妊娠期糖尿病对6月龄婴儿发育行为影响的前瞻性出生队列研究
本文选题:MeSH + 糖尿病 ; 参考:《安徽医科大学》2016年硕士论文
【摘要】:目的探究妊娠期糖尿病(gestational diabetes mellitus,GDM)对6月龄婴儿发育行为的影响,分析个人因素和社会因素在联接GDM与儿童发育行为中的调节作用。方法本研究是马鞍山优生优育队列(Ma’anshan Birth Cohort,MABC)研究的一部分。以马鞍山市妇幼保健院为调查点,在孕妇知情同意的前提下,于2013年5月至2014年9月对初次前来产检建册且孕≤14周的孕妇进行问卷调查并填写《孕产期母婴记录表》,收集其基本信息,包括孕妇及其丈夫基本人口统计学资料、家庭慢性疾病史、生活行为资料等;在孕妇孕24~28周期间行75g口服糖耐量试验(oral glucose tolerance test,OGTT)并记录空腹血浆葡萄糖值、服糖后1、2 h血糖值;新生儿出生后测量其体重、头围、身长,并记录分娩相关信息;婴儿6月龄时由带养者带至马鞍山市妇幼保健院体检,对婴儿进行ASQ测试,测量并记录其体重、身高等。正态分布资料采用均数和标准差描述,偏态分布资料采用中位数和四分位间距描述;GDM暴露组和对照组之间一般特征量差异的检验采用t检验和c2检验;多元logistic回归模型分析GDM影响因素;分别采用二项logistic回归模型和两样本的非参数检验(Mann-Whitney U test)分析GDM暴露对6月龄婴儿发育行为的影响;两样本t检验分析发育正常组和发育迟缓组母亲孕早、中、晚三期空腹血糖值的差异。P0.05代表差异有统计学意义。结果2013年5月至2014年9月期间,共纳入孕妇3 474例,最终2 753对母婴纳入本次研究,其中暴露组(母亲患GDM)366例(13.3%),对照组(母亲未患GDM)2 387例。6月龄婴儿ASQ测试沟通能区、大运动能区、精细运动能区、解决问题能区和个人-社会能区的发育迟缓率分别为31.1%、27.2%、27.6%、32.4%和28.7%。与对照组孕妇相比,暴露组的孕妇分娩年龄较大[(27.51±4.09)岁vs.(26.00±3.41)岁,P0.001],初潮年龄较小[(13.74±1.38)岁vs.(13.94±1.33)岁,P=0.006],孕前BMI均值较高[(22.21±3.20)kg/m2 vs.(20.68±2.73)kg/m2,P0.001];暴露组经产妇比例较高(14.5%vs.10.1%,P=0.011)、剖宫产比例较多(60.9%vs.49.4%,P0.001),孕妇为城镇户口(70.2%vs.61.7%,P=0.002)或近半年主要居住于城镇(95.4%vs.92.4%,P=0.040)的情况较多,暴露组家庭人均月收入低于2500元者比对照组比例高(31.7%vs.25.3%,P=0.012),差异均有统计学意义。另外,暴露组孕妇为独生女(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)的比例均较对照组高,且差异有显著意义。与对照组新生儿相比,暴露组的新生儿除了胎龄较小[(273.05±11.38)天vs.(276.75±8.77)天,P0.001]外,出生体重[(3 476.67±541.36)g vs.(3355.77±420.79)g,P0.001]、头围[(34.29±1.05)cm vs.(34.03±1.59)cm,P=0.006]、胸围[(33.78±1.68)cm vs.(33.47±1.49)cm,P=0.001]均较大,差异有统计学意义。而两组的6月龄婴儿体重、身长、头围、皮下脂肪厚度及ASQ五个能区发育迟缓率的差异均无显著意义。以ASQ总分和沟通能力、粗大运动、精细运动、解决问题、个人-社会五个能区得分为检验变量,以是否患GDM为分组变量,进行两样本的非参数检验(Mann-Whitney U test)。结果显示,ASQ五个能区中,暴露组和对照组婴儿发育得分差异无显著性(P0.05)。以孕妇是否患GDM为自变量(未患GDM者为对照组),分别以沟通能力、粗大运动、精细运动、解决问题、个人-社会五项能区的二分类变量为应变量(发育正常为对照组),以孕妇年龄分组、孕期增重情况、怀孕意愿、新生儿胎龄、头围、胸围、6月龄身高、皮下脂肪厚度等为协变量,进行二项logistic回归分析(模型1)。结果,与对照组相比暴露组6月龄婴儿的各项能区得分差异无统计学意义。在模型1的基础上,增加家庭人均月收入、父母亲文化程度为协变量进行二项logistic回归分析(模型2);在模型2的基础上,增加6月龄喂养方式为协变量进行二项logistic回归(模型3),结果差异无统计学意义。孕早、中、晚三期FPG值的P25、P50、P75界值随孕期进程呈下降趋势,而P100界值呈上升趋势。两样本t检验法比较五项能区发育正常组和发育迟缓组孕早、中、晚期空腹血糖值均值的差异,结果显示,粗大运动能区(MD=0.04,95%CI:0.01~0.08,P=0.012)、精细运动能区(MD=0.05,95%CI:0.02~0.08,P=0.005)和个人-社会能区(MD=0.06,95%CI:0.03~0.09,P=0.001)发育迟缓者的母亲孕早期空腹血糖平均水平较发育正常者母亲高,且差异有统计学意义。孕晚期FPG值的比较中,粗大运动能区(MD=-0.09,95%CI:-0.15~-0.04,P=0.001)、精细运动能区(MD=-0.07,95%CI:-0.13~0.02,P=0.006)、解决问题能区(MD=-0.09,95%CI:-0.14~0.04,P=0.001)和个人-社会能区(MD=-0.15,95%CI:-0.21~-0.10,P0.001)发育迟缓组的FPG值均较发育正常组低,且差异有统计学意义。结论母亲患GDM对6月龄婴儿发育迟缓无显著影响,血糖对胎儿发育的影响可能存在关键期。孕期GDM对儿童近期发育行为可能无损害或损害不明显,建议针对大龄儿童,如学龄儿童或青少年进一步评价其智商、执行功能等。
[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.
【学位授予单位】:安徽医科大学
【学位级别】:硕士
【学位授予年份】:2016
【分类号】:R714.256
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