Objective To observe the effect of the different onset of gestational diabetes mellitus (GDM) on the birth weight and incidence of related diseases in neonates. Methods Using prospective studies, a total of 1092 cas-es of pregnant women, who admitted to Department of Obstetrics of Guicheng Hospital of Nanhai District of Foshan and established medical records for regular GDM check from January 2013 to March 2015, were selected as the research ob-jects. Among these pregnant women, 92 pregnant women who met the GDM diagnostic criteria and were followed up for delivery were assigned to the GDM group, which were divided into early (n=21), middle (n=43) and late (n=28) GDM groups according to the incidence of pregnancy. At the same time, 50 cases of healthy pregnant women were enrolled in-to the control group. The neonatal birth weight, birth trace blood sugar, related indicators of blood fat, occurrence of mac-rosomia were compared. The incidence of fetal abnormalities, hypoglycemia, bilirubin and other related diseases were statistically analyzed. Results The average body weight of male and female newborns at birth in the early GDM group were (3693±329) g, (3571±286) g, respectively, which were significantly higher than (3518±297) g and (3406±214) g in the middle GDM group and (3475±209) g and (3387±190)g in the late GDM group (P<0.05). The proportion of mac-rosomia in male and female newborns in the early GDM group were 25.00％and 22.22％, respectively, which were sig-nificantly higher than 17.39％and 15.00％in the middle GDM group and 13.33％and 15.38％in the late GDM group (P<0.05). The trace blood sugar, apolipoprotein A (ApoA), apolipoprotein B (ApoB), triglycerides (TG) were respective-ly (2.29 ± 0.37) mmol/L, (0.59 ± 0.16) g/L, (0.35 ± 0.11) g/L, (0.66 ± 0.15) mmol/L in the early GDM group versus corre-sponding (2.52 ± 0.51) mmol/L, (0.67 ± 0.21) g/L, (0.43 ± 0.10) g/L, (0.58 ± 0.14) mmol/L in the middle GDM group and (2.59±0.56) mmol/L, (0.70±0.24) g/L, (0.47±0.12) g/L, (0.56±0.11) mmol/L in the late GDM group (P<0.05). The inci-dence of hypoglycemia, hyperbilirubinemia, neonatal pneumonia and aspiration pneumonia in the GDM group were25.00％, 16.30％and 11.96％respectively, which were higher than 2.00％, 4.00％and 2.00％in the control group (P<0.05). In the early GDM group, the rate of hypoglycemia, organ immaturity and fetal malformation, hyperbilirubinemia were 42.86％, 14.29％and 23.81％, which were significantly higher than corresponding 23.36％, 2.33％, 16.28％of the middle GDM group and 14.29％, 0, 10.71％ in the late GDM group (P<0.05). Conclusion The earlier the onset of GDM, the more serious the disorder of blood glucose and lipid metabolism in newborns, and the higher the incidence of macrosomia and neonatal related diseases. More attention should be paid for the obstetric and newborn pediatricians.%目的 观察不同发病孕期糖尿病(GDM)产妇对新生儿结局和相关疾病发生率的影响.方法 采用前瞻性研究,对2013年1月至2015年3月在佛山市南海区桂城医院产科建卡的孕妇1092例定期行GDM检查,将符合GDM诊断标准并跟踪至分娩的92例孕妇设为GDM组,根据发病孕期分为早期组(n=21)、中期组(n=43)和晚期组(n=28),同时选择同期健康孕妇50例作为对照组,比较各组新生儿出生时体质量,出生时微量血糖、血脂相关指标及巨大儿发生情况等,并统计胎儿畸形、低血糖、胆红素血症等相关疾病的发生率.结果 GDM早期组男、女新生儿出生时平均体质量分别为(3693±329)g、(3571±286)g,高于GDM中期组的(3518±297)g、(3406±214)g和晚期组的(3475±209)g、(3387±190)g,差异均有统计学意义(P<0.05);GDM早期组男、女新生儿中,巨大儿构成比例分别为25.00％和22.22％,GDM中期组分别为17.39％和15.00％,GDM晚期组分别为13.33％和15.38％,GDM早期组男、女新生儿巨大儿构成比例明显高于中期组和晚期组,差异均有统计学意义(P<0.05);GDM早期组新生儿微量血糖、载脂蛋白A(ApoA)、载脂蛋白B(ApoB)分别为(2.29±0.37)mmol/L、(0.59±0.16)g/L、(0.35±0.11)g/L,明显低于中期组的(2.52±0.51)mmol/L、(0.67±0.21)g/L、(0.43±0.10)g/L和晚期组的(2.59±0.56)mmol/L、(0.70±0.24)g/L、(0.47±0.12)g/L,甘油三酯(TG)为(0.66±0.15)mmol/L,明显高于中期组的(0.58±0.14)mmol/L和晚期组的(0.56±0.11)mmol/L,差异均有统计学意义(P<0.05);GDM组新生儿低血糖、胆红素血症和新生儿肺炎及吸入性肺炎发生率分别为25.00％、16.30％、11.96％,明显高于对照组的2.00％、4.00％、2.00％,差异均有统计学意义(P<0.05).GDM早期组新生儿低血糖、器官发育不成熟及胎儿畸形、胆红素血症发生率分别为42.86％、14.29％和23.81％,明显高于GDM中期组的23.36％、2.33％、16.28％和晚期组的14.29％、0、10.71％,差异均有统计学意义(P<0.05).结论 糖尿病产妇发病孕期越早,新生儿血糖和血脂代谢紊乱越严重,巨大儿和新生儿相关疾病发生率越高,应引起产科和新生儿科医师的高度重视.
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