产前糖皮质激素对妊娠期糖尿病母亲分娩的晚期早产儿低血糖发生率的影响
Effect of prenatal glucocorticoid on hypoglycemia in late preterm infants born to diabetes mothers
林玉聪 1高亮 1林新祝 1郑直1
作者信息
- 1. 厦门大学附属妇女儿童医院,厦门市妇幼保健院新生儿科,厦门市围产-新生儿感染重点实验室,厦门市围产医学临床研究中心,厦门 361003
- 折叠
摘要
目的 探讨产前糖皮质激素(antenatal corticosteroid,ACS)对妊娠期糖尿病母亲分娩的晚期早产儿生后24 h内低血糖发生率的影响.方法 选择2017年1月至2022年12月厦门市妇幼保健院新生儿科收治的妊娠期糖尿病母亲分娩的晚期早产儿进行回顾性研究,根据生后24 h内首次血糖值是否＜2.2 mmol/L分为低血糖组和非低血糖组,比较两组患儿围产期及母亲妊娠期情况,采用单因素分析及多因素logistic回归分析筛选晚期早产儿发生低血糖的危险因素.根据产前倍他米松给药情况将晚期早产儿分为未用ACS组、ACS不足(＜2剂)组、足量ACS(2剂)组;根据首剂倍他米松给药至分娩的时间间隔,将接受ACS的晚期早产儿分为＜2 d组、2～7 d组和＞7d组;分析产前激素不同给药时机和给药剂量与晚期早产儿发生低血糖的相关性.结果 共纳入1 294例患儿,低血糖组222例、非低血糖组1 072例,两组胎龄、出生体重比较差异无统计学意义(P＞0.05).多因素logistic回归分析显示,妊娠期糖尿病母亲接受ACS治疗,晚期早产儿生后24 h内发生低血糖的风险增加(OR=1.461,95％CI 1.060～2.013).与未用ACS相比,应用足量ACS患儿的低血糖发生风险增加(OR=2.991,95％CI 1.933～4.630).与应用ACS距离分娩＜2 d相比,距离分娩2～7d应用ACS对晚期早产儿生后低血糖发生风险影响最明显(OR=2.998,95％CI 1.939～4.633),ACS治疗距离分娩＞7 d时对新生儿生后低血糖发生风险影响下降(OR=2.332,95％CI 1.149～4.735).结论 应用ACS会增加妊娠期糖尿病母亲分娩的晚期早产儿生后24 h内低血糖的发生风险,并且低血糖的发生风险与ACS的剂量呈正相关,同时ACS对低血糖发生率的影响在使用后2～7d效应最强.
Abstract
Objective To investigate the effect of antenatal corticosteroid(ACS)on the risk of hypoglycemia within 24 h after birth in late premature infants born to mothers with gestational diabetes mellitus(GDM).Methods A retrospective study was conducted on late premature infants born to mothers with GDM who were hospitalized in Xiamen Maternal and Child Health Hospital from January 2017 to December 2022.Infants were divided into hypoglycemia group and non-hypoglycemia group based on whether hypoglycemia(＜2.2 mmol/L)occurred within the fiirst 24 h after birth.Perinatal data of the infants and gestational data of the mothers were compared between the two groups.Univariate analysis and multivariate logistic regression analysis were used to identify the risk factors for hypoglycemia in late premature infants.According to the prenatal dose of betamethasone,the late premature infants were categorized into three groups:no ACS group,incomplete ACS group(＜2 doses)and complete ACS group(2 doses).Based on the interval between the first dose of betamethasone treatment and delivery,infants receiving ACS were divided into 3 groups:＜2 d,2-7 d,and＞7 d.The correlation between various timings and dosages of ACS administration and the incidence of hypoglycemia was analyzed.Results A total of 1 294 children were included in the study,with 1 072 in the non-hypoglycemia group and 222 in the hypoglycemia group.There were no significant differences in gestational age and birth weight between the two groups.Multivariate logistic regression analysis showed that ACS administration in mothers with GDM increased the risk of hypoglycemia in late preterm infants within the first 24 h after birth(OR=1.461,95％CI 1.060-2.013).Compared with the no ACS group,the risk of hypoglycemia was increased in the complete ACS group(OR=2.991,95％CI 1.933-4.630).The highest risk of hypoglycemia was observed when ACS was administered 2-7 d before delivery compared to＜2 d group(OR=2.998,95％CI1.939-4.633).The risk decreased when ACS was administered more than 7 d prior to delivery(OR=2.332,95％CI 1.149-4.735).Conclusions The use of ACS increases the risk of hypoglycemia within the first 24 h after birth in late preterm infants born to mothers with gestational diabetes,this risk is positively correlated with the dosage of ACS,exhibiting the most pronounced effect when ACS is administered 2-7 d before delivery.
关键词
糖皮质激素/低血糖/妊娠期糖尿病/晚期早产儿Key words
Glucocorticoid/Hypoglycemia/Gestational diabetes mellitus/Late preterm infants引用本文复制引用
出版年
2024
NETL
NSTL
万方数据