Ballard J L, Rosenn B, Khoury J C, Miodovnik M
Department of Pediatrics, University of Cincinnati College of Medicine, OH 45267-0541.
J Pediatr. 1993 Jan;122(1):115-9. doi: 10.1016/s0022-3476(05)83503-6.
Fetal hyperinsulinism in infants of diabetic mothers (IDMs) produces increased fetal growth leading to macrosomia, which may or may not be proportionate. Disproportionate macrosomia refers to excessive weight characterized by a high weight/length ratio. We tested the hypotheses that (1) macrosomia in IDMs would be characterized by a high ponderal index (defined as weight/length ratio) and (2) infants with macrosomia who have a high ponderal index would have increased neonatal morbidity--specifically, hyperbilirubinemia, hypoglycemia, polycythemia, and acidosis. We studied 170 IDMs and 510 non-IDMs matched 1:3 for gestational age, race, and year of delivery. Forty-five percent of IDMs had macrosomia compared with 8% of control infants (p = 0.001), and 19% of IDMs had disproportionate macrosomia compared with 1% of control infants (p = 0.001). The rates of hyperbilirubinemia (p = 0.02), hypoglycemia (p = 0.01), and acidosis (p = 0.01) were greatest in infants with disproportionate macrosomia and least in nonmacrosomic infants. The incidence of polycythemia was not significantly different between the groups. We suggest that disproportionate macrosomia in the IDM is associated with an increased likelihood of neonatal complications.
患有糖尿病母亲的婴儿（IDMs）出现胎儿高胰岛素血症会导致胎儿生长加速，进而引发巨大儿，巨大儿的体型可能相称，也可能不相称。不相称巨大儿是指以高体重/身长比为特征的体重过重。我们检验了以下假设：（1）IDMs中的巨大儿将以高体重指数（定义为体重/身长比）为特征；（2）体重指数高的巨大儿婴儿的新生儿发病率会增加——具体而言，是高胆红素血症、低血糖、红细胞增多症和酸中毒。我们研究了170名IDMs和510名非IDMs，这些非IDMs在孕周、种族和分娩年份上与IDMs按1:3进行匹配。45%的IDMs有巨大儿，而对照组婴儿这一比例为8%（p = 0.001），19%的IDMs有不相称巨大儿，而对照组婴儿这一比例为1%（p = 0.001）。高胆红素血症（p = 0.02）、低血糖（p = 0.01）和酸中毒（p = 0.01）的发生率在不相称巨大儿婴儿中最高，在非巨大儿婴儿中最低。两组之间红细胞增多症的发生率没有显著差异。我们认为，IDM中不相称巨大儿与新生儿并发症发生可能性增加有关。
