妊娠期糖尿病对婴儿期体格及智力发育影响的队列研究

发布时间：2018-01-12 06:03

本文关键词：妊娠期糖尿病对婴儿期体格及智力发育影响的队列研究　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究旨在探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇孕期糖脂代谢对其子代婴儿期体格和1岁智力发育的影响。方法:采用前瞻性队列设计,于2014年5月至2015年5月选取在铜陵市妇幼保健院产前门诊做常规产检并在此院分娩的孕早期单胎孕妇,按照纳入排除标准,建立前瞻性观察队列。本研究在此基础上,于2015年7月至2016年5月对632名子代婴儿期的体格发育及1岁时智力发育进行随访调查。运用贝利婴幼儿发展量表(BSID-CR)(中国城市修订版)对婴儿1岁时的运动及智力发育水平进行测定。采用自编调查问卷,收集婴儿喂养情况及体格发育等信息。采用Pearson积矩相关及逐步多元线性回归分析模型,分析妊娠期糖尿病孕妇孕期糖脂代谢指标与婴儿期体格发育、1岁智力发育的关系。结果:(1)本研究共随访到555例合格的婴儿,其中GDM组177例,对照组378例;两组母亲年龄、孕前体质指数(BMI)及婴儿年龄差异具有统计学意义(P0.05)。对两组巨大儿发生率进行比较发现,GDM组发生率为13.0%,对照组为7.1%,差异具有统计学意义(P0.05)。GDM组中有87%的婴儿吃到初乳,对照组有94.2%的婴儿吃到初乳,两组差异具有统计学意义(P0.01)。(3)GDM组母亲孕早期的空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、孕中期FPG、口服葡萄糖耐量试验(OGTT)-1h和2h血糖、胰岛素、孕晚期FPG及TG、脐血血清胰岛素浓度均高于对照组,且差异具有统计学意义(P0.05);孕中期血清TC、HDL及LDL浓度均低于对照组,且差异具有统计学意义(P0.001)。(4)在出生时及42天两个时点,GDM组男婴年龄别身长(LAZ)、年龄别体重(WAZ)值均高于对照组,差异具有统计学意义(P0.05)。女婴各时点LAZ、WAZ和身长别体重(WLZ)均无统计学差异。智力发育测定结果显示:GDM组婴儿1岁的智力发育指数(MDI)及心理运动发育指数(PDI)均低于对照组,差异具有统计学意义(P0.05)。(5)逐步多元线性回归分析结果显示:孕晚期TC(b=-1.352,P0.001)与42天LAZ呈负相关;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)与42天WAZ呈负相关,GDM与其呈正相关(b=0.268,P=0.005);孕中期胰岛素与42天WLZ呈负相关(b=-0.186,P=0.049),孕晚期胰岛素(b=0.222,P=0.016)、脐血HDL(b=0.349,P0.001)与其呈正相关;孕中期胰岛素与3月龄LAZ呈正相关(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)与其呈负相关性;孕晚期TG(b=0.173,P=0.043)、脐血饱和脂肪酸(SFA)(b=0.190,P=0.017)与12月龄LAZ呈正相关,孕早期FPG与12月龄WAZ呈负相关(b=-0.173,P=0.047),孕中期糖化血红蛋白(Hb A1c)水平与12月龄WLZ呈负相关(b=-0.189,P=0.041)。(6)智力发育多元线性回归结果显示: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)与MDI呈负相关,孕晚期母血DHA与其呈正相关(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)、脐血g-ALA(b=-0.237,P=0.006)与PDI均呈负相关。结论:GDM孕妇同时存在糖代谢异常和脂代谢异常,且GDM孕妇整个孕期血糖水平均高于正常妊娠者,血脂则表现为孕早期、晚期高于对照组,中期低于对照组;GDM对子代婴儿期体格发育的影响可能存在性别差异;GDM组婴儿MDI、PDI值低于对照组,提示GDM可能影响子代婴儿期的智力发育;控制好孕期血糖血脂水平、适时添加辅食有助于婴儿体格及智力发育。
[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.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256

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