不同喂养方式对妊娠期糖尿病子代早期神经发育的影响-现代医学

不同喂养方式对妊娠期糖尿病子代早期神经发育的影响

单位：1. 南通大学附属医院, 江苏南通 226000;
2. 南京市妇幼保健院, 江苏南京 210004;
3. 苏州市尹山湖医院, 江苏苏州 215000

分类号：R714.7

出版年·卷·期（页码）：2026·54·第一期（101-107）

摘要：

目的：探讨不同喂养方式对妊娠期糖尿病(GDM)产妇子代早期神经发育的影响。方法：选取2021年9月至2022年4月于南通大学附属医院产科分娩的208例GDM单胎产妇及其子代为研究对象，根据婴儿主要喂养方式分为母乳喂养组、混合喂养组和人工喂养组。采用Gesell发育诊断量表评估子代在3月龄和6月龄时适应性、大运动、精细动作、语言及个人-社交5个能区的发育商(DQ)评分，通过多因素线性回归分析不同喂养方式与DQ评分的关联。结果：3月龄时，调整混杂因素后，母乳喂养组子代在适应性(β=12.47，95%CI：9.97~14.97)、大运动(β=12.63，95%CI：10.62~14.65)、精细动作(β=14.86，95%CI：11.25~18.47)、语言(β=3.06，95%CI：0.91~5.21)及个人-社交(β=8.47，95%CI：5.79~11.15)能区的DQ评分均显著高于人工喂养组(均 P<0.001)；混合喂养组除语言能区外(β=1.72，95%CI：-0.64~4.08，P=0.125)，其余4个能区 DQ 评分亦显著高于人工喂养组(均 P<0.001)。6月龄时，纯母乳喂养组上述5个能区DQ评分仍显著高于人工喂养组(适应性：β=15.82，95%CI：13.68~17.97；大运动：β=12.69，95%CI：10.37~15.01；精细动作：β=15.86，95%CI：12.86~18.85；语言：β=4.39，95%CI：2.82~7.14；个人-社交：β=8.39，95%CI：5.79~10.98，均 P<0.001)；混合喂养组5个能区DQ 评分均显著高于人工喂养组(均 P<0.05)。趋势检验显示，随着母乳占比增加，3月龄和 6月龄子代各能区 DQ 评分呈显著递增趋势(均P<0.001)。结论：母乳喂养对GDM产妇子代早期神经发育促进呈现明显的剂量-反应关系，尤其在适应性、大运动及个人-社交能区优势突出。临床应加强对 GDM 产妇的母乳喂养支持与规范化指导，以改善子代神经发育结局。

Objective: To observe and compare the effects of different feeding patterns on early neurodevelopment of maternal gestational diabetes mellitus(GDM) offspring. Methods: A total of 208 singleton GDM mothers and their offspring who delivered at the Department of Obstetrics, Affiliated Hospital of Nantong University from September 2021 to April 2022 were selected as the research subjects. They were divided into three groups according to the infants' main feeding patterns: exclusive breastfeeding group, mixed feeding group, and artificial feeding group. The Gesell Developmental Diagnosis Scale was used to assess the developmental quotient(DQ) score of the offspring in five domains(adaptability, gross motor skills, fine motor skills, language, and personal-social skills) at 3 months and 6 months of age. Multivariate linear regression analysis was performed to examine the association between different feeding patterns and DQ scores. Results: At 3 months of age, after adjusting for confounding factors, the DQ scores of the exclusive breastfeeding group were significantly higher than those of the artificial feeding group in all five domains: adaptability(β=12.47, 95%CI 9.97-14.97), gross motor skills(β=12.63, 95% CI 10.62-14.65), fine motor skills(β=14.86, 95%CI 11.25-18.47), language(β=3.06, 95%CI 0.91-5.21), and personal-social skills(β=8.47, 95%CI 5.79-11.15)(all P<0.001). For the mixed feeding group, the DQ scores in the other four domains except language(β=1.72, 95%CI -0.64-4.08, P=0.125) were also significantly higher than those in the artificial feeding group(all P<0.001). At 6 months of age, the exclusive breastfeeding group still showed significantly higher DQ scores than the artificial feeding group in all five domains: adaptability(β=15.82, 95%CI 13.68-17.97), gross motor skills(β=12.69, 95%CI 10.37-15.01), fine motor skills(β=15.86, 95% CI 12.86-18.85), language(β=4.39, 95%CI 2.82-7.14), and personal-social skills(β=8.39, 95%CI 5.79-10.98)(all P<0.001). Additionally, the DQ scores in all five domains of the mixed feeding group were significantly higher than those of the artificial feeding group(all P<0.05). Trend test showed that with the increase in the proportion of breast milk, the DQ scores of offspring in all domains at 3 months and 6 months of age presented a significant increasing trend(all P<0.001). Conclusion: Breastfeeding has a dose-response with the promotion of early neurodevelopment in offspring of GDM mothers, particularly in adaptability, gross motor skills, and personal-social skills. Clinically, it is imperative to strengthen breastfeeding support and standardized guidance for GDM mothers to optimize the neurodevelopmental outcomes of their offspring.

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