Cordero L, Treuer S H, Landon M B, Gabbe S G
Department of Pediatrics, Ohio State University Medical Center, Columbus, USA.
Arch Pediatr Adolesc Med. 1998 Mar;152(3):249-54. doi: 10.1001/archpedi.152.3.249.
To describe the clinical outcome of infants born to mothers with gestational diabetes mellitus (GDM) and preexisting insulin-dependent diabetes mellitus (IDDM).
A tertiary care regional perinatal center with a specialized diabetes-in-pregnancy program.
Case series.
Five hundred thirty infants were born to 332 women with GDM and 177 women with IDDM. Thirty-six percent of these 530 newborns were large for gestational age, 62% were appropriate for gestational age, and only 2% were small for gestational age. Seventy-six (14%) of all infants were born before 34 weeks' gestation, 115 (22%) between 34 and 37 weeks of gestation, and 339 (64%) at term. Two hundred thirty-three infants (47%) were admitted to the neonatal intensive care unit due to respiratory distress syndrome (RDS), prematurity, hypoglycemia, or congenital malformation. Hypoglycemia (more common among infants of maternal diabetic classes C through D-R) was documented in 137 (27%) of all newborns. One hundred eighty-two infants (34%) had RDS of varying severity. Polycythemia (5% of infants), hyperbilirubinemia (25%), and hypocalcemia (4%) were other morbidities present. Two hundred forty-four infants were admitted for routine care and enteral feedings. Forty-three of these newborns required subsequent transfer to the neonatal intensive care unit for treatment of hypoglycemia (16 cases), RDS (19 cases), or both (8 cases). Routine care failures were more common among infants whose mothers had advanced diabetes, but less frequent among breast-fed infants.
With modern management, fewer morbidities can be expected in infants of diabetic mothers. Those infants born to women with IDDM remain at risk for hypoglycemia, which can be treated in one half of the cases by enteral feedings alone. The majority of cases of RDS are mild and require short admissions to special care nurseries. Optimal care of infants of diabetic mothers is based on prevention, early recognition, and treatment of common conditions. Severe congenital malformations, significant prematurity, RDS, recurrent hypoglycemic episodes, and asymptomatic infants of women with advanced IDDM should be admitted to special care nurseries. Breast-feeding among women with GDM and IDDM should be encouraged.
描述患有妊娠期糖尿病（GDM）和孕前胰岛素依赖型糖尿病（IDDM）的母亲所生婴儿的临床结局。
一家设有专门的妊娠糖尿病项目的三级区域围产期护理中心。
病例系列研究。
332例患有GDM的女性和177例患有IDDM的女性共分娩了530名婴儿。这530名新生儿中，36%为大于胎龄儿，62%为适于胎龄儿，仅2%为小于胎龄儿。所有婴儿中，76例（14%）在孕34周前出生，115例（22%）在孕34至37周出生，339例（64%）足月出生。233例婴儿（47%）因呼吸窘迫综合征（RDS）、早产、低血糖或先天性畸形入住新生儿重症监护病房。所有新生儿中，137例（27%）出现低血糖（在母亲糖尿病C至D-R级别的婴儿中更常见）。182例婴儿（34%）患有不同严重程度的RDS。其他并发症包括红细胞增多症（5%的婴儿）、高胆红素血症（25%）和低钙血症（4%）。244例婴儿因常规护理和肠内喂养入院。这些新生儿中有43例随后因低血糖（16例）、RDS（19例）或两者（8例）而转至新生儿重症监护病房接受治疗。常规护理失败在母亲患有晚期糖尿病的婴儿中更为常见，但在母乳喂养的婴儿中较少见。
通过现代管理，糖尿病母亲所生婴儿的并发症有望减少。IDDM女性所生的婴儿仍有低血糖风险，其中一半病例仅通过肠内喂养即可治疗。大多数RDS病例较轻，只需短期入住特殊护理病房。糖尿病母亲所生婴儿的最佳护理基于对常见情况的预防、早期识别和治疗。严重先天性畸形、显著早产、RDS、反复低血糖发作以及晚期IDDM女性的无症状婴儿应入住特殊护理病房。应鼓励GDM和IDDM女性进行母乳喂养。
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