Soler N G, Soler S M, Malins J M
Diabetes Care. 1978 Nov-Dec;1(6):340-50. doi: 10.2337/diacare.1.6.340.
While the modern approach to management of diabetic pregnancy has reduced the perinatal mortality significantly, the neonatal morbidity remains high. This study has investigated factors which may account for the persisting high neonatal morbidity when birth trauma has been virtually eliminated and the incidence of respiratory distress syndrome (RDS) considerably reduced. Major congenital malformations emerge not only as the leading cause of perinatal losses but also as an important cause of morbidity. Delivery before 37 weeks increased the incidence of RDS and hypocalcemia, and it is suggested that, when strict metabolic control is used and with the help of facilities to monitor the fetus closely in the last weeks of pregnancy, the number of infants delivered at this early date can be further reduced. The present study also indicates that normoglycemia should also be encouraged on the day of delivery as maternal hyperglycemia at this stage increases the incidence of neonatal hypoglycemia. Jaundice, which very commonly affects newborn infants of diabetic mothers, is influenced by the use of oxytocin for vaginal delivery and by infant overweight (greater than 90th percentile) at birth, factors which are not beyond control. Finally, route of delivery per se may not be important in relation to neonatal morbidity.
虽然现代糖尿病妊娠管理方法已显著降低围产期死亡率，但新生儿发病率仍然很高。本研究调查了在出生创伤几乎消除且呼吸窘迫综合征（RDS）发病率大幅降低的情况下，仍导致新生儿发病率居高不下的因素。严重先天性畸形不仅成为围产期死亡的主要原因，也是发病的重要原因。37周前分娩会增加RDS和低钙血症的发病率，建议在采用严格代谢控制并借助在妊娠最后几周密切监测胎儿的设施的情况下，可进一步减少在此早期分娩的婴儿数量。本研究还表明，分娩当天也应鼓励血糖正常，因为此时母亲高血糖会增加新生儿低血糖的发病率。黄疸在糖尿病母亲的新生儿中非常常见，它受催产素用于阴道分娩以及出生时婴儿超重（大于第90百分位数）的影响，而这些因素并非无法控制。最后，分娩方式本身可能与新生儿发病率无关。
