目的 分析孕妇既往存在2型糖尿病(T2D)史和妊娠期糖尿病(GDM)对新生儿呼吸窘迫综合征(NRDS)发病的影响。 方法 选择2015年1月-2020年9月于苍南县人民医院住院的妊娠妇女进行回顾性队列研究,使用电子医疗记录对儿童进行回顾性研究,通过校正潜在混杂因素的Cox回归风险比,估计与母体宫内糖尿病相关的早产新生儿NRDS的相对风险。 结果 本研究共纳入618对母婴,其中67名(10.8%)在宫内暴露于T2D,106名(17.2%)在宫内暴露于GDM,共80早产儿 (12.9%)被诊断为NRDS,暴露于T2D、GDM或无糖尿病后,NRDS的患病率分别为25.4%(17/67)、21.7%(23/10)和9.0%(40/445)。风险分析显示,分娩时孕周在32～34周的新生儿比35～37周的新生儿有更大的风险(HR=2.11,95%CI:1.21～3.96,P<0.001);与怀孕期间无糖尿病相比,无论孕周如何,母亲既往存在T2D(HR=1.96,95%CI:1.28～3.42,P=0.006)、妊娠期需要抗糖尿病药物治疗的GDM(HR=1.83,95%CI:1.22～3.10,P=0.017)与儿童NRDS风险增加显著相关,妊娠期不需要抗糖尿病药物治疗的GDM与儿童NRDS无关(P=0.375)。 结论 与妊娠期无糖尿病相比,儿童NRDS的风险主要是暴露在既有的T2D环境中,需要药物治疗的GDM的风险较小且不受孕妇分娩周期影响,而不需要药物治疗的GDM其新生儿NRDS风险不会显著增加。

Objective To analyze the effects of previous history of maternal type 2 diabetes mellitus (T2D) in pregnant women and gestational diabetes mellitus (GDM) on the incidence of neonatal respiratory distress syndrome (NRDS), in order to provide evidence for preventing NRDS. Methods A retrospective cohort study was conducted among pregnant women hospitalized in Cangnan County People's Hospital from January 2015 to September 2020.Electronic medical records were retrospectively collected.Cox regression risk ratio of potential confounding factors was adjusted, then the relative risk of NRDS associated with maternal intrauterine diabetes in preterm infants was estimated. Results A total of 618 pairs of mothers and infants were included in this study, of whom 67 (10.8%) were exposed to T2D, 106 (17.2%) were exposed to GDM, and 80(12.9%) premature infants were diagnosed with NRDS.The prevalence of NRDS in infants exposed to T2D, GDM or no diabetes was 25.4% (17/67), 21.7% (23/106) and 9.0% (40/445), respectively.Risk analysis showed that newborns with gestational age of 32 to 34 weeks at delivery had a higher risk of NRDS than those at 35 to 37 weeks (HR=2.11, 95%CI: 1.21 - 3.96, P＜0.001).Compared with no diabetes during pregnancy, gestational diabetes with previous T2D (HR=1.96, 95%CI:1.28 - 3.42, P=0.006) and requiring antidiabetic drugs during pregnancy(HR=1.83, 95%CI: 1.22 - 3.10, P=0.017) were significantly associated with increased risk of NRDS.For gestational diabetes not requiring antidiabetic medication during pregnancy, there was no correlation between GDM and NRDS (P=0.375). Conclusions NRDS is predominantly attributed to exposure to the established T2D environment compared with non-diabetes during pregnancy.And the risk for NRDS is lower in children with maternal GDM requiring medication treatment, while the risk would not be significantly increased in children with maternal GDM not requiring medication.