【佳文分享】妊娠合并糖尿病患者新生儿的管理
，对于产前超声提示胎儿体重过大或者增长速度过快的孕母，要评估分娩方式，做好臂丛神经损伤、产程监护及复苏抢救的各项准备。
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，绝大多数是在生后1 h内完成，之后每3 h监测1次喂奶前血糖浓度，持续24～48 h，并及时纠正异常的血糖。
糖尿病母亲分娩的巨大儿，特别是因此行剖宫产娩出的新生儿，经常合并有短暂呼吸急促或者呼吸窘迫，所以，既能更好的监测生命体征并维持稳定，又能通过体位变动促进肺液吸收。
由于巨大儿是发生代谢综合征的高危人群，因此要做好，根据体格检查和实验室指标判断是否纳入高危儿随访系统，并及时提供健康干预措施。
2. 先天性畸形
母乳喂养能够减少肥胖的发生风险，研究显示，母乳喂养时间每增加1个月，肥胖发生风险就会下降4%，考虑与母乳成分更有利于婴儿消化吸收，避免剩余热卡堆积，婴儿早期生长速度太快就会增加儿童期、成年期发生肥胖、代谢综合征或心血管疾病的风险［25］。
在一个为期4周的随机对照研究中，与配方奶喂养相比，母乳喂养的早产儿在13～16岁时血压、脂质代谢、胰岛素抵抗等方面的表现更好［26］。
对于宫内暴露在高糖环境的新生儿，生后能够获得足够的母乳喂养（＞6个月）依然能够减少儿童期肥胖水平、降低BMI、改善整体体型，而且这种效果不分种族、性别、儿童期饮食差异和运动水平［27］。
维生素D与妊娠合并糖尿病的母胎结局存在强烈相关，补充维生素D能够提高胰岛素敏感性，减轻血糖波动，降低子痫、早产、小于胎龄儿等的发生率［23］。因此，孕期和产后母亲均应摄入足够的维生素D，以保证足够的胎儿生长需求及产后母乳中的含量，新生儿亦应补充，以减少发生喘息、哮喘等疾病发生的风险。
总之，妊娠合并高血糖改变了胚胎正常发育的环境，引起器官功能的变化，导致出生后新生儿可能出现各种器官功能障碍的情况，临床上需提高对高血糖的重视程度，进行相应的监护和检查。同时要意识到胚胎编程的改变可能也会引起生后长时间的功能异常，因此要注意做好糖尿病母亲新生儿的追踪随访和规范管理。
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(收稿日期：2020-11-15)
钟鑫琪. 妊娠合并糖尿病患者新生儿的管理［J/CD］. 中华产科急救电子杂志， 2021， 10(1): 44-48.
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