妊娠糖尿病对新生儿出生体格发育的影响

发布时间：2018-05-15 03:43

本文选题：妊娠糖尿病 + 丝氨酸蛋白酶抑制剂　；参考：《郑州大学》2017年硕士论文

【摘要】：目的探讨妊娠糖尿病(Gestational diabetes mellitus,GDM)孕妇孕前体质指数(Body mass index,BMI)和孕期增重(Gestational weight gain,GWG)对初生婴儿体格发育的影响以及GDM孕妇孕晚期血脂、丝氨酸蛋白酶抑制剂(Vaspin)和内脏脂肪素(Visfatin)水平与初生婴儿体格发育的关系。方法2015年11月~2016年5月在郑州大学第二附属医院产科收集所有分娩的GDM孕妇308例和部分正常孕妇800例及其新生儿资料,并采集孕妇产前静脉血清标本227例(GDM孕妇血清96例,糖耐量正常孕妇血清131例),测定血清总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、Vaspin和Visfatin水平。将孕妇分为GDM组和正常对照组;根据孕前BMI将孕妇分为孕前消瘦组、正常组与超重/肥胖组;根据GWG将孕妇分为GWG不足组、适宜组和过多组。根据出生体重将新生儿分为低出生体重儿、正常体重儿和巨大儿。采用卡方检验、t检验、方差分析、二分类和多分类logistic回归分析、Pearson或Spearman相关分析等方法,分析GDM组和正常对照组孕妇孕前BMI、GWG对新生儿出生体重、身长、胸围、头围和Ponderal指数的影响。比较孕晚期GDM组和正常对照组孕妇血脂、Vaspin和Visfatin水平,分析其与新生儿出生体重、身长、胸围、头围和Ponderal指数的关系。结果(1)GDM组新生儿的出生体重、胸围、头围和Ponderal指数均大于正常对照组(P0.05)。(2)GDM是娩出巨大儿的危险因素(OR=2.307,95%CI:1.470~3.622),易使新生儿出现较大Ponderal指数(OR=1.617,95%CI:1.117~2.341)。(3)GWG适宜的GDM孕妇,孕前BMI正常组新生儿的Ponderal指数小于孕前超重/肥胖组(P0.05)。GWG适宜的正常对照组内,孕前消瘦组新生儿的出生体重低于BMI正常组(P0.05)。GWG过多的正常对照组内,孕前消瘦组的新生儿的胸围和头围均小于BMI正常组和超重/肥胖组(P0.05)。多分类logistic回归分析中,孕前消瘦易使新生儿出现较短出生身长(OR=2.214,95%CI:1.169~4.192)。孕前超重/肥胖是娩出巨大儿的危险因素(OR=1.956,95%CI:1.145~3.342),易使新生儿出现较大Ponderal指数(OR=1.710,95%CI:1.094~2.671)。(4)孕前BMI正常的GDM组内,GWG不足组新生儿的出生体重和Ponderal指数均小于GWG过多组(P0.05);孕前BMI正常的正常对照组内,GWG不足组和适宜组新生儿的出生体重和胸围均小于GWG过多组(P0.05)。多分类logistic回归分析中,GWG不足易使新生儿出现较小出生头围(OR=1.888,95%CI:1.186~3.004)。(5)GDM组和正常对照组孕妇血TG水平与新生儿的胸围呈正相关(r=0.203,P=0.047;r=0.288,P=0.001)。(6)孕晚期孕妇血清中Vaspin和Visfatin水平与新生儿出生体重、身长、胸围、头围和Ponderal指数均不相关(P0.05)。结论(1)GDM是娩出巨大儿的危险因素,易使新生儿出现较大的Ponderal指数,对新生儿的出生身长和头围无影响。(2)孕前超重/肥胖是娩出巨大儿的危险因素,易使新生儿出现较大Ponderal指数。孕前消瘦易使新生儿出现较短出生身长。GWG不足易使新生儿出现较小出生头围。(3)孕晚期孕妇血甘油三酯水平与新生儿的胸围呈正相关,而Vaspin和Visfatin水平与新生儿的出生体重、身长、胸围、头围和Ponderal指数不相关。
[Abstract]:Objective to investigate the effect of pre pregnancy body mass index (Body mass index, BMI) and weight gain during pregnancy (Gestational weight gain, GWG) on the physical development of newborn infants and the level of blood lipid in the late pregnancy, the level of serine protease inhibitor and visceral fatty acid and newborn infant in Gestational diabetes mellitus (GDM). Methods the relationship between children's physical development was collected in November 2015 ~2016 ~2016 in the Second Affiliated Hospital of Zhengzhou University to collect all 800 cases of pregnant women and 800 cases of normal pregnant women and their newborns, and collect 227 cases of pre partum venous serum specimens (96 cases of GDM pregnant women, 131 cases of normal pregnant women with normal glucose tolerance), and determine the total bile of serum. Sterols, high-density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, triglyceride, Vaspin and Visfatin levels. The pregnant women were divided into GDM group and normal control group; pregnant women were divided into pre pregnancy emaciation group, normal group and overweight / obese group according to pre pregnancy BMI. According to GWG, pregnant women were divided into GWG deficiency group, suitable group and too many groups. According to birth weight, the new birth weight will be new. The children were divided into low birth weight infants, normal weight infants and giant infants. Using chi square test, t test, variance analysis, two classification and multiple classification logistic regression analysis, Pearson or Spearman correlation analysis, the birth weight, length, chest circumference, head circumference, and Ponderal index of newborn infants were analyzed by BMI and GWG in GDM group and normal control group. The relationship between the blood lipid, Vaspin and Visfatin levels in the GDM group and the normal control group was compared with the birth weight, length, circumference and Ponderal index of the newborn. Results (1) the birth weight, the chest circumference, the head circumference and the Ponderal index in the GDM group were all larger than the normal control group (P0.05). (2) GDM was a dangerous cause of childbirth. OR=2.307,95%CI:1.470~3.622 was easy to make a larger Ponderal index (OR=1.617,95%CI:1.117~2.341) for newborns. (3) the suitable GDM pregnant women with GWG, the Ponderal index in the normal BMI group before pregnancy was less than that in the normal control group of the overweight / obese group before pregnancy (P0.05).GWG (P0.05), and the birth weight of the newborn in the pre pregnancy emaciation group was lower than that of the BMI normal group (P0.) 05) in the normal control group, the chest circumference and head circumference of the pre pregnancy emaciation group were less than that of the BMI normal group and the overweight / obese group (P0.05). In the multi classification logistic regression analysis, the pre pregnancy emaciation was easy to make the newborn birth longer (OR=2.214,95%CI:1.169~4.192). The overweight / obesity before pregnancy was a risk factor for the childbirth of the giant infants (OR=1.). 956,95%CI:1.145~3.342), it is easy to make a larger Ponderal index (OR=1.710,95%CI:1.094~2.671) for newborns. (4) the birth weight and Ponderal index of newborns in GWG deficient group are less than those of the group of GWG (P0.05) before pregnancy, and the birth weight and chest in the normal normal pair group and the suitable group of newborn infants are in the normal normal pairs of GWG before pregnancy. The circumference was less than GWG group (P0.05). In the multi classification logistic regression analysis, the deficiency of GWG was easy to make newborns with smaller birth circumference (OR=1.888,95%CI:1.186~3.004). (5) the serum TG level of pregnant women in GDM and normal controls was positively correlated with the chest circumference of the newborn (r=0.203, P=0.047; r=0.288, P=0.001). (6) pregnant women in the late pregnancy Levels were not related to birth weight, body length, chest circumference, head circumference and Ponderal index (P0.05). Conclusion (1) GDM is a risk factor for childbirth. It is easy to make newborns with larger Ponderal index and no influence on the birth length and head circumference of the newborn. (2) overweight / obesity before pregnancy is a risk factor for childbirth. There is a larger Ponderal index. Pre pregnancy emaciation makes newborns less likely to have a shorter birth.GWG deficiency. (3) there is a positive correlation between the level of triglyceride in the late pregnancy and the chest circumference of the newborn, while the level of Vaspin and Visfatin is not related to the birth weight of the newborn, the length of the body, the chest circumference, the head circumference and the Ponderal index.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R714.256

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