당뇨 임산부의 HbA1c 농도에 따른 신생아의 예후
Evaluating Neonatal Morbidity According to Maternal HbA1c in Infants of Diabetic Mother
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목적: 임신 중 당뇨는 임산부 뿐만 아니라 태아나 신생아에 영향을 미치므로 임신 동안 적절한 당의 조절은 신생아 의예후에 매우 중요하다. 임신 동안 고혈당 노출 여부를 확인할 수 있는 임산부의 HbA1c검사와 출생 신생아의 예후와의 관계를 보고자 하였다. 방법: 2007년 7월부터 2012년 7월 까지 만 5년 동안 원광대학교 병원 산과에서 임신 중 당뇨로 진단된 산모와 출생하여 신생아실과 신생아 집중치료실에 입원한 신생아를 대상으로 하였다. 당뇨병 산모에서 출생한 총128명의 환아 중 임신중기 이후 HbA1c가 검사된 73명을 대상으로 HbA1c의 측정 정도(≥7%군, 6.9-6.5%군, ≤6.4%군)에따른 산모와 신생아의 특성, 주산기합병증 등을 후향적으로 조사하고 분석하였다. 결과: HbA1c가 측정된 시기는 평균 30±5.0주 이었고, 평균 농도는 6.7±1.4%이었다. 출생 신생아의 평균 출생체중은3,094±831.6 g 이었으며, ≥7%군에서 ≤6.4%군에 비해 높은 체중을 보였다(3,370±950.8 g vs. 2,855±661.97 g,P=0.0113). 신생아합병증은 ≥7%군에서 ≤6.4%군에 비해 저혈당(56.0% vs. 28.6%, P=0.0381), 거대아(36.0%vs 4.8%, P=0.0015), 선천성심장병(28% vs. 0%, P=0.0055)에서 높은 빈도를 보였다. 저혈당의 정도는 ≥7%군에서 ≤6.4%군 보다 의의 있게 낮았으며(26.5±10.5 vs 35.9±8.3 mg/dL, P=0.0196), 거대아(≥4,000 g)로 분만된 신생아들에서 HbA1c군 간의 출생체중 비교는 의의가 없었다. 결론: 임산부에서 혈당 조절 실패로 HbA1c가 7% 이상을 보이면, 출생한 신생아에서 저혈당, 거대아, 선천성심장병의발생 가능성에 주의 하여야 할 것으로 보인다.
Abstract
Purpose: Blood glucose control in diabetic mothers during pregnancy is very importantbecause it can affect fetal and neonatal outcomes. We therefore investigated theclinical outcomes of infants of diabetic mothers in relation to the maternal HbA1c level. Methods: The subjects were diabetic mothers and their newborns who were admittedin Wonkwang University Hospital from July 2007 to June 2012. We retrospectivelyreviewed the medical records of 73 neonates, out of the 128 born to diabetic mothersand investigated neonatal and maternal characteristics based on the differences inmaternal HbA1c levels. 55 neonates was excluded because maternal HbA1c wasnot measured. Results: The mean time for testing the maternal HbA1c was 30±5.0 weeks, and themean level was 6.7±1.4%. The mean birth weight in neonates was 3,094±831.6 gand was higher in the group with ≥7% HbA1c than in the group with ≤6.4% HbA1c(3,370±950.8 g vs. 2,855±661.97 g, P =0.0113). When assessing neonatal morbidity,the rates of hypoglycemia (56.0% vs. 28.6%, P =0.0381), large baby (36.0% vs. 4.8%,P =0.0015) and congenital heart disease (CHD) (28% vs. 0%, P =0.0055) were higherin the group with ≥7% HbA1c than in those with ≤6.4% HbA1c. Serum blood sugarlevel was significantly lower in the group with ≥7% HbA1c than those with ≤6.4%HbA1c (26.5±10.5 vs. 35.9±8.3 mg/dL, P=0.0196). When considering the rate of largebabies (≥4,000g), there were no differences in birth weights between both groups. Conclusion: If the maternal HbA1c level during pregnancy is above 7% with glucosecontrol failure, infants born to diabetic mothers are susceptible to hypoglycemia,large baby syndrome and CHD.
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