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中华妇幼临床医学杂志(电子版) ›› 2025, Vol. 21 ›› Issue (06) : 643 -649. doi: 10.3877/cma.j.issn.1673-5250.2025.06.006

论著

妊娠期糖尿病孕妇分娩小于胎龄儿的早期生长发育模式
张雅琪, 熊超, 邱琳, 杨蓉†()   
  1. 华中科技大学同济医学院附属武汉儿童医院（武汉市妇幼保健院）孕产群体保健科，武汉　430016
  • 收稿日期:2024-10-16 修回日期:2025-11-03 出版日期:2025-12-01
  • 通信作者: 杨蓉

Early growth and development pattern of small for gestational age infants delivered by mothers with gestational diabetes mellitus

Yaqi Zhang, Chao Xiong, Lin Qiu, Rong Yang†()   

  1. Department of Maternal Health Care, Wuhan Children′s Hospital (Wuhan Maternal and Child Health Care Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan 430016, Hubei Province, China
  • Received:2024-10-16 Revised:2025-11-03 Published:2025-12-01
  • Corresponding author: Rong Yang
  • Supported by:
    National Natural Science Foundation of China(81903331)
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引用本文：

张雅琪, 熊超, 邱琳, 杨蓉. 妊娠期糖尿病孕妇分娩小于胎龄儿的早期生长发育模式[J/OL]. 中华妇幼临床医学杂志(电子版), 2025, 21(06): 643-649.

Yaqi Zhang, Chao Xiong, Lin Qiu, Rong Yang. Early growth and development pattern of small for gestational age infants delivered by mothers with gestational diabetes mellitus[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2025, 21(06): 643-649.

目的

探讨妊娠期糖尿病(GDM)孕妇分娩的小于胎龄(SGA)儿早期生长发育模式。

方法

选择2012—2014年于武汉儿童医院分娩的358例孕妇及其活产单胎SGA儿为研究对象。根据孕妇孕龄32孕周前是否被诊断为GDM，将其分为GDM组(n＝44，GDM孕妇及其分娩的SGA儿)及非GDM组(n＝314，非GDM孕妇及其分娩的SGA儿)。采取前瞻性出生队列研究方法，对2组SGA儿进行定期随访，监测其体格发育指标。采用Mann-Whitney U检验，对2组SGA儿0(出生时)、6、12、18、24个月龄的年龄别体重Z评分(WAZ)与年龄别身长Z评分(LAZ)，以及生后每6个月(本研究定义为年龄段1、2、3、4，分别对应0~6个月龄、6~12个月龄、12~18个月龄、18~24个月龄)的体重增长速率Z评分(V-WIZ)及身长增长速率Z评分(V-LIZ)，进行组间及按照性别分层的统计学比较。本研究经华中科技大学同济医学院附属武汉儿童医院医学伦理委员会批准(审批文号：2010R009-F04)，并与所有孕妇签署临床研究知情同意书。

结果

①GDM组孕妇分娩孕龄小于非GDM组，妊娠期高血压疾病(HDP)发生率高于非GDM组，并且差异均有统计学意义(P<0.05)。②GDM组孕妇分娩的SGA儿年龄段1的V-LIZ为0.31(－0.36，0.92)，低于非GDM组孕妇分娩SGA儿的0.80(0.08，1.53)；GDM组孕妇分娩的女性SGA儿年龄段1的V-WIZ为0.90(0.25，1.94)、V-LIZ为0.01(－0.61，0.92)，分别高于、低于非GDM组孕妇分娩女性SGA儿的V-WIZ[0.63(－0.18，1.34)]及V-LIZ[0.92(0.01，1.53)]，并且差异均有统计学意义(Z＝－2.28、－2.27、－2.69，P＝0.022、0.028、0.007)。③GDM组孕妇分娩的SGA儿各个月龄(0、6、12、18、24个月龄)的WAZ及LAZ曲线比较结果显示，男性与女性SGA儿的WAZ在6个月龄前均增加较快，LAZ在12个月龄前均增加较快；女性SGA儿0~6个月龄的LAZ曲线较男性SGA儿平缓。④GDM组孕妇分娩的男性与女性SGA儿4个年龄段的V-WIZ、V-LIZ分别比较，差异均无统计学意义(P>0.05)。

结论

GDM孕妇分娩的SGA儿的早期生长发育模式不同于非GDM组，并且存在明显性别差异，主要表现为GDM组女性SGA儿在6个月龄前呈现体重增长较快、身长增长滞后的模式。

关键词: 糖尿病，妊娠, 婴儿，小于胎龄, 生长和发育, 性别因素, 体重增长, 身高, 前瞻性研究, 队列研究
Objective

To investigate the early growth and development pattern of small for gestational age (SGA) infants born to mothers with gestational diabetes mellitus (GDM).

Methods

A total of 358 pregnant women and their live singleton SGA infants delivered at Wuhan Children′s Hospital from 2012 to 2014 were selected for this study. Based on whether the mothers were diagnosed with GDM before 32 weeks of gestation, the subjects were divided into GDM group (n=44, GDM mothers and their SGA infants) and non-GDM group (n=314, mothers without GDM and their SGA infants). A prospective, birth cohort study was designed, the regular follow-ups were conducted on SGA infants of two groups and to monitor their physical development indicators. The weight for age Z-score (WAZ) and length for age Z-score (LAZ) at age of 0 (birth), 6, 12, 18, and 24 months of SGA infants, as well as the velocity of weight increments Z-score (V-WIZ) and length of increments Z-score (V-LIZ) every 6 months after birth (defined in this study as age brackets 1, 2, 3, and 4, corresponding to 0-6 months, 6-12 months, 12-18 months, and 18-24 months of age, respectively) of SGA infants, were compared between two groups and stratified by gender by Mann-Whitney U test. This study was approved by the Medical Ethics Committee of Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology (Approval No. 2010R009-F04). Informed consent forms was obtained from all participating pregnant women.

Results

① The gestational age at delivery of pregnant women in GDM group was lower, and the incidence of hypertensive disorders of pregnancy (HDP) was higher than those in non-GDM group, and the differences were statistically significant (P<0.05). ② The V-LIZ for SGA infants at age bracket 1 in GDM group was 0.31 (-0.36, 0.92), which was lower than that of 0.80 (0.08, 1.53) in non-GDM group; meanwhile, the V-WIZ and V-LIZ for female SGA infants at age bracket 1 in GDM group were 0.90 (0.25, 1.94) and 0.01 (-0.61, 0.92), respectively, which were higher and lower than those of 0.63 (-0.18, 1.34) and 0.92 (0.01, 1.53), respectively in non-GDM group, and above differences were statistically significant (Z=-2.28, -2.27, -2.69; P=0.022, 0.028, 0.007). ③ A comparison of WAZ and LAZ curves for SGA infants in GDM group at various months of age (0, 6, 12, 18, 24 months) showed that WAZ increased rapidly before 6 months of age and LAZ increased rapidly before 12 months of age for both male and female SGA infants. Furthermore, the LAZ curve of aged 0-6 months for female SGA infants was flatter compared to male SGA infants. ④ There were no significant differences between male and female SGA infants in GDM group in V-WIZ and V-LIZ of the four age brackets, respectively (P>0.05).

Conclusions

The early growth patterns of SGA infants born to GDM mothers are different from those in the non-GDM group. There is a significant gender difference, which is that female SGA infants present a pattern of faster weight gain but lagging length growth before 6 months of age.

Key words: Diabetes, gestational, Infant, small for gestational age, Growth and development, Sex factors, Weight gain, Body height, Prospective studies, Cohort studies
表1 2组孕妇一般临床资料比较
组别 例数 年龄(岁，±s) 受教育程度[例数(%)] 分娩孕龄(周，±s) 产妇类型[例数(%)]
初中及以下 高中/中专 大专/本科 研究生 初产妇 经产妇
GDM组 44 28.9±3.8 5(11.4) 11(25.0) 26(59.1) 2(4.5) 39.0±0.9 41(93.2) 3(6.8)
非GDM组 314 27.9±3.4 35(11.2) 59(18.9) 200(64.1) 18(5.8) 39.4±1.3 302(96.2) 12(3.8)
统计量   t＝－1.84 χ2＝0.98 t＝2.38 χ2＝0.86
P值   0.066 0.805 0.020 0.190
组别 例数 被动吸烟[例数(%)] 孕前BMI[例数(%)] HDP[例数(%)] 孕期增重(kg，±s) 胎儿性别[例数(%)]
<18.5 kg/m2 18.5~24.0 kg/m2 ≥24.0 kg/m2 男 女
GDM组 44 6(13.6) 12(27.3) 26(59.1) 6(13，6) 5(11.4) 14.6±5.6 19(43.2) 25(56.8)
非GDM组 314 70(22.3) 107(34.1) 190(60.5) 17(5.4) 10(3.3) 15.9±4.9 119(37.9) 195(62.1)
统计量   χ2＝1.73 χ2＝4.61 χ2＝6.43 t＝1.55 χ2＝0.35
P值   0.188 0.100 0.011 0.122 0.500
表2 2组孕妇分娩SGA儿4个年龄段V-WIZ和V-LIZ比较[M(Q1，Q3)]
组别 例数 V-WIZ V-LIZ
年龄段1 年龄段2 年龄段3 年龄段4 年龄段1 年龄段2 年龄段3 年龄段4
GDM组 44 0.87(0.05，1.94) －0.63(－1.80，0.29) －0.81(－1.75，－0.07) －0.85(－1.63，－0.11) 0.31(－0.36，0.92) 0.32(－0.69，1.52) 0.16(－1.66，0.98) －0.33(－0.62，1.56)
非GDM组 314 0.56(－0.14，1.33) －0.59(－1.52，0.36) －1.03(－1.96，－0.14) －0.94(－1.82，0.13) 0.80(0.08，1.53) 0.41(－0.90，1.09) －0.46(－1.54，0.50) 0.34(－0.62，1.56)
Z值   －2.01 －0.90 －0.75 －0.35 －2.28 －0.91 －0.77 0.11
P值   0.093 0.362 0.455 0.727 0.022 0.362 0.443 0.992
表3 2组孕妇分娩男性SGA儿4个年龄段V-WIZ和V-LIZ比较[M(Q1，Q3)]
组别 例数 V-WIZ V-LIZ
年龄段1 年龄段2 年龄段3 年龄段4 年龄段1 年龄段2 年龄段3 年龄段4
GDM组 19 0.85(－0.40，1.99) －0.44(－1.67，－0.07) －0.17(－0.97，0.12) －1.10(－1.53，－0.45) 0.80(0.20，0.81) 0.31(－0.90.1.53) －0.46(－1.44，0.98) －0.52(－0.52，1.56)
非GDM组 119 0.50(0.04，1.31) －0.54(－1.48，0.30) －0.77(－1.56，0.12) －0.88(－1.96，0.41) 0.80(0.21，1.40) 0.07(－0.90，0.72) －0.46(－1.44，0.50) 0.52(－0.73，2.08)
Z值   －0.41 －0.18 －1.20 －0.09 －0.09 －0.95 －0.14 －0.34
P值   0.683 0.856 0.229 0.926 0.931 0.340 0.887 0.735
表4 2组孕妇分娩女性SGA儿4个年龄段V-WIZ和V-LIZ比较[M(Q1，Q3)]
组别 例数 V-WIZ V-LIZ
年龄段1 年龄段2 年龄段3 年龄段4 年龄段1 年龄段2 年龄段3 年龄段4
GDM组 25 0.90(0.25，1.94) －1.52(－2.07，0.43) －1.42(－2.01，－0.34) －0.66(－1.77，0.06) 0.01(－0.61，0.92) 0.66(－0.62，1.52) 0.29(－2.01，0.75) －0.14(－1.11，1.32)
非GDM组 195 0.63(－0.18，1.34) －0.68(－1.52，0.43) －1.23(－2.01，－0.34) －1.05(－1.73，－0.07) 0.92(0.01，1.53) 0.66(－0.75，1.52) －0.63(－1.54，0.52) 0.34(－0.62，1.32)
Z值   －2.27 －1.07 －0.36 －0.56 －2.69 －0.47 －0.74 －0.04
P值   0.028 0.286 0.719 0.577 0.007 0.639 0.460 0.971
图1 GDM组孕妇分娩SGA儿各月龄WAZ及LAZ曲线比较(图1A：WAZ曲线；图1B：LAZ曲线)注：GDM为妊娠期糖尿病，SGA为小于胎龄。WAZ为年龄别体重Z评分，LAZ为年龄别身长Z评分
表5 GDM组孕妇分娩的男性与女性SGA儿4个年龄段V-WIZ和V-LIZ比较[M(Q1，Q3)]
性别 例数 V-WIZ V-LIZ
年龄段1 年龄段2 年龄段3 年龄段4 年龄段1 年龄段2 年龄段3 年龄段4
男性 19 0.85(－0.40，1.99) －0.44(－1.67，－0.07) －0.17(－0.97，0.12) －1.10(－1.53，－0.45) 0.80(0.20，0.81) 0.31(－0.90.1.53) －0.46(－1.44，0.98) －0.52(－0.52，1.56)
女性 25 0.90(0.25，1.94) －1.52(－2.07，0.43) －1.42(－2.01，－0.34) －0.66(－1.77，0.06) 0.01(－0.61，0.92) 0.66(－0.62，1.52) 0.29(－2.01，0.75) －0.14(－1.11，1.32)
Z值   －0.79 －0.67 －1.89 －0.48 －1.23 －0.11 －0.19 －1.04
P值   0.427 0.503 0.059 0.627 0.221 0.909 0.849 0.301
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