探讨早期规范化管理在妊娠期糖尿病(GDM)孕妇分娩新生儿中的应用价值及其随访。

选择2015年1月1日至12月31日，在南京医科大学附属妇幼保健院孕期接受产前检查时确诊为GDM孕妇所分娩的140例新生儿为研究对象，并纳入GDM组(接受早期规范化管理)。选取同期于本院接受产前检查的非GDM孕妇所分娩的130例新生儿纳入对照组(接受常规管理)。采集2组受试儿的一般临床资料、生后3个月龄内的喂养方式及其随访至1岁及2岁时体格发育、神经心理指标，以及母亲孕前人体质量指数(BMI)。采用成组t检验，对2组受试儿的出生体重、随访至1岁及2岁时体格发育、神经心理指标进行统计学比较。采用χ²检验，对受试儿性别构成比、早产儿所占比例等指标进行比较。本研究遵循的程序符合南京医科大学附属无锡妇幼保健院人体试验委员会制定的伦理学标准，得到该委员会批准(审批文号：2016-01-0729-12)，并与受试儿监护人签署临床研究知情同意书。

①2组受试儿的性别构成比、出生体重及早产儿所占比例等一般临床资料比较，差异均无统计学意义(P>0.05)。②GDM组受试儿母亲孕前BMI为(22.1±3.1)kg/m²，高于对照组的(20.6±2.4)kg/m²，2组比较，差异有统计学意义(t＝4.275，P<0.001)。2组受试儿母亲不同孕前BMI所占比例比较，差异有统计学意义(χ²＝10.560，P＝0.005)。③2组受试儿生后3个月龄内不同喂养方式所占比例比较，差异亦无统计学意义(P>0.05)。④对GDM组受试儿随访至1岁及2岁时，其身高、体重、头围和BMI等体格发育相关指标分别与对照组比较，差异均无统计学意义(P>0.05)。⑤对2组受试儿随访至2岁时，其体重正常、超重及肥胖所占比例比较，差异亦无统计学意义(P>0.05)。⑥对2组受试儿分别随访至1岁及2岁时，其发育商得分比较，差异亦均无统计学意义(P>0.05)。对GDM组受试儿随访至1岁及2岁时，其适应能力、语言能力、社交行为的实际月龄，均低于对照组，2组比较，差异均有统计学意义(随访至1岁时：t＝－2.022、－2.880、－3.981，P<0.05；随访至2岁时：t＝－5.420、－4.857、－2.298，P<0.05)，而2组受试儿在大运动及精细运动的实际月龄比较，差异均无统计学意义(P>0.05)。⑦GDM组140例新生中，其母亲孕期血糖控制良好者为98例(70.0%)。母亲孕期血糖控制不良者所分娩新生儿的出生体重、低出生体重儿和巨大儿所占比例，均高于孕期血糖控制良好者，但是差异均无统计学意义(P>0.05)；对孕期血糖控制不良母亲分娩新生儿随访至2岁时，均较控制良好母亲分娩新生儿随访至2岁时的身高、体重稍高与稍重，但是二者比较，差异均无统计学意义(P>0.05)；体重正常、超重和肥胖儿童在孕期血糖控制不良和控制良好者中所占比例比较，差异亦无统计学意义(P>0.05)。

对GDM孕妇分娩新生儿自围生期起施行早期规范化管理，具有重要意义。临床除了在关注GDM孕妇分娩新生儿营养及喂养方式避免体格发育出现偏离的同时，亦应重视后续神经心理发育指导，促进其身心全面发展。

To explore clinical values of early standardized management in children delivered by gestational diabetes mellitus (GDM) pregnant women and their follow-up.

From January 1 to December 31, 2015, a total of 140 neonates who delivered by GDM pregnant women at The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University were selected into GDM group (received early standardized management). Meanwhile, another 130 neonates who delivered by mothers had not been diagnosed with GDM during pregnancy were included into control group (received routine management). The general clinical data, maternal pre-pregnancy body mass index (BMI), feeding patterns within 3 months after birth, and follow-up information of physical development and neuropsychology development of 2 groups were analyzed. The birth weight, maternal pre-pregnancy BMI, physical development and neuropsychology development at 1-year and 2-year old were analyzed by independent-samples t test. The gender composition ratio and the proportion of preterm infants were compared by chi-square test. This study protocol was in line with the Institutional Review Board of The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University (Approval Number: 2016-01-0729-12), and informed contents were obtained from the guardians of all subjects.

①There were no significant differences in the gender composition ratio, the proportion of preterm infants, birth weight and other general clinical data between two groups (P>0.05). ②The maternal pre-pregnancy BMI in GDM group was (22.1±3.1) kg/m^2, which was higher than that of control group (20.6±2.4) kg/m^2, and there was a statistically significant difference between two groups (t=4.275, P<0.001). There was also a statistically significant difference in the proportion of mothers with different pre-pregnancy BMI between two groups (χ²=10.560, P=0.005). ③There was no significant difference between two groups in the proportion of different feeding methods within 3 months after birth (P>0.05). ④There were no significant differences in the height, weight, head circumference and BMI between two groups at 1-year and 2-year old during follow-up (P>0.05). ⑤There were no significant difference in the proportion of normal weight, overweight and obesity between two groups at the time point of two-year follow-up (P>0.05). ⑥There were no significant differences in the scores of developmental quotient between two groups at 1-year and 2-year old during follow-up (P>0.05). In GDM group, the actual age of adaptive ability, language ability, and social behavior were lower than those of control group at 1-year and 2-year old during follow-up. There were statistically significant differences between two groups (one-year old: t=-2.022, -2.880, -3.981; P<0.05; two-year old: t=-5.420, -4.857, -2.298; P<0.05). But there were no significant differences between two groups in the actual age of gross motor and fine motor (P>0.05). ⑦Among 140 newborns in GDM group, 98 (70.0%) had good blood glucose control during pregnancy. The birth weight, proportion of low birth weight and macrosomia in newborns born to mothers with poor blood glucose control during pregnancy were higher than those born to mothers with good blood glucose control, but the difference were not statistically significant (P>0.05). At the time of follow-up to the age of 2-year old, the height and weight of newborns born to those with poor blood glucose control during pregnancy were higher than those born to those with good blood glucose control during pregnancy, but there were no statistical differences between two groups (P>0.05). In addition, there was no significant difference in the proportion of normal weight, overweight and obesity between those with poor blood glucose control and those with good control during pregnancy (P>0.05).

It is of great significance for GDM pregnant women to carry out early standardized management from perinatal period. In addition to paying attention to nutrition and feeding methods of children delivered by GDM pregnant women to avoid physical development deviation, clinical attention should also be paid to the guidance of children′s neuropsychological development so as to promote their physical and mental development in an all-round way.