Golshahi Fatemeh, Iqbal Zufa, Madani Zahra Hamidi, Zamanpour Zeynab, Sahebdel Behrokh, Saedi Nafiseh, Khanjani Somayeh, Golshahi Jafar, Shirazi Mahboobeh, Rashidian Pegah, Parsaei Mohammadamin
Department of Ob & Gyn, Fellowship of Maternal-Fetal Medicine, Fetal & Neonatal Research Center, Yas Hospital Complex, Tehran University of Medical Sciences, Maternal, Tehran, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
BMC Pregnancy Childbirth. 2025 Apr 9;25(1):412. doi: 10.1186/s12884-025-07522-2.
Gestational diabetes mellitus (GDM) is linked to adverse fetal outcomes like macrosomia and neonatal hypoglycemia, with its global incidence increasing. While prior research indicates GDM may impair placental function and fetal oxygen delivery, direct evidence is limited. This study compares umbilical cord arterial blood gas measurements in pregnancies with and without GDM.
This retrospective study analyzed medical records from four hospitals in Tehran, Rasht, Ahvaz, and Isfahan in Iran, focusing on term singleton pregnancies (gestational age ≥ 37 weeks) that underwent elective cesarean sections between January and July 2024. Exclusions included maternal age < 18 or > 45 years, pre-existing diabetes, thyroid, hypertensive, malignant, metabolic, or autoimmune disorders, intrauterine growth restriction, hypertensive disorders of pregnancy, and substance use during pregnancy. GDM was diagnosed using a 75-gram oral glucose tolerance test at 24-28 weeks. Primary outcomes included umbilical cord arterial blood gas measures (potential of hydrogen [pH], partial pressure of carbon dioxide [PCO], partial pressure of oxygen [PO], bicarbonate [HCO], and base deficit). The neonatal outcomes were measured as secondary outcomes. Statistical analyses utilized Chi-square, Fisher's exact, and independent t-tests.
Data from 430 pregnancies, including 87 with GDM, were analyzed. Pregnancies with GDM showed significantly lower pH (7.33 ± 0.08 vs. 7.36 ± 0.06, P-value = 0.006) and greater base deficit (-1.82 ± 3.79 vs. -0.50 ± 2.74 mEq/L, P-value = 0.003). However, no significant between-group differences were observed in PCO, PO, or HCO (P-value > 0.05). Furthermore, we observed no significant differences in the mean birthweight, 1-minute, or 5-minute Apgar scores (P-values > 0.05), while neonates in the GDM group required more resuscitation (28.7% vs. 12.0%, P-value < 0.001) and neonatal intensive care unit admissions (34.5% vs. 16.9%, P-value < 0.001).
Pregnancies with GDM showed higher umbilical cord blood acidity, indicating impaired placental function and reduced fetal oxygenation. These findings underscore the need for enhanced monitoring, such as regular fetal surveillance and close glycemic control, along with timely interventions like early neonatal resuscitation protocols and preparedness for neonatal intensive care unit admissions, to mitigate impaired fetal oxygenation in GDM.
Not applicable.
妊娠期糖尿病（GDM）与巨大儿和新生儿低血糖等不良胎儿结局相关，其全球发病率呈上升趋势。虽然先前的研究表明GDM可能损害胎盘功能和胎儿氧输送，但直接证据有限。本研究比较了患有和未患有GDM的妊娠中脐动脉血气测量结果。
这项回顾性研究分析了伊朗德黑兰、拉什特、阿瓦士和伊斯法罕四家医院的病历，重点关注2024年1月至7月期间接受择期剖宫产的足月单胎妊娠（孕周≥37周）。排除标准包括产妇年龄<18岁或>45岁、孕前糖尿病、甲状腺疾病、高血压、恶性肿瘤、代谢或自身免疫性疾病、胎儿生长受限、妊娠期高血压疾病以及孕期药物使用。在孕24 - 28周时使用75克口服葡萄糖耐量试验诊断GDM。主要结局包括脐动脉血气指标（酸碱度[pH]、二氧化碳分压[PCO₂]、氧分压[PO₂]、碳酸氢根[HCO₃⁻]和碱剩余）。将新生儿结局作为次要结局进行测量。统计分析采用卡方检验、Fisher精确检验和独立t检验。
分析了430例妊娠的数据，其中87例患有GDM。患有GDM的妊娠显示pH值显著降低（7.33±0.08 vs. 7.36±0.06，P值 = 0.006），碱剩余增加（-1.82±3.79 vs. -0.50±2.74 mEq/L，P值 = 0.003）。然而，在PCO₂、PO₂或HCO₃⁻方面未观察到组间显著差异（P值>0.05）。此外，我们在平均出生体重、1分钟或5分钟阿氏评分方面未观察到显著差异（P值>0.05），而GDM组的新生儿需要更多的复苏（28.7% vs. 12.0%，P值<0.001）和入住新生儿重症监护病房（34.5% vs. 16.9%，P值<0.001）。
患有GDM的妊娠显示脐血酸度较高，表明胎盘功能受损和胎儿氧合减少。这些发现强调了加强监测的必要性，如定期胎儿监测和密切血糖控制，以及及时干预，如早期新生儿复苏方案和为新生儿重症监护病房入住做好准备，以减轻GDM中胎儿氧合受损的情况。
不适用。
