Rizzo T A, Dooley S L, Metzger B E, Cho N H, Ogata E S, Silverman B L
Department of Medicine, Northwestern University Medical School, Children's Memorial Hospital, Chicago, Illinois, USA.
Am J Obstet Gynecol. 1995 Dec;173(6):1753-8. doi: 10.1016/0002-9378(95)90422-0.
Our purpose was to assess to what extent disturbances in antepartum maternal metabolism and perinatal complications and morbidities contribute to poorer psychomotor development in offspring of diabetic mothers.
One hundred ninety-six pregnant women and their singleton offspring participated in this prospective cohort-analytic study. Ninety-five women had pregestational diabetes mellitus, and 101 women had gestational diabetes mellitus. Serial estimates of circulating maternal fuels were obtained throughout each index pregnancy along with detailed records of the perinatal course and outcome. Offspring were administered the psychomotor development index of the Bayley Scales of Infant Development at age 2 years and the Bruininks-Oseretsky Test Of Motor Proficiency at ages 6, 8, and 9 years. Tests were performed blinded to the mother's antepartum metabolic status, and perinatal history, and the child's previous test scores. Partial correlations and analyses of covariance were used to control for other influences and confounds, such as family socioeconomic status, racial or ethnic origin, patient group (i.e., pregestational or gestational diabetes mellitus), and sex of child.
Children's average score on the Bruininks-Oseretsky test at ages 6 to 9 years correlated significantly with maternal second (p < 0.02) and third trimester (p < 0.001) beta-hydroxybutyrate. There was also a borderline association between the children's scores on the psychomotor development index at age 2 years and maternal third-trimester beta-hydroxybutyrate levels (p = 0.06). No other correlations approached significance.
Intrauterine metabolic experiences continue to influence the neurodevelopmental course in offspring of diabetic mothers. Prevailing practices in diabetes management and obstetric and neonatal care appear to effectively mitigate the potential long-term effects of most perinatal complications and morbidities. Management and obstetric and neonatal care appear to effectively miltigate the potential long-term effects of most perinatal complications and morbidities.
我们的目的是评估产前母亲代谢紊乱以及围产期并发症和发病率在多大程度上导致糖尿病母亲后代的精神运动发育较差。
196名孕妇及其单胎后代参与了这项前瞻性队列分析研究。95名女性患有孕前糖尿病，101名女性患有妊娠期糖尿病。在每次索引妊娠期间，对母亲循环中的代谢燃料进行系列评估，并详细记录围产期过程和结局。后代在2岁时接受贝利婴儿发育量表的精神运动发育指数测试，并在6岁、8岁和9岁时接受布鲁宁克斯-奥塞瑞茨基运动熟练度测试。测试在不知道母亲产前代谢状况、围产期病史以及孩子之前测试分数的情况下进行。使用偏相关和协方差分析来控制其他影响因素和混杂因素，如家庭社会经济地位、种族或族裔、患者组（即孕前或妊娠期糖尿病）以及孩子的性别。
6至9岁儿童在布鲁宁克斯-奥塞瑞茨基测试中的平均得分与母亲孕中期（p < 0.02）和孕晚期（p < 0.叭）的β-羟基丁酸水平显著相关。2岁儿童的精神运动发育指数得分与母亲孕晚期β-羟基丁酸水平之间也存在临界关联（p = 0.06）。没有其他相关性达到显著水平。
子宫内的代谢经历继续影响糖尿病母亲后代的神经发育过程。糖尿病管理以及产科和新生儿护理的现行做法似乎有效地减轻了大多数围产期并发症和发病率的潜在长期影响。管理以及产科和新生儿护理似乎有效地减轻了大多数围产期并发症和发病率的潜在长期影响。
