探讨新生儿低血糖的产科相关危险因素。

选择2014年9月1日至2015年12月31日于大连医科大学附属第一医院产科出生并于生后30 min内检测血糖水平并且确诊为新生儿低血糖患儿92例为研究对象，并纳入病例组。采用系统抽样法，随机抽取同期在本院出生并且血糖水平处于正常参考值范围的92例新生儿为对照组。对2组新生儿低血糖患儿的母亲年龄、孕次、产次、孕前人体质量指数(BMI)、妊娠合并和(或)并发症、分娩方式，新生儿胎龄、出生体重、性别及是否为早产儿、巨大儿、低出生体重儿(LBWI)、大于胎龄(LGA)儿、小于胎龄(SGA)儿、双胎等临床资料进行回顾性分析。采用单因素分析和多因素非条件logistic回归分析方法，对上述新生儿低血糖的产科相关危险因素进行统计学分析。本研究遵循的程序符合大连医科大学附属第一医院伦理审查委员会制定的伦理学标准，得到该委员会批准。

① 2组新生儿胎龄、生后30 min血糖水平及早产儿、LBWI发生率等比较，差异均有统计学意义(t＝－5.081、－19.907，χ²＝8.725、5.545；P<0.05)。2组新生儿出生体重、性别构成比及巨大儿、SGA儿、LGA儿发生率等比较，差异均无统计学意义(χ²＝1.516、1.815、1.512，P>0.05)。②病例组92例新生儿低血糖患儿中，83例(90.2%)无临床症状表现，仅9例(9.8%)有临床症状表现，但临床症状均不典型。③病例组患儿母亲孕前BMI及孕前超重或肥胖构成比均高于对照组[(23.9±4.5)kg/m² vs (21.5±2.7) kg/m^2, 45.7% vs 12.0%]，并且差异均有统计学意义(t＝4.245，χ²＝25.468；P<0.05)，但2组患儿母亲的年龄、孕次、产次比较，差异均无统计学意义(t＝0.483，Z＝－0.492、－0.603；P>0.05)。④ 2组新生儿母亲妊娠合并糖尿病、妊娠期高血压疾病发生率及剖宫产分娩率、择期剖宫产分娩率分别比较(40.2% vs 12.0%, 32.6% vs 6.5%, 94.6% vs 52.2%, 63.2% vs 41.7%)，差异有统计学意义(χ²＝19.054、19.892、42.307、5.819，P<0.05)，但胎膜早破、宫内感染、宫内窘迫发生率等比较，差异无统计学意义(P>0.05)。⑤多因素非条件logistic回归分析结果显示，母亲孕前超重或肥胖、妊娠合并糖尿病、剖宫产分娩、早产儿，均为新生儿低血糖的产科危险因素(OR＝3.355、3.368、9.174、4.981，95%CI：1.416～7.950、1.369～8.286、3.142～26.787、1.187～20.898；P<0.05)。

孕前控制体重，孕期规范管理糖尿病及高血压等疾病，减少产科并发症，降低剖宫产率，缩短术前禁食时间，术前积极补液，对降低及预防新生儿低血糖的发生具有积极作用。

To investigate the obstetric risk factors of neonatal hypoglycemia.

There were 92 cases of newborns who were tested blood glucose within thirty minutes after birth and identified as at risk of neonatal hypoglycemia at the First Affiliated Hospital of Dalian Medical University during September 1, 2014 to December 31, 2015 (case group). In the meantime, 92 cases of newborns with normal blood glucose level as control group were randomly selected from the same hospital by systematic sampling method during the same period. Relative risk factors which might cause neonatal hypoglycemia, such as maternal age, gravidity and parity history, pre-pregnancy body mass index (BMI), pregnancy complications, delivery mode, gestational age, birth weight, newborn gender, the incidence of premature babies, macrosomia, low birth weight infants (LBWI), large for gestational age(LGA) infants, small for gestational age (SGA) infants, twins and so on were retrospectively analyzed. Data were performed by using single factor and multiple unconditioned logistic regression analysis. This research was in line with ethics standards promulgated by the ethical review committee of the First Affiliated Hospital of Dalian Medical University, which had been approved by the committee.

①There were significant differences between two groups in the aspects of neonatal gestational age, blood glucose concentration within thirty minutes after birth, and incidence of premature infants and LBWI (t=-5.081, t=-19.907, χ²=8.725, χ²=5.545; P<0.05). But there were no significant differences between two groups in the birth weight, gender ratio and incidence of macrosomia, SGA infants and LGA infants (t=-0.553, χ²=0.087, 1.516, 1.815, 1.512; P>0.05). ②Among 92 neonatal hypoglycemia infants (case group), 83 cases (90.2%) had no clinical symptoms, another 9 cases had clinical manifestations (9.8%), but not typical.③In case group, the pre-pregnancy BMI and the incidence rate of maternal pre-pregnancy overweight or obesity were both higher than those of control group[(23.9±4.5)kg/m² vs (21.5±2.7)kg/m^2, 45.7% vs 12.0%], and both the differences were statistically significant (t=4.245, χ²=25.468; P<0.05). But there were no significant difference between two groups in maternal age, gravidity, parity(t=0.483, Z=-0.492, Z=-0.603; P>0.05). ④ The incidence rates of pregnancy combined diabetes mellitus, gestational hypertension disease, cesarean section and elective cesarean were higher than those of control group(40.2% vs 12.0%, 32.6% vs 6.5%, 94.6% vs 52.2%, 63.2% vs 41.7%), and the differences were statistically significant (χ²=19.054, 19.892, 42.307, 5.819; P<0.05). But there were no significant differences in the incidence rates of premature rupture of membranes, intrauterine infection, intrauterine distress between the two groups (P>0.05). ⑤ Multiple unconditional logistic regression analysis showed that, maternal pre-pregnancy overweight or obesity, pregnancy combined diabetes mellitus, cesarean section and premature infants were risk factors of neonatal hypoglycemia(OR=3.355, 3.368, 9.174, 4.981; 95%CI: 1.416-7.950, 1.369-8.286, 3.142-26.787, 1.187-20.898; P<0.05).

Controlling pre-pregnancy weight, strengthening the standard management of diseases such as diabetes and hypertension disease during pregnancy, decreasing obstetric complications, reducing the incidence rate of cesarean section, shortening the preoperative fasting duration and giving preoperative rehydration, are all playing positive roles in reducing and preventing the incidence of neonatal hypoglycemia.