| 摘要: |
| ［摘要］ 目的 分析妊娠期糖尿病（GDM）对存在围产期感染高危因素足月新生儿早发感染的影响，为及时发现潜在感染风险及有效围产期干预提供依据。方法 回顾性分析2020年10月至2022年12月于清华大学北京清华长庚医院产科分娩、存在围产期感染高危因素的578例足月新生儿的临床资料。根据新生儿是否发生早发感染分为感染组（159例）和非感染组（419例）。根据母亲是否患GDM分为GDM组（112例）和非GDM组（466例）。所有GDM母亲均通过饮食及运动干预控制血糖在正常范围内。采用多因素logistic回归分析新生儿早发感染的影响因素。结果 GDM组与非GDM组早发感染发生率比较差异无统计学意义（30.36% vs 26.82%， χ2=0.565，P=0.452）。感染组男婴比例、出生体质量高于非感染组，胎龄大于非感染组，差异有统计学意义（P<0.05）。感染组母亲剖宫产比例、产时发热、羊水Ⅲ度粪染及产前血清炎症指标升高的比例高于非感染组，母亲妊娠末期宫颈分泌物培养B族链球菌（GBS）阳性比例低于非感染组，差异有统计学意义（P<0.05）。多因素logistic回归分析结果显示，胎龄增大、母亲产时发热及产前血清炎症指标升高是新生儿早发感染的独立危险因素（P<0.05），而母亲患GDM与新生儿早发感染无独立相关性（P>0.05）。感染组中，GDM母亲患儿治疗3 d后降钙素原（PCT）水平显著低于非GDM母亲患儿［0.25(0.16，0.38)ng/mL vs 0.35(0.24，0.58)ng/mL，Z=2.354，P=0.019］，两组其他资料比较差异无统计学意义（P>0.05）。结论 对于存在围产期感染高危因素的足月新生儿，母亲患GDM且经饮食及运动干预控制血糖在正常范围内并未增加其早发感染的风险，且不加重原有感染程度，不延长住院时间。胎龄增大、母亲产时发热及产前血清炎症指标升高是新生儿早发感染的独立危险因素。 |
| 关键词: 妊娠期糖尿病 足月新生儿 早发感染 围产期感染高危因素 |
| DOI：10.3969/j.issn.1674-3806.2026.09.09 |
| 分类号:R 722.13 |
| 基金项目:北京市自然科学基金项目（编号：7202239） |
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| Analysis of effects of gestational diabetes mellitus on early-onset infection in full-term newborns with high-risk factors for perinatal infection |
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Du Yanyan1, Sun Rui1, Chao Shuang1, Zhang Lei2, Huang Zhenyu2, Wang Yuejiao1
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1.Department of Pediatrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China; 2.Department of Obstetrics and Gynecology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing 102218, China
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| Abstract: |
| ［Abstract］ Objective To analyze effects of gestational diabetes mellitus(GDM) on early-onset infection in full-term newborns with high-risk factors for perinatal infection, thereby providing a basis for the timely identification of potential infection risks and effective perinatal interventions. Methods A retrospective analysis was conducted on the clinical data of 578 full-term newborns delivered in Department of Obstetrics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua Medicine, Tsinghua University between October 2020 and December 2022, who possessed high-risk factors for perinatal infection. The newborns were divided into infection group(n=159) and non-infection group(n=419) according to whether early-onset infection occurred, and their mothers were classified into GDM group(n=112) and non-GDM group(n=466) according to whether they had maternal GDM. All the mothers in the GDM group maintained blood glucose levels within the normal range through diet and exercise intervention. Multivariate logistic regression analysis was employed to identify risk factors for early-onset infection in the newborns. Results No statistically significant difference was observed in the incidence of early-onset infection between the GDM group and the non-GDM group(30.36% vs 26.82%, χ2=0.565, P=0.452). The proportion of male infants, birth weight, and gestational age in the infection group were significantly larger than those in the non-infection group(P<0.05). The proportions of cesarean section, intrapartum fever, grade Ⅲ meconium-stained amniotic fluid(MSAF) and elevated pre-partum serum inflammatory markers in the mothers of the infection group were significantly higher than those in the mothers of the non-infection group(P<0.05), while the proportion of positive group B Streptococcus(GBS) culture from maternal cervical secretions at the end of pregnancy in the infection group was significantly lower than that in the non-infection group(P<0.05). Multivariate logistic regression analysis revealed that increased gestational age, maternal intrapartum fever, and elevated pre-partum serum inflammatory markers were independent risk factors for early-onset infection in the newborns(P<0.05), whereas maternal GDM showed no independent correlation with early-onset infection in the newborns(P>0.05). In the infection group, procalcitonin(PCT) levels in infants of GDM mothers were significantly lower than those in infants of non-GDM mothers 3 days after treatment［0.25(0.16, 0.38)ng/mL vs 0.35(0.24, 0.58)ng/mL, Z=2.354, P=0.019］; no statistically significant differences were found in the other data between the two groups(P>0.05). Conclusion For full-term newborns with high-risk factors for perinatal infection, maternal GDM controlled by diet and exercise intervention to maintain normal blood glucose levels does not increase the risk of early-onset infection in the full-term newborns, nor does it exacerbate the severity of existing infections or prolong hospital stay. Increased gestational age, maternal intrapartum fever and elevated pre-partum serum inflammatory markers are independent risk factors for early-onset infection in newborns. |
| Key words: gestational diabetes mellitus(GDM) full-term newborns early-onset infection high-risk factors for perinatal infection |
