組和肥胖組,均具顯著性差異(P0.01); GDM組所生新生兒出生體重顯著高于GIGT組和NDM組(P0.01)。難產(chǎn)率NDM組最高,胎盤、羊水、臍帶異常發(fā)生率正常組最高。孕晚期母血GIGT組甘油三酯和HbA1c高于GDM組,均具顯著性差異(P0.05)。新生兒臍血GIGT組ApoA1低于NDM組,具顯著性差異(P0.05); GIGT組HbA1c高于GDM組,具顯著性差異(PO.05); GIGT組胰島素低于GDM組,具顯著性差異(P0.05); NDM組胰島素低于GDM組,具顯著性差異(P0.05)。高危組所生新生兒出生體重與對(duì)照組所生新生兒出生體重沒有明顯差異。高危組難產(chǎn)率和胎盤、羊水、臍帶異常發(fā)生率均高于對(duì)照組和總體。孕晚期母血高危組Lp a、甘油三酯、C肽水平高于對(duì)照組Lp a、甘油三酯、C肽水平,具顯著性差異(P0.01)；高危組HbA1c水平高于對(duì)照組HbA1c水平,具顯著性差異(P0.05)；對(duì)照組ApoA1、ApoB、 LDL-CH和膽固醇水平高于高危組ApoA1、ApoB、LDL-CH和膽固醇水平,具顯著性差異(P0.01)。臍血高危組C肽水平高于對(duì)照組C肽水平,具顯著性差異(P0.05)；對(duì)照組膽固醇水平高于高危組膽固醇水平,具顯著性差異(P0.05)。難產(chǎn)率HBW組最高,LBW組、NBW組的難產(chǎn)率均低于總體的難產(chǎn)率,隨著出生體重的增加,難產(chǎn)率增加。胎盤、羊水、臍帶異常發(fā)生率LBW組最高,NBW組和HBW組的胎盤、羊水、臍帶異常發(fā)生率均低于總體的胎盤、羊水、臍帶異常發(fā)生率,隨著出生體重的增加,胎盤、羊水、臍帶異常發(fā)生率降低。孕晚期母血HBW組HDL-CH水平低于LBW組、NBW組HDL-CH水平,均具顯著性差異(P0.01), NBW組HDL-CH水平低于LBW組HDL-CH水平,具顯著性差異(P0.05)。臍血HBW組C肽水平高于NBW組C肽水平,具顯著性差異(P0.01); HBW組胰島素水平高于NBW組胰島素水平,具顯著性差異(P0.01), HBW組胰島素水平高于LBW組胰島素水平,具顯著性差異(P0.05); HBW組HbA1c水平高于NBW組HbA1c水平,具顯著性差異(P0.05); HBW組甘油三酯水平高于LBW組甘油三酯水平,具顯著性差異(P0.05)。 結(jié)論：產(chǎn)婦孕前BMI與高出生體重兒的發(fā)生率呈正相關(guān)。孕晚期母血與新生兒臍血HDL-CH水平均隨孕前BMI的增高而降低。母親孕期吸煙,高血壓、糖尿病等危險(xiǎn)因素對(duì)胎盤、羊水,臍帶異常發(fā)生率、難產(chǎn)率、低出生體重兒和巨大兒的發(fā)生率有明顯影響。
[Abstract]:Objective: To study the relationship between maternal pre pregnancy BMI, maternal blood glucose during pregnancy, the risk factors during pregnancy, fetal birth and neonatal umbilical cord blood biochemical indicators, and analyze and determine the correlation between BMI during pregnancy, gestational blood glucose and fetal birth weight and neonatal biochemical indicators.
Methods: from January 1, 2010 to January 1, 2011 in Cixi, Yiwu, Dongyang, Wenling four areas of maternal and child health hospital for prenatal care and delivery in the hospital 36-37 weeks of gestation of pregnant women in 1318 cases, and blood tests for the general survey of pregnancy, pregnant women after childbirth, extraction of neonatal umbilical cord blood test, and neonatal birth condition was investigated. Based on the statistical analysis of the neonatal birth weight, neonatal umbilical cord blood biochemical indicators, to understand the effect of intrauterine environment in the neonatal birth condition.
Results: in 1318 cases, a total of 305 people in the marasmus group; normal group 913; obesity group a total of 100 cases of maternal.1318, gestational impaired glucose tolerance group were 90; diabetic mother pregnancy group 24; the normal blood glucose group were 1204.1318 cases in the control group, a total of 1170 people in high risk group; a total of 148 cases of neonatal.1318 in low birth weight infants group 14; children with normal birth weight group 1229; high birth weight infants were 75.1318 cases of neonatal birth, 598 cases had normal; 720 cases of dystocia. Childbirth without umbilical cord, placenta, amniotic fluid problems in 740 cases, 578 cases with placenta, amniotic fluid and umbilical cord problem. Infants born to obese birth weight was significantly higher than that of marasmus group and normal group (P0.01). The highest rate of dystocia in obesity group, marasmus group, normal group were lower than the overall rate of dystocia rate of dystocia, increased with the increase of BMI value. The placental maternal pre pregnancy sheep. Water, abnormality of umbilical cord in normal group was the highest, the marasmus group of amniotic fluid, placenta, umbilical cord abnormal rate were lower than the overall, placenta, normal group and obese group the incidence of abnormal amniotic fluid, umbilical cord. Maternal pregnancy and blood triglyceride levels, obesity group was higher than that of thin group, normal group triglyceride levels, significant difference (P0.05); obesity group C peptide level was higher than that of thin group, normal group C peptide level, with significant difference (P0.01); insulin, HDL-CH and cholesterol levels between any two groups showed significant differences (P0.01); group LDL-CH was higher than the level of normal group and obese group showed significant differences (P0.01), normal group LDL-CH level was higher in obese group LDL-CH, with significant difference (P0.05). Umbilical cord blood C peptide level obesity group was higher than that of thin group, normal group C peptide levels showed significant differences (P0.01); the level of ApoA1 weight loss group was higher than that of normal group and obese group were Significant differences (P0.01), normal group ApoAl level was higher in obese group, with significant difference (P0.05); the level of HDL-CH was higher than normal group and obese group, there was significant difference (P0.05); the level of cholesterol in marasmus group than normal group and obese group, there was significant difference (P0.01); the infants birth weight in GDM group was significantly higher than that of GIGT group and NDM group (P0.01). NDM group was the highest, dystocia, placenta, amniotic fluid, umbilical cord abnormal rate in normal group was the highest. Maternal blood triglyceride and HbA1c GIGT group than in the GDM group, there was significant difference (P0.05). Group ApoA1 was lower than that of neonatal umbilical cord blood GIGT NDM group, with significant difference (P0.05); GIGT HbA1c group than in the GDM group, with significant difference (PO.05); GIGT group of insulin than in the GDM group, with significant difference (P0.05); NDM group of insulin than in the GDM group, with significant difference (P0.05). The high risk group by birth weight and for The control group had no significant difference in birth weight of newborns. The high-risk group, the rate of dystocia and placenta, amniotic fluid, umbilical cord abnormal rate was higher than that of control group. Maternal blood and the high risk group Lp a, triglyceride, C peptide levels higher than the control group Lp a, triglyceride, C peptide level, with significant difference (P0.01) the level of HbA1c; high risk group was higher than the control group HbA1c, with significant difference (P0.05); the control group ApoA1, ApoB, LDL-CH and cholesterol levels were higher than those in high risk group of ApoA1, ApoB, LDL-CH and cholesterol levels, with significant difference (P0.01). The high risk group umbilical cord blood C peptide levels higher than the control group C peptide levels significantly the difference (P0.05); control group, cholesterol levels higher than the level of cholesterol in high risk group, with significant difference (P0.05). The highest rate of HBW group LBW group NBW group, dystocia, dystocia rate was lower than the overall rate of dystocia, with increasing birth weight, increase the rate of dystocia. The placenta, amniotic fluid The incidence of abnormal umbilical cord, placenta, LBW group was the highest, NBW group and HBW group amniotic fluid, umbilical cord abnormalities were lower than the overall incidence of abnormal amniotic fluid, placenta, umbilical cord, with the increase of birth weight, placenta, amniotic fluid, umbilical cord abnormalities and reduce the incidence of late pregnancy. Maternal serum HBW level of HDL-CH group was lower than that of LBW group the level of HDL-CH in group NBW were significant difference (P0.01), the level of HDL-CH in NBW group was lower than HDL-CH level of LBW group, with significant difference (P0.05). C group of umbilical cord blood HBW peptide levels higher than that of NBW group C peptide level, with significant difference (P0.01); insulin levels in HBW group was higher than that of NBW group with insulin levels. Significant differences (P0.01), the level of insulin insulin levels in HBW group was higher than that in group LBW, with significant difference (P0.05); the level of HbA1c HBW was higher than that of HbA1c level of NBW group, with significant difference (P0.05); the level of triglyceride triglyceride levels in HBW group was higher than that of LBW group, with significant difference (P0.05).
Conclusion: maternal pre pregnancy BMI associated with high birth weight infants. The incidence of positive HDL-CH level of maternal blood and neonatal cord blood were increased with pre pregnancy BMI decreased. Maternal smoking, hypertension, diabetes and other risk factors of placenta, amniotic fluid, umbilical cord, abnormal rate, difficult to yield, low birth weight and macrosomia the incidence rate has obvious effect.

【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R722.1

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