Nursing intervention on neonates delivered by diabetic mothers 糖尿病母亲新生儿的护理The Maternal and Child Health Hospital of Hunan Province 湖南省妇幼保健院Yu Luo 罗煜Overview of diabetic mothers and fetus 糖尿病母亲与胎儿概述Influence of gestational diabetes on fetus 妊娠期糖尿病对胎儿的影响Influence of gestational diabetes on the neonates 妊娠期糖尿病对新生儿的影响23Complications prevention of diabetic mothers neonates 糖尿病母亲新生儿并发症防治4Breastfeeding problem of diabetic mothers neonates 糖尿病母亲新生儿的母乳喂养问题5Main content 主要内容1Overview 概 述There are two forms of diabetes in pregnancy, one is the female already diagnosed diabetes before pregnancy,which is known as pregnancy complicated with diabetes mellitus;妊娠期糖尿病有两种情况，一种未妊娠前已有糖尿病的患者妊娠，又称为糖尿病合并妊娠； Another : before pregnancy glucose metabolism is normal or glucose tolerance is potentially impaired , diabetes appears or is found during pregnancy , which is also called gestational diabetes mellitus (GDM).另一种为妊娠前糖代谢正常或潜在糖耐量减退，妊娠期才出现或发现糖尿病，又称为妊娠期糖尿病（GDM） 。Overview 概 述More than 80% diabetic mothers are affected by Gestational Diabetes Mellitus (GDM), pregnancy complicated with diabetics affects less than 20% diabetic mothers. 糖尿病孕妇中80%以上为GDM，糖尿病合并妊娠者不足20%The incidence of GDM ranges from 1% to14% in the world, and 1% to 5% in China, the incidence is increasing in recent years.世界各国报道GDM在国际上发生率1%-14%，中国国内为1%-5%，近年有明显增高趋势。Overview 概 述GDM is induced by pregnancy but Most of them can return to normal postpartum, women once diagnosed with gestational diabetes have an increased risk of developing type 2 diabetes mellitus in the future. neonates delivered by GDM mother are vulnerable to many clinical problems who need special care and treatment.GDM多数产后能恢复正常，但将来患型糖尿病的机会增加。糖尿病母亲新生儿易发生许多临床问题，需要特别护理和治疗。Pathophysiology 病理生理GDM mothers glucose levels is high, a lot of glucose travels across the placenta to the fetus, stimulates proliferation of fetal islet beta cell, increases insulin secretion, which leads to hyperinsulinism.糖尿病母亲血糖高，大量葡萄糖通过胎盘进入胎儿，刺激胎儿胰岛细胞增生，胰岛素分泌增加，发生高胰岛素血症。Hyperinsulinemia and hyperglycemia bring serious effect on growth of fetal tissues and metabolism, cause a series of clinical problems.高胰岛素血症和血糖升高对胎儿各脏器的生长发育及内分泌代谢产生严重影响，引发一系列的临床问题。Influence of gestational diabetes on fetus妊娠期糖尿病对胎儿的影响Effect of high blood glucose levels on the fetus in different period 不同时期血糖升高对胎儿影响Teratogenic, abortion 致畸、流产Fetal hyperinsulinemia 胎儿高胰岛素血症Maternity and children metabolic abnormalities 产妇、子代代谢异常Pre-gestation / early gestation 孕前/早孕Middle and late gestation 中、晚孕at a specified future date 远期Effect of high blood glucose levels on the fetus in different period 不同时期血糖升高对胎儿影响Effect on the fetus 对胎儿的影响 1 The incidence of macrosomia is 25% - 42%.巨大胎儿的发生率高达25%-42%。Effect on the foetus 对胎儿的影响with high blood glucose of the Pregnant women , fetal is in the hyperinsulinemia environment caused by maternal hyperglycemia for a long time ,which stimulates protein, fat synthesis, and inhibits fat decomposition, causes excessive fetal growth. 孕妇血糖高，胎儿长期处于母体高血糖所致的高胰岛素血症环境中 蛋白质、脂肪合成，脂肪分解作用胎儿躯干过度发育。 Obesity or overweight of GDM pregnant women are risk factors of macrosomia GDM孕妇过胖或体重指数过大是巨大儿的危险因素, the incidence of macrosomia can be decreased if GDM is controlled properly . 如在妊娠期母亲糖尿病得到适当控制，巨大儿发生率可减少。Effect on the fetus 对胎儿的影响2. The incidence of FGR is 21%.胎儿生长受限（FGR）发生率为21%。Early gestational hyperglycemia inhibits the growth of embryos embryonic development lag behind at the very beginning of pregnant 妊娠早期高血糖有抑制胚胎发育的作用孕早期胚胎发育落后。 Diabetes combined with microangiopathy give rise to placental vascular abnormalities, which affect the development of fetus.糖尿病合并微血管病变胎盘血管出现异常，影响胎儿发育。Effect on the fetus 对胎儿的影响3.The incidence of abortion and premature delivery is 10-25%易发生流产和早产，发生率为10-25%。 Early pregnancy can make blood abnormality of embryo development, embryonic death, abortion.In early gestation stage, high blood glucose cause the abnormal embryonic development embryon died - abortion.妊娠早期血糖高可使胚胎发育异常胚胎死亡流产。Combined with polyhydramnios premature delivery.合并羊水过多早产。Combined with hypertension disease, fetal distress pregnancy should be terminated in advance premature delivery.并发妊娠期高血压疾病、胎儿窘迫需提前终止妊娠早产。Effect on the fetus 对胎儿的影响4. Fetal malformation rate is 6% - 8%, which is higher than non- diabetic pregnant women, the rate of serious malformation is 7-10 times than normal pregnancy. 胎儿畸形率为6%-8%，高于非糖尿病孕妇，严重畸形发生率为正常妊娠 的7-10倍。Fetal abnormalities screening should be carried out in Pregnancy with diabetes.妊娠合并糖尿病患者应在妊娠期加强对胎儿畸形的筛查。Effect on the fetus 对胎儿的影响The adverse effects are related to maternal hyperglycemia, ketoacidosis, anaerobic and diabetes drug toxicity. 可能与母体妊早期高血糖、酮症酸中毒、缺氧或者与糖尿病药物毒性有关。Research show that fetal malformations have came into being in the first 9 weeks of gestation, and hyperglycemia can cause serious malformation.有研究表明，孕9周时胎儿畸形已形成，在胚胎发育时期，孕妇高血糖可导致严重畸形发生。Fetal malformation 胎