宫内环境与新生儿出生状况的研究

发布时间：2018-03-13 20:14

本文选题：宫内环境　切入点：BMI　出处：《浙江大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的：研究产妇孕前BMI、产妇孕期血糖、孕期危险因素与胎儿出生情况、新生儿脐血各项生化指标之间的关系,分析并确定孕妇孕期BMI、孕期血糖与胎儿出生体重及新生儿各项生化指标的相关性。方法：选取2010年1月1日至2011年1月1日在慈溪、义乌、东阳、温岭四地区妇幼保健院行产前检查并在该医院分娩的孕36-37周的孕妇1318例,对其进行孕期一般情况调查及抽血检验,孕妇分娩后,抽取新生儿脐血进行检验,并进行新生儿出生情况调查,通过对新生儿出生体重、新生儿脐血相关生化指标等的统计分析,了解宫内不良环境对新生儿出生状况的影响。结果：1318例产妇中,消瘦组共305人；正常组共913人；肥胖组共100人。1318例产妇中,妊娠期糖耐量受损组共90人；妊娠期糖尿病母亲组共24人；正常血糖组共1204人。1318例产妇中,对照组共1170人；高危组共148人。1318例新生儿中,低出生体重儿组共14人；正常出生体重儿组共1229人；高出生体重儿组共75人。1318例新生儿分娩情况,正常顺产598例；难产720例。分娩时无胎盘、脐带、羊水问题者740例,具胎盘、羊水或脐带问题者578例。肥胖组所生新生儿出生体重显著高于消瘦组和正常组(P0.01)。肥胖组难产率最高,消瘦组、正常组的难产率均低于总体的难产率,随着产妇孕前BMI值的升高而升高。胎盘、羊水、脐带异常发生率正常组最高,消瘦组的胎盘、羊水、脐带异常发生率均低于总体、正常组和肥胖组的胎盘、羊水、脐带异常发生率。产妇孕晚期血样中,肥胖组甘油三酯水平高于消瘦组、正常组甘油三酯水平,具显著性差异(P0.05)；肥胖组C肽水平高于消瘦组、正常组C肽水平,具显著性差异(P0.01)；胰岛素、HDL-CH和胆固醇水平任意两组间均具显著性差异(P0.01)；消瘦组LDL-CH水平高于正常组和肥胖组,均具显著性差异(P0.01),正常组LDL-CH水平高于肥胖组LDL-CH水平,具显著性差异(P0.05)。脐血肥胖组C肽水平高于消瘦组、正常组C肽水平,均具显著性差异(P0.01)；消瘦组ApoA1水平高于正常组和肥胖组,均具显著性差异(P0.01),正常组ApoAl水平高于肥胖组,具显著性差异(P0.05)；消瘦组HDL-CH水平高于正常组和肥胖组,均具显著性差异(P0.05)；消瘦组胆固醇水平高于正常组和肥胖组,均具显著性差异(P0.01); GDM组所生新生儿出生体重显著高于GIGT组和NDM组(P0.01)。难产率NDM组最高,胎盘、羊水、脐带异常发生率正常组最高。孕晚期母血GIGT组甘油三酯和HbA1c高于GDM组,均具显著性差异(P0.05)。新生儿脐血GIGT组ApoA1低于NDM组,具显著性差异(P0.05); GIGT组HbA1c高于GDM组,具显著性差异(PO.05); GIGT组胰岛素低于GDM组,具显著性差异(P0.05); NDM组胰岛素低于GDM组,具显著性差异(P0.05)。高危组所生新生儿出生体重与对照组所生新生儿出生体重没有明显差异。高危组难产率和胎盘、羊水、脐带异常发生率均高于对照组和总体。孕晚期母血高危组Lp a、甘油三酯、C肽水平高于对照组Lp a、甘油三酯、C肽水平,具显著性差异(P0.01)；高危组HbA1c水平高于对照组HbA1c水平,具显著性差异(P0.05)；对照组ApoA1、ApoB、 LDL-CH和胆固醇水平高于高危组ApoA1、ApoB、LDL-CH和胆固醇水平,具显著性差异(P0.01)。脐血高危组C肽水平高于对照组C肽水平,具显著性差异(P0.05)；对照组胆固醇水平高于高危组胆固醇水平,具显著性差异(P0.05)。难产率HBW组最高,LBW组、NBW组的难产率均低于总体的难产率,随着出生体重的增加,难产率增加。胎盘、羊水、脐带异常发生率LBW组最高,NBW组和HBW组的胎盘、羊水、脐带异常发生率均低于总体的胎盘、羊水、脐带异常发生率,随着出生体重的增加,胎盘、羊水、脐带异常发生率降低。孕晚期母血HBW组HDL-CH水平低于LBW组、NBW组HDL-CH水平,均具显著性差异(P0.01), NBW组HDL-CH水平低于LBW组HDL-CH水平,具显著性差异(P0.05)。脐血HBW组C肽水平高于NBW组C肽水平,具显著性差异(P0.01); HBW组胰岛素水平高于NBW组胰岛素水平,具显著性差异(P0.01), HBW组胰岛素水平高于LBW组胰岛素水平,具显著性差异(P0.05); HBW组HbA1c水平高于NBW组HbA1c水平,具显著性差异(P0.05); HBW组甘油三酯水平高于LBW组甘油三酯水平,具显著性差异(P0.05)。结论：产妇孕前BMI与高出生体重儿的发生率呈正相关。孕晚期母血与新生儿脐血HDL-CH水平均随孕前BMI的增高而降低。母亲孕期吸烟,高血压、糖尿病等危险因素对胎盘、羊水,脐带异常发生率、难产率、低出生体重儿和巨大儿的发生率有明显影响。
[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.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R722.1

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