Effect of early standardized management of pregnant women with gestational diabetes mellitus on newborns and their follow-up

Abstract

Objective To explore clinical values of early standardized management in children delivered by gestational diabetes mellitus (GDM) pregnant women and their follow-up. Methods From January 1 to December 31, 2015, a total of 140 neonates who delivered by GDM pregnant women at The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University were selected into GDM group (received early standardized management). Meanwhile, another 130 neonates who delivered by mothers had not been diagnosed with GDM during pregnancy were included into control group (received routine management). The general clinical data, maternal pre-pregnancy body mass index (BMI), feeding patterns within 3 months after birth, and follow-up information of physical development and neuropsychology development of 2 groups were analyzed. The birth weight, maternal pre-pregnancy BMI, physical development and neuropsychology development at 1-year and 2-year old were analyzed by independent-samples t test. The gender composition ratio and the proportion of preterm infants were compared by chi-square test. This study protocol was in line with the Institutional Review Board of The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University (Approval Number: 2016-01-0729-12), and informed contents were obtained from the guardians of all subjects. Results ①There were no significant differences in the gender composition ratio, the proportion of preterm infants, birth weight and other general clinical data between two groups (P>0.05). ②The maternal pre-pregnancy BMI in GDM group was (22.1±3.1) kg/m2, which was higher than that of control group (20.6±2.4) kg/m2, and there was a statistically significant difference between two groups (t=4.275, P 0.05). ④There were no significant differences in the height, weight, head circumference and BMI between two groups at 1-year and 2-year old during follow-up (P>0.05). ⑤There were no significant difference in the proportion of normal weight, overweight and obesity between two groups at the time point of two-year follow-up (P>0.05). ⑥There were no significant differences in the scores of developmental quotient between two groups at 1-year and 2-year old during follow-up (P>0.05). In GDM group, the actual age of adaptive ability, language ability, and social behavior were lower than those of control group at 1-year and 2-year old during follow-up. There were statistically significant differences between two groups (one-year old: t=-2.022, -2.880, -3.981; P 0.05). ⑦Among 140 newborns in GDM group, 98 (70.0%) had good blood glucose control during pregnancy. The birth weight, proportion of low birth weight and macrosomia in newborns born to mothers with poor blood glucose control during pregnancy were higher than those born to mothers with good blood glucose control, but the difference were not statistically significant (P>0.05). At the time of follow-up to the age of 2-year old, the height and weight of newborns born to those with poor blood glucose control during pregnancy were higher than those born to those with good blood glucose control during pregnancy, but there were no statistical differences between two groups (P>0.05). In addition, there was no significant difference in the proportion of normal weight, overweight and obesity between those with poor blood glucose control and those with good control during pregnancy (P>0.05). Conclusions It is of great significance for GDM pregnant women to carry out early standardized management from perinatal period. In addition to paying attention to nutrition and feeding methods of children delivered by GDM pregnant women to avoid physical development deviation, clinical attention should also be paid to the guidance of children′s neuropsychological development so as to promote their physical and mental development in an all-round way. Key words: Diabetes, gestational; Perinatal care; Growth and development; Intelligence; Pregnant women; Infant, newborn; Child