| Objective: Utilizing retrospective data analysis methods to identify maternal risk factors that affect neonatal outcomes of infants born to Gestational Diabetes Mellitus(GDM) mothers. Our goal is to find evidence for early intervention and prevention the adverse outcomes of neonates associated with GDM.Methods: Mothers and infants who were admitted to Child Care Service Center of Yan City from May 30 th, 2012 to May 30 th, 2015 were included in this study. Infants were divided into GDM hospitalization group, GDM non-hospitalization group and non-GDM hospitalization infants as control group. The control group was neonates born to non-GDM mother, less than 7 days old and were admitted to the nursery at the same time but for other reasons. We collected the general maternal history data and neonatal conditions of hospitalization(all indices of Neonatal Critical Illness Score), disease constitution and prognosis.Results:1. Maternal risk factorsGDM hospitalization group and GDM non-hospitalization group: Total of 366 mothers in GDM hospitalization group, maternal age(31.30±6.08 year), gestational week(34.90±2.87 week), body weight at the end of pregnancy(78.87±12.00) kg, singleton 345 cases(94.26%), multiple-birth 21 cases(5.74%), primiparas 139 cases(37.98%), multiparas 227 cases(62.02%), In vitro fertilization(IVF) 27 cases(7.38%). There were 650 mothers in GDM non-hospitalization group, age at pregnancy(31.04±6.41) y, gestational week(36.89±2.10)w, body weight at the end of pregnancy(79.51±11.88)kg, singleton 630 cases(96.92%), multiple-birth 20 cases(3.08%), primiparas 272 cases(41.85%), multiparas 378 cases(58.15%), IVF 24 cases(3.69%). We found that in GDM hospitalization group the gestational age tends to be low and the rate of IVF pregnancy was high compared to non-hospitalization group(P<0.05). We also found that the incidence of pregnancy induced hypertension(PIH), polyhydramnios, oligohydramnios, chorioamnionitis and fetal distress were significant higher in GDM hospitalization group compared with GDM non-hospitalization group(P<0.05).2. Neonatal outcomesGDM hospitalization group and GDM non-hospitalization group(control group) :2.1 Maternal and Neonatal history: Total of 366 neonates in GDM hospitalization group, mean age at pregnancy(31.30±6.08) y, primiparas 139 cases, multiparas 227 cases,male 218 cases, female 148 cases, gestational age 29~41+2w, mean gestational age(34.90±2.87)w, birth weight 0.86~5.9 kg, mean birth weight(2.82±1.01)kg, single birth 345 cases, multiple birth 21 cases, caesarean delivery babies 278 cases, natural birth babies 88 cases, IVF 27 cases. Total of 366 neonates in control group, mean age at pregnancy(28.56±5.73)y, primiparas 163 cases, multiparas 203 cases, male243 cases, femal e 123 cases, gestational age 30+2~42w, mean gestational age(35.95±2.83)w, birth weight 1.0~5.26 kg, mean birth weight(2.59±0.79)kg, single birth 343 cases, multiple birth 23 cases, caesarean delivery babies 217 cases, natural birth babies 149 cases, IVF 18 cases. Advanced maternal age, high incidences of PIH and choriaminitis were identified in GDM hospitalization group compared to control group(P<0.05). There were significant differences in caesarean delivery rate, gestational age, birth weight and large for gestational age between the two groups(P<0.05).2.2 Neonatal adverse outcomes: GDM hospitalization group had higher rate of preterm babies, fetal macrosomia, hypoglycemia, neonatal hyperbilirubinemia, neonatal respiratory distress syndrome(NRDS) and neonatal asphyxia, the differences were significant(P<0.05).2.3 Compares of conditions of hospitalization, hospital stay and prognosis: PH was lower in GDM hospitalization group(P<0.05), and there were no significant differences in heart rate, blood pressure, respiration, Pa O2, Na+, K+, BUN, HCT, abdominal distention or gastrointestinal hemorrhage(P>0.05). Hospital stays in GDM hospitalization group was longer than control group(13.46±10.84)d vs(11.21±9.85)d,(P<0.05). There were 21 recovery cases, 341 improvement cases, 4 dead cases in GDM hospitalization group, while they are 27, 332, 7 cases in control group. There were no significant differences in prognosis between the two groups(P>0.05).3. Compares of risk factors of neonates of GDM mothers with bad outcomes:3.1 Univariate logistic regression analysis: There were significant differences in small gestational age, multiple birth, IVF babies, PIH, polyhydramnios, oligohydramnios, chorioamnionitis and fetal distress(P<0.05).3.2 Multiple logistic regression analysis: The results showed that births(OR=2.034, 95% CI=1.030-4.019), PIH(OR=6.288, 95% CI=4.492-8.802), polyhydramnios(OR=1.995, 95% CI=1.164-3.419), oligohydramnios(OR=2.686, 95% CI=1.590-4.537), fetal distress(OR=1.927, 95% CI=1.132-3.281) were five risk factors of neonatal bad outcomes.Conclusions:1. Gestational diabetes mellitus can lead to severe neonatal adverse outcomes;2.Births, PIH, polyhydramnios, oligohydramnios, fetal distress are five risk factors that contribute to worse neonatal outcomes;3. It is very important to strengthen antenatal examination, education and control mothers’ blood sugar. |
PDF Full Text Request