本文選題：MeSH + 糖尿病��； 參考：《安徽醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的探究妊娠期糖尿病(gestational diabetes mellitus,GDM)對6月齡嬰兒發(fā)育行為的影響,分析個人因素和社會因素在聯(lián)接GDM與兒童發(fā)育行為中的調(diào)節(jié)作用。方法本研究是馬鞍山優(yōu)生優(yōu)育隊列(Ma’anshan Birth Cohort,MABC)研究的一部分。以馬鞍山市婦幼保健院為調(diào)查點,在孕婦知情同意的前提下,于2013年5月至2014年9月對初次前來產(chǎn)檢建冊且孕≤14周的孕婦進行問卷調(diào)查并填寫《孕產(chǎn)期母嬰記錄表》,收集其基本信息,包括孕婦及其丈夫基本人口統(tǒng)計學(xué)資料、家庭慢性疾病史、生活行為資料等;在孕婦孕24~28周期間行75g口服糖耐量試驗(oral glucose tolerance test,OGTT)并記錄空腹血漿葡萄糖值、服糖后1、2 h血糖值;新生兒出生后測量其體重、頭圍、身長,并記錄分娩相關(guān)信息;嬰兒6月齡時由帶養(yǎng)者帶至馬鞍山市婦幼保健院體檢,對嬰兒進行ASQ測試,測量并記錄其體重、身高等。正態(tài)分布資料采用均數(shù)和標(biāo)準(zhǔn)差描述,偏態(tài)分布資料采用中位數(shù)和四分位間距描述;GDM暴露組和對照組之間一般特征量差異的檢驗采用t檢驗和c2檢驗;多元logistic回歸模型分析GDM影響因素;分別采用二項logistic回歸模型和兩樣本的非參數(shù)檢驗(Mann-Whitney U test)分析GDM暴露對6月齡嬰兒發(fā)育行為的影響;兩樣本t檢驗分析發(fā)育正常組和發(fā)育遲緩組母親孕早、中、晚三期空腹血糖值的差異。P0.05代表差異有統(tǒng)計學(xué)意義。結(jié)果2013年5月至2014年9月期間,共納入孕婦3 474例,最終2 753對母嬰納入本次研究,其中暴露組(母親患GDM)366例(13.3%),對照組(母親未患GDM)2 387例。6月齡嬰兒ASQ測試溝通能區(qū)、大運動能區(qū)、精細(xì)運動能區(qū)、解決問題能區(qū)和個人-社會能區(qū)的發(fā)育遲緩率分別為31.1%、27.2%、27.6%、32.4%和28.7%。與對照組孕婦相比,暴露組的孕婦分娩年齡較大[(27.51±4.09)歲vs.(26.00±3.41)歲,P0.001],初潮年齡較小[(13.74±1.38)歲vs.(13.94±1.33)歲,P=0.006],孕前BMI均值較高[(22.21±3.20)kg/m2 vs.(20.68±2.73)kg/m2,P0.001];暴露組經(jīng)產(chǎn)婦比例較高(14.5%vs.10.1%,P=0.011)、剖宮產(chǎn)比例較多(60.9%vs.49.4%,P0.001),孕婦為城鎮(zhèn)戶口(70.2%vs.61.7%,P=0.002)或近半年主要居住于城鎮(zhèn)(95.4%vs.92.4%,P=0.040)的情況較多,暴露組家庭人均月收入低于2500元者比對照組比例高(31.7%vs.25.3%,P=0.012),差異均有統(tǒng)計學(xué)意義。另外,暴露組孕婦為獨生女(41.5%vs.34.6%,P=0.009)、其父母有糖尿病史(8.5%vs.5.1%,P=0.026;7.7%vs.2.9%,P0.001)的比例均較對照組高,且差異有顯著意義。與對照組新生兒相比,暴露組的新生兒除了胎齡較小[(273.05±11.38)天vs.(276.75±8.77)天,P0.001]外,出生體重[(3 476.67±541.36)g vs.(3355.77±420.79)g,P0.001]、頭圍[(34.29±1.05)cm vs.(34.03±1.59)cm,P=0.006]、胸圍[(33.78±1.68)cm vs.(33.47±1.49)cm,P=0.001]均較大,差異有統(tǒng)計學(xué)意義。而兩組的6月齡嬰兒體重、身長、頭圍、皮下脂肪厚度及ASQ五個能區(qū)發(fā)育遲緩率的差異均無顯著意義。以ASQ總分和溝通能力、粗大運動、精細(xì)運動、解決問題、個人-社會五個能區(qū)得分為檢驗變量,以是否患GDM為分組變量,進行兩樣本的非參數(shù)檢驗(Mann-Whitney U test)。結(jié)果顯示,ASQ五個能區(qū)中,暴露組和對照組嬰兒發(fā)育得分差異無顯著性(P0.05)。以孕婦是否患GDM為自變量(未患GDM者為對照組),分別以溝通能力、粗大運動、精細(xì)運動、解決問題、個人-社會五項能區(qū)的二分類變量為應(yīng)變量(發(fā)育正常為對照組),以孕婦年齡分組、孕期增重情況、懷孕意愿、新生兒胎齡、頭圍、胸圍、6月齡身高、皮下脂肪厚度等為協(xié)變量,進行二項logistic回歸分析(模型1)。結(jié)果,與對照組相比暴露組6月齡嬰兒的各項能區(qū)得分差異無統(tǒng)計學(xué)意義。在模型1的基礎(chǔ)上,增加家庭人均月收入、父母親文化程度為協(xié)變量進行二項logistic回歸分析(模型2);在模型2的基礎(chǔ)上,增加6月齡喂養(yǎng)方式為協(xié)變量進行二項logistic回歸(模型3),結(jié)果差異無統(tǒng)計學(xué)意義。孕早、中、晚三期FPG值的P25、P50、P75界值隨孕期進程呈下降趨勢,而P100界值呈上升趨勢。兩樣本t檢驗法比較五項能區(qū)發(fā)育正常組和發(fā)育遲緩組孕早、中、晚期空腹血糖值均值的差異,結(jié)果顯示,粗大運動能區(qū)(MD=0.04,95%CI:0.01~0.08,P=0.012)、精細(xì)運動能區(qū)(MD=0.05,95%CI:0.02~0.08,P=0.005)和個人-社會能區(qū)(MD=0.06,95%CI:0.03~0.09,P=0.001)發(fā)育遲緩者的母親孕早期空腹血糖平均水平較發(fā)育正常者母親高,且差異有統(tǒng)計學(xué)意義。孕晚期FPG值的比較中,粗大運動能區(qū)(MD=-0.09,95%CI:-0.15~-0.04,P=0.001)、精細(xì)運動能區(qū)(MD=-0.07,95%CI:-0.13~0.02,P=0.006)、解決問題能區(qū)(MD=-0.09,95%CI:-0.14~0.04,P=0.001)和個人-社會能區(qū)(MD=-0.15,95%CI:-0.21~-0.10,P0.001)發(fā)育遲緩組的FPG值均較發(fā)育正常組低,且差異有統(tǒng)計學(xué)意義。結(jié)論母親患GDM對6月齡嬰兒發(fā)育遲緩無顯著影響,血糖對胎兒發(fā)育的影響可能存在關(guān)鍵期。孕期GDM對兒童近期發(fā)育行為可能無損害或損害不明顯,建議針對大齡兒童,如學(xué)齡兒童或青少年進一步評價其智商、執(zhí)行功能等。
[Abstract]:Objective to explore the effects of gestational diabetes mellitus (GDM) on the developmental behavior of 6 month old infants and to analyze the role of individual and social factors in the adjustment of GDM and children's development behavior. Methods this study was part of the study of the Ma'anshan eugenics cohort (Ma 'Anshan Birth Cohort, MABC). In Ma'anshan City, the study was a part of the study of the Ma' Anshan Birth Cohort, MABC. Under the premise of informed consent of pregnant women, maternity and child health care hospital, on the premise of pregnant women's informed consent, conducted a questionnaire survey on pregnant women who had first come to the hospital for inspection and less than 14 weeks pregnant from May 2013 to September 2014 and filled in the maternal and infant records of pregnancy and collected the basic information, including the basic demographic data of pregnant women and their husbands, family history of chronic diseases, and life. For data such as data, 75g oral glucose tolerance test (oral glucose tolerance test, OGTT) was performed during 24~28 weeks of pregnant women and the value of glucose in fasting plasma was recorded and 1,2 h blood glucose after taking sugar; the weight, head circumference and length of the newborn were measured after birth, and the information of childbirth was recorded. The baby was taken to Ma'anshan Maternal and Child Health-Care Hospital body at 6 month old. The infants were tested by ASQ test, measured and recorded their weight and height. The normal distribution data were described by mean and standard deviation. The data of partial distribution were described with median and four division intervals; the test of general characteristic difference between GDM exposure group and control group was tested by t test and C2 test, and multivariate logistic regression model was used to analyze the influence of GDM The effects of two logistic regression models and the non parametric test of two samples (Mann-Whitney U test) were used to analyze the effects of GDM exposure on the developmental behavior of 6 month old infants, and two sample t test was used to analyze the difference of.P0.05 representation of the difference of.P0.05 in the early, middle and late three stages of the normal group and the retarded group. 20 During the period of 13 years from May to September 2014, 3474 cases of pregnant women were included, and the final 2753 pairs of mother and infant were included in this study, of which 366 cases (13.3%) of exposure group (mother GDM), 2387 cases of.6 month old baby ASQ test communication area, large sports energy area, fine kinetic energy area, solution problem energy area and personal social energy zone development retardation rate in the exposure group. 31.1%, 27.2%, 27.6%, 32.4% and 28.7%. were compared with the pregnant women in the control group. The pregnant women of the exposure group were older [(27.51 + 4.09) years old, vs. (26 + 3.41) years old, P0.001], the age of early menarche was smaller [(13.74 + 1.38) years of age vs. (13.94 + 1.33) years old, P=0.006], BMI was higher [(22.21 +] kg/m2 vs.) kg/m2, P0.001]; exposed group of menstruation. The proportion of women was higher (14.5%vs.10.1%, P=0.011), the proportion of cesarean section was more (60.9%vs.49.4%, P0.001), pregnant women as urban registered permanent residence (70.2%vs.61.7%, P=0.002) or nearly half a year were mainly living in urban (95.4%vs.92.4%, P=0.040), and the per capita monthly income of the exposed group was lower than the control group (31.7%vs.25.3%, P=0.012), and the difference was all higher than that of the control group (31.7%vs.25.3%, P=0.012). In addition, the proportion of parents with diabetes history (8.5%vs.5.1%, P=0.026; 7.7%vs.2.9%, P0.001) in the exposed group was higher than that of the control group (41.5%vs.34.6%, P=0.009), and the difference was significant. Compared with the control group, the neonates in the exposed group were smaller than the gestational age [(273.05 + 11.38) days vs. (276.75 + 8.77)). At day, P0.001], the birth weight [(3476.67 + 541.36) g vs. (3355.77 + 420.79) g, P0.001], head circumference [(34.29 + 1.05) cm vs. (34.03 + 1.59) cm, P=0.006], chest circumference [(33.78 + 1.68) cm vs. (33.47 + 1.49) cm) were all larger, and the differences were statistically significant. There was no significant difference in the difference in the rate of retardation. ASQ total score and communication ability, gross exercise, fine exercise, problem solving, five scores of individual and social energy areas were tested as variables, and the non parameter test (Mann-Whitney U test) of two samples was carried out with whether or not to be divided into group variables (Mann-Whitney U test). The results showed that in the five ASQ areas, the exposure group and the control group infants were found. There was no significant difference in development score (P0.05). If pregnant women had GDM as the independent variable (without GDM as the control group), the two classified variables of five areas of individual and society were the communication ability, the rough exercise, the fine exercise, the problem solving, and the individual social groups (normal development as the group), the pregnant women age group, the pregnancy weight gain, the pregnancy intention. Birth fetal age, head circumference, chest circumference, 6 month old height, and subcutaneous fat thickness were co variables, and two logistic regression analysis (model 1). Results, compared with the control group, there was no significant difference in the scores of the energy areas of the 6 month old infants in the exposure group. On the basis of the model 1, the monthly income of the family was added, and the parents' cultural degree was covariate. Two logistic regression analysis (model 2) was performed. On the basis of model 2, 6 month old feeding methods were added to two logistic regression (model 3), and the difference was not statistically significant. The P25, P50, P75 boundary values of early pregnancy, middle, and late three were down downward with the process of pregnancy, while the P100 boundary value was on the rise. The two sample t test method was compared. The difference in the mean of early, middle and late fasting blood glucose values in the five areas of the normal and developmental retardation group, the results showed that the MD=0.04,95%CI:0.01~0.08, the P=0.012, the MD=0.05,95%CI:0.02~0.08, the P=0.005 and the MD=0.06,95%CI:0.03~0.09, P=0.001 (MD=0.06,95%CI:0.03~0.09, P=0.001) developed in the mother's early pregnancy The average level of fasting blood glucose was higher than that of those with normal development, and the difference was statistically significant. In the comparison of FPG values in the late pregnancy, MD=-0.09,95%CI:-0.15~-0.04 (P=0.001), MD=-0.07,95%CI:-0.13~0.02 (P=0.006), MD=-0.09,95%CI:-0.14~0.04 (P=0.001) and personal social energy area (MD=-0.). The FPG value of 15,95%CI:-0.21~-0.10, P0.001) was lower than that of the normal development group, and the difference was statistically significant. Conclusion the mother suffering from GDM has no significant effect on the developmental delay of 6 month old infants, and the effect of blood glucose on fetal development may be critical. For older children, such as school-age children or adolescents, their IQ and executive function were further evaluated.
【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】：2016
【分類號】：R714.256

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