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怀孕期间的糖尿病和后代的心脏功能:系统审查和元分析
Camilla Bjørn Skovsgaard1, Anna Møller1, Jesper Vandborg Bjerre1
1Department of Paediatrics, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Frontiers in pediatrics
|August 2, 2024
概括
孕期糖尿病会影响婴儿的心脏功能,在头六个月内导致高和全身功能下降. 对老年儿童的长期影响尚不清楚,需要进一步研究.
科学领域:
- 心脏病学 心脏病学
- 孕产妇和胎儿医学 孕产妇和胎儿医学
- 儿童心脏病学 儿童心脏病学
背景情况:
- 怀孕期间的糖尿病是一个日益关注的问题,对后代的潜在长期健康影响越来越大.
- 之前的研究表明,母亲糖尿病与胎儿发育的改变,包括心血管方面的变化之间存在联系.
- 了解这些影响对于早期干预和改善长期健康结果至关重要.
研究的目的:
- 系统地审查和综合现有的证据,关于怀孕期间糖尿病对后代心脏功能的影响.
- 评估新生儿,婴儿和幼儿的心脏参数,这些婴儿在怀孕期间暴露于母亲糖尿病.
- 为了确定与母婴糖尿病暴露相关的特定心声回声检测结果.
主要方法:
- 对四个主要数据库 (PubMed,Embase,Cochrane CENTRAL,Web of Science) 进行了全面的系统审查.
- 包括1992年至2023年6月期间发表的研究,重点是通过心声学检查后代 (年龄<18岁) 心脏功能.
- 分析了31项涉及1679例病例和2694例对照的观察性研究,并在可行的情况下进行了元分析.
主要成果:
- 暴露于母亲糖尿病的新生儿在生命的第一周内表现出心脏缩 (心室内隔膜透气直径增加) 和整体心脏功能受损 (心肌性能指数下降).
- 新生儿的透缩功能 (LV E/A比率) 也有所降低,而静脉功能 (左心室喷射分数) 没有显著差异.
- 超和全球功能受损的类似发现在1-6个月内持续存在,但在较大的儿童 (1-8岁) 中没有发现显著差异.
结论:
- 怀孕期间的糖尿病与六个月龄以下的婴儿心脏缩和全球心脏功能受损有关.
- 在早期婴儿期观察到的心脏影响似乎已经消失,或者老年儿童的标准心声回声学无法检测到.
- 建议使用心脏MRI等先进成像技术进行进一步的纵向研究,以充分阐明对后代的长期心血管后果.
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