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Article(id=1322925165427962550, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924976893993108, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.16.019, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1758643200000, receivedDateStr=2025-09-24, revisedDate=1785686400000, revisedDateStr=2026-08-03, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339538198, onlineDateStr=2026-10-30, pubDate=1787587200000, pubDateStr=2026-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339538198, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339538198, creator=13701087609, updateTime=1793339538198, updator=13701087609, issue=Issue{id=1322924976893993108, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='16', pageStart='2769', pageEnd='2960', issueExtLink='null', onlineDate='null', pubDate='1787587200000', pubDateStr='2026-08-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793339493249, creator='13701087609', updateTime=1793343103544, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940119640047671, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924976893993108, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940119640047672, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924976893993108, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2898, endPage=2903, ext={EN=ArticleExt(id=1322925165885141687, articleId=1322925165427962550, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Trajectory of sodium ion concentration change in breast milk of pregnant women with gestational diabetes mellitus and its correlation with delayed onset of lactogenesis, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the trajectory of breast milk sodium ion concentration change in pregnant women with gestational diabetes mellitus and its relationship with delayed onset of lactogenesis.

Methods

Using the convenience sampling method,a total of 169 pregnant women with gestational diabetes mellitus from two tertiary grade A hospitals in Guangdong province from August 2024 to April 2025 were selected as the research subjects.They were surveyed using a general information questionnaire.Breast milk sodium ion concentrations were measured at 24 hours,48 hours,and 72 hours after delivery.

Results

The breast milk sodium ion concentrations of pregnant women with gestational diabetes mellitus at 24 hours,48 hours,and 72 hours after delivery were (62.92±8.83) mmol/L,(42.58±9.72) mmol/L,and (27.17±12.95) mmol/L,respectively.Based on the trajectory model,two trajectories of breast milk sodium ion concentration changes were determined:the low sodium ion concentration-rapid decline group(69.8%) and the high sodium ion concentration-slow decline group(30.2%).The incidence of delayed lactation initiation in the low sodium ion concentration-rapid decline group was 13.6%,and that in the high sodium ion concentration-slow decline group was 76.5%.There was statistically significant difference in terms of the incidence of delayed onset of lactogenesis between the two groups(P<0.001).The high sodium ion concentration-slow decline group had a higher risk of delayed onset of lactogenesis as the reference group.

Conclusions

The changes in breast milk sodium ion concentration in pregnant women with gestational diabetes mellitus are correlated with delayed onset of lactogenesis.The trajectory of breast milk sodium ion concentration changes could objectively predict the occurrence of delayed onset of lactogenesis.Clinical medical staff could use the changes in breast milk sodium ion concentration to predict the occurrence of delayed onset of lactogenesis.

, authors=Min XU, Yuting LUO, Yanxin WU, Yunxia LIU, Lingling DING, authorsList=Min XU, Yuting LUO, Yanxin WU, Yunxia LIU, Lingling DING, authorCompany=null, correspAuthors=Min XU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322925166732391099, articleId=1322925165427962550, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=妊娠期糖尿病产妇母乳钠离子浓度变化轨迹及其与泌乳启动延迟的相关性, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

探索妊娠期糖尿病产妇母乳钠离子浓度变化轨迹及其与泌乳启动延迟的关系。

方法

采用便利抽样法，选取2024年8月—2025年4月广东省2所三级甲等医院的169例妊娠期糖尿病产妇为研究对象，采用一般资料调查表对其进行问卷调查，在分娩后24 h、48 h及72 h分别进行母乳钠离子浓度检测。

结果

妊娠期糖尿病产妇分娩后24 h、48 h及72 h母乳钠离子浓度分别为（62.92±8.83）mmol/L、（42.58±9.72）mmol/L、（27.17±12.95）mmol/L。基于轨迹模型确定2种母乳钠离子浓度变化轨迹，分别是低钠离子浓度-快速下降组（69.8%）和高钠离子浓度-缓慢下降组（30.2%）。低钠离子浓度-快速下降组产妇泌乳启动延迟的发生率为13.6%，高钠离子浓度-缓慢下降组产妇泌乳启动延迟的发生率为76.5%，两组产妇泌乳启动延迟发生率比较差异有统计学意义（P<0.001）。以低钠离子浓度-快速下降组作为参考组，高钠离子浓度-缓慢下降组泌乳启动延迟的风险更高。

结论

妊娠期糖尿病产妇母乳钠离子变化与泌乳启动延迟具有相关性，母乳钠离子浓度变化轨迹可以客观预测泌乳启动延迟的发生。临床工作者可借助母乳钠离子浓度变化预测泌乳启动延迟的发生。

, authors=徐敏, 罗玉婷, 吴艳欣, 刘运霞, 丁玲玲, authorsList=徐敏, 罗玉婷, 吴艳欣, 刘运霞, 丁玲玲, authorCompany=null, correspAuthors=徐敏, authorNote=null, correspAuthorsNote=
XU Min， E-mail：
徐敏，副主任护师，硕士研究生，E-mail：
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doi=null, pmid=null, pmcid=null, year=2024, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=18, rfOrder=17, authorNames=张彬彬, journalName=null, refType=null, unstructuredReference=张彬彬.老年急性心肌梗死患者衰弱轨迹、预测因素及对预后的影响[D].济南:山东大学,2024., articleTitle=老年急性心肌梗死患者衰弱轨迹、预测因素及对预后的影响, refAbstract=null), Reference(id=1322925178187035395, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, doi=null, pmid=null, pmcid=null, year=2018, volume=13, issue=2, pageStart=135, pageEnd=141, url=null, language=null, rfNumber=19, rfOrder=18, authorNames=Hoban R, Bigger H, Schoeny M, journalName=Breastfeeding Medicine, refType=null, unstructuredReference=Hoban R,Bigger H,Schoeny M,et al.Milk volume at 2 weeks predicts mother's own milk feeding at neonatal intensive care unit discharge for very low birthweight infants[J].Breastfeeding Medicine,2018,13(2):135-141., articleTitle=Milk volume at 2 weeks predicts mother's own milk feeding at neonatal intensive care unit discharge for very low birthweight infants, refAbstract=null), Reference(id=1322925178279310084, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, doi=null, pmid=null, pmcid=null, year=2016, volume=32, issue=3, pageStart=NP36, pageEnd=NP43, url=null, language=null, rfNumber=20, rfOrder=19, authorNames=Haile Z T, Oza-Frank R, Azulay Chertok I R, journalName=Journal of Human Lactation, refType=null, unstructuredReference=Haile Z T,Oza-Frank R,Azulay Chertok I R,et al.Association between history of gestational diabetes and exclusive breastfeeding at hospital discharge[J].Journal of Human Lactation,2016,32(3):NP36-NP43., articleTitle=Association between history of gestational diabetes and exclusive breastfeeding at hospital discharge, refAbstract=null), Reference(id=1322925178400944901, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, doi=null, pmid=null, pmcid=null, year=2021, volume=114, issue=3, pageStart=1219, pageEnd=1228, url=null, language=null, rfNumber=21, rfOrder=20, authorNames=Pang W W, Geddes D T, Lai C T, journalName=The American Journal of Clinical Nutrition, refType=null, unstructuredReference=Pang W W,Geddes D T,Lai C T,et al.The association of maternal gestational hyperglycemia with breastfeeding duration and markers of milk production[J].The American Journal of Clinical Nutrition,2021,114(3):1219-1228., articleTitle=The association of maternal gestational hyperglycemia with breastfeeding duration and markers of milk production, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322925167030186684, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, xref=1, ext=[AuthorCompanyExt(id=1322925167034380989, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, companyId=1322925167030186684, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1The First Affiliated Hospital of Sun Yat-sen University, Guangdong 510080 China), AuthorCompanyExt(id=1322925167042769598, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, companyId=1322925167030186684, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1中山大学附属第一医院，广东 510080)])], figs=[ArticleFig(id=1322925170939278051, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=EN, label=Figure 1, caption=Trajectory of sodium ion concentration change in breast milk of pregnant women with gestational diabetes mellitus, figureFileSmall=SZD+Mv2V0/XFcrhmsS7//g==, figureFileBig=nKLda4eMtpnpx+dp2I2R4g==, tableContent=null), ArticleFig(id=1322925171010581220, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=CN, label=图1, caption=妊娠期糖尿病产妇母乳钠离子浓度的变化轨迹, figureFileSmall=SZD+Mv2V0/XFcrhmsS7//g==, figureFileBig=nKLda4eMtpnpx+dp2I2R4g==, tableContent=null), ArticleFig(id=1322925171199324901, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=EN, label=Table 1, caption=

General information of pregnant women with gestational diabetes mellitus（n=169）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类例数（%）
文化程度初中及以下10(5.9)
高中或中专37(21.9)
专科20(11.8)
本科42(24.9)
硕士研究生及以上60(35.5)
职业公务员/事业单位工作人员35(20.7)
职员96(56.8)
个体6(3.6)
其他32(18.9)
泌乳相关培训无91(53.8)
有78(46.2)
血清白蛋白<35 g/L是110(65.1)
否59(34.9)
母乳喂养经历无111(65.7)
有58(34.3)
母婴同室是131(77.5)
否38(22.5)
分娩早产儿是10(5.9)
否159(94.1)
初产是98(58.0)
否71(42.0)
分娩方式急诊剖宫产37(21.9)
择期剖宫产50(29.6)
阴道分娩82(48.5)
泌乳启动前添加
配方奶		有91(53.8)
无78(46.2)
), ArticleFig(id=1322925171274822374, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=CN, label=表1, caption=

妊娠期糖尿病产妇一般资料（n=169）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类例数（%）
文化程度初中及以下10(5.9)
高中或中专37(21.9)
专科20(11.8)
本科42(24.9)
硕士研究生及以上60(35.5)
职业公务员/事业单位工作人员35(20.7)
职员96(56.8)
个体6(3.6)
其他32(18.9)
泌乳相关培训无91(53.8)
有78(46.2)
血清白蛋白<35 g/L是110(65.1)
否59(34.9)
母乳喂养经历无111(65.7)
有58(34.3)
母婴同室是131(77.5)
否38(22.5)
分娩早产儿是10(5.9)
否159(94.1)
初产是98(58.0)
否71(42.0)
分娩方式急诊剖宫产37(21.9)
择期剖宫产50(29.6)
阴道分娩82(48.5)
泌乳启动前添加
配方奶		有91(53.8)
无78(46.2)
), ArticleFig(id=1322925171341931239, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=EN, label=Table 2, caption=

Analysis of the trajectory changes in breast milk sodium ion concentration change of pregnant women with gestational diabetes mellitus

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICEntropy类别概率
模型13 722.9713 744.8811.000
模型23 650.6803 688.2390.8660.70/0.30
模型33 651.4183 704.6260.7010.53/0.18/0.29
模型43 662.9973 731.8550.6460.42/0.30/0.17/0.11
), ArticleFig(id=1322925171497120488, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=CN, label=表2, caption=

妊娠期糖尿病产妇母乳钠离子浓度变化轨迹

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICEntropy类别概率
模型13 722.9713 744.8811.000
模型23 650.6803 688.2390.8660.70/0.30
模型33 651.4183 704.6260.7010.53/0.18/0.29
模型43 662.9973 731.8550.6460.42/0.30/0.17/0.11
), ArticleFig(id=1322925171564229353, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=EN, label=Table 3, caption=

Univariate analysis of influencing factors of the potential profile for sodium ion concentration change in the breast milk of pregnant women with gestational diabetes mellitus

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类低钠离子浓度-快速下降组（n=118）高钠离子浓度-缓慢下降组（n=51）统计值P
年龄（岁）31.71±4.2130.45±3.67t=1.8550.065
文化程度（例）初中或以下91χ²=41.610<0.001
高中或中专2413
专科182
本科411
硕士研究生及以上2634
职业（例）公务员/事业单位工作人员2411χ²=14.3560.002
职员5937
个体42
其他311
泌乳相关培训（例）无6724χ²=1.3540.245
有5127
孕前BMI（kg/m2）22.89±3.3922.43±3.30t=0.8170.415
分娩前BMI（kg/m2）27.03±3.3026.61±2.94t=0.7830.435
血清白蛋白<35 g/L（例）是7436χ²=0.9720.324
否4415
母乳喂养经历（例）有4711χ²=5.2680.022
无7140
母婴同室（例）是8546χ²=6.7390.009
否335
早产儿（例）是91χ²=1.1620.281
否10950
初产（例）是6731χ²=0.2340.628
否5120
分娩方式（例）急诊剖宫产316χ²=5.0210.081
择期剖宫产3515
阴道分娩5230
泌乳启动前添加配方奶 （例）有5635χ²=6.4220.011
无6216
新生儿性别（人）男5118χ²=0.9260.336
女6733
新生儿体重（kg）3.14(2.96,3.43)3.03(2.83,3.19)Z=2.6270.009
新生儿低血糖（人）是2620χ²=5.3070.021
否9231
), ArticleFig(id=1322925171660698346, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=CN, label=表3, caption=

妊娠期糖尿病产妇母乳钠离子浓度变化潜在剖面影响因素的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类低钠离子浓度-快速下降组（n=118）高钠离子浓度-缓慢下降组（n=51）统计值P
年龄（岁）31.71±4.2130.45±3.67t=1.8550.065
文化程度（例）初中或以下91χ²=41.610<0.001
高中或中专2413
专科182
本科411
硕士研究生及以上2634
职业（例）公务员/事业单位工作人员2411χ²=14.3560.002
职员5937
个体42
其他311
泌乳相关培训（例）无6724χ²=1.3540.245
有5127
孕前BMI（kg/m2）22.89±3.3922.43±3.30t=0.8170.415
分娩前BMI（kg/m2）27.03±3.3026.61±2.94t=0.7830.435
血清白蛋白<35 g/L（例）是7436χ²=0.9720.324
否4415
母乳喂养经历（例）有4711χ²=5.2680.022
无7140
母婴同室（例）是8546χ²=6.7390.009
否335
早产儿（例）是91χ²=1.1620.281
否10950
初产（例）是6731χ²=0.2340.628
否5120
分娩方式（例）急诊剖宫产316χ²=5.0210.081
择期剖宫产3515
阴道分娩5230
泌乳启动前添加配方奶 （例）有5635χ²=6.4220.011
无6216
新生儿性别（人）男5118χ²=0.9260.336
女6733
新生儿体重（kg）3.14(2.96,3.43)3.03(2.83,3.19)Z=2.6270.009
新生儿低血糖（人）是2620χ²=5.3070.021
否9231
), ArticleFig(id=1322925171757167339, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=EN, label=Table 4, caption=

Logistic regression analysis of factors affecting the delayed onset of lactogenesis in pregnant women with gestational diabetes

, figureFileSmall=null, figureFileBig=null, tableContent=
指标回归系数POR值95%CI
高钠离子浓度-缓慢下降组3.124<0.0522.733[9.357，61.554]
母乳喂养经历（无）1.854<0.056.387[2.056，22.502]
), ArticleFig(id=1322925171845247724, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322925165427962550, language=CN, label=表4, caption=

妊娠期糖尿病产妇发生泌乳启动延迟影响因素的Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
指标回归系数POR值95%CI
高钠离子浓度-缓慢下降组3.124<0.0522.733[9.357，61.554]
母乳喂养经历（无）1.854<0.056.387[2.056，22.502]
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妊娠期糖尿病产妇母乳钠离子浓度变化轨迹及其与泌乳启动延迟的相关性
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徐敏 , 罗玉婷 , 吴艳欣 , 刘运霞 , 丁玲玲
护理研究 | 综合研究 2026,40(16): 2898-2903
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护理研究 |综合研究 2026 , 40 (16) : 2898 -2903
妊娠期糖尿病产妇母乳钠离子浓度变化轨迹及其与泌乳启动延迟的相关性
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徐敏 , 罗玉婷, 吴艳欣, 刘运霞, 丁玲玲
作者信息
  • 1中山大学附属第一医院，广东 510080
通讯作者:
XU Min， E-mail：
徐敏，副主任护师，硕士研究生，E-mail：
Trajectory of sodium ion concentration change in breast milk of pregnant women with gestational diabetes mellitus and its correlation with delayed onset of lactogenesis
Min XU , Yuting LUO, Yanxin WU, Yunxia LIU, Lingling DING
Affiliations
  • 1The First Affiliated Hospital of Sun Yat-sen University, Guangdong 510080 China
出版时间: 2026-08-25 doi: 10.12102/j.issn.1009-6493.2026.16.019
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摘要
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目的

探索妊娠期糖尿病产妇母乳钠离子浓度变化轨迹及其与泌乳启动延迟的关系。

方法

采用便利抽样法，选取2024年8月—2025年4月广东省2所三级甲等医院的169例妊娠期糖尿病产妇为研究对象，采用一般资料调查表对其进行问卷调查，在分娩后24 h、48 h及72 h分别进行母乳钠离子浓度检测。

结果

妊娠期糖尿病产妇分娩后24 h、48 h及72 h母乳钠离子浓度分别为（62.92±8.83）mmol/L、（42.58±9.72）mmol/L、（27.17±12.95）mmol/L。基于轨迹模型确定2种母乳钠离子浓度变化轨迹，分别是低钠离子浓度-快速下降组（69.8%）和高钠离子浓度-缓慢下降组（30.2%）。低钠离子浓度-快速下降组产妇泌乳启动延迟的发生率为13.6%，高钠离子浓度-缓慢下降组产妇泌乳启动延迟的发生率为76.5%，两组产妇泌乳启动延迟发生率比较差异有统计学意义（P<0.001）。以低钠离子浓度-快速下降组作为参考组，高钠离子浓度-缓慢下降组泌乳启动延迟的风险更高。

结论

妊娠期糖尿病产妇母乳钠离子变化与泌乳启动延迟具有相关性，母乳钠离子浓度变化轨迹可以客观预测泌乳启动延迟的发生。临床工作者可借助母乳钠离子浓度变化预测泌乳启动延迟的发生。

妊娠期糖尿病  /  泌乳启动延迟  /  钠离子浓度  /  相关性  /  护理
Objective

To explore the trajectory of breast milk sodium ion concentration change in pregnant women with gestational diabetes mellitus and its relationship with delayed onset of lactogenesis.

Methods

Using the convenience sampling method,a total of 169 pregnant women with gestational diabetes mellitus from two tertiary grade A hospitals in Guangdong province from August 2024 to April 2025 were selected as the research subjects.They were surveyed using a general information questionnaire.Breast milk sodium ion concentrations were measured at 24 hours,48 hours,and 72 hours after delivery.

Results

The breast milk sodium ion concentrations of pregnant women with gestational diabetes mellitus at 24 hours,48 hours,and 72 hours after delivery were (62.92±8.83) mmol/L,(42.58±9.72) mmol/L,and (27.17±12.95) mmol/L,respectively.Based on the trajectory model,two trajectories of breast milk sodium ion concentration changes were determined:the low sodium ion concentration-rapid decline group(69.8%) and the high sodium ion concentration-slow decline group(30.2%).The incidence of delayed lactation initiation in the low sodium ion concentration-rapid decline group was 13.6%,and that in the high sodium ion concentration-slow decline group was 76.5%.There was statistically significant difference in terms of the incidence of delayed onset of lactogenesis between the two groups(P<0.001).The high sodium ion concentration-slow decline group had a higher risk of delayed onset of lactogenesis as the reference group.

Conclusions

The changes in breast milk sodium ion concentration in pregnant women with gestational diabetes mellitus are correlated with delayed onset of lactogenesis.The trajectory of breast milk sodium ion concentration changes could objectively predict the occurrence of delayed onset of lactogenesis.Clinical medical staff could use the changes in breast milk sodium ion concentration to predict the occurrence of delayed onset of lactogenesis.

gestational diabetes mellitus  /  delayed onset of lactogenesis  /  sodium ion concentration  /  correlation  /  nursing
徐敏, 罗玉婷, 吴艳欣, 刘运霞, 丁玲玲. 妊娠期糖尿病产妇母乳钠离子浓度变化轨迹及其与泌乳启动延迟的相关性. 护理研究, 2026 , 40 (16) : 2898 -2903 . DOI: 10.12102/j.issn.1009-6493.2026.16.019
Min XU, Yuting LUO, Yanxin WU, Yunxia LIU, Lingling DING. Trajectory of sodium ion concentration change in breast milk of pregnant women with gestational diabetes mellitus and its correlation with delayed onset of lactogenesis[J]. Chinese Nursing Research, 2026 , 40 (16) : 2898 -2903 . DOI: 10.12102/j.issn.1009-6493.2026.16.019
正文
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妊娠期糖尿病（gestational diabetes mellitus，GDM）是妊娠期间出现的不同程度的糖耐量异常，是妊娠期间最常见的并发症之一[1]。泌乳启动延迟（delayed onset of lactogenesis，DOL）是指产妇在产后72 h才有明显的乳房胀感或充盈感[2]。研究表明，妊娠期糖尿病产妇发生泌乳启动延迟的风险高于非妊娠期糖尿病产妇[3]，泌乳启动延迟的发生率高达35.0%[4]。泌乳启动延迟是早期母乳喂养遇到的困难之一，可增加产妇断奶的风险[5]。有研究发现，我国产妇泌乳启动延迟的发生率为18%~39%，可能导致婴儿配方奶粉的长期补充和纯母乳喂养率的降低[6]。目前，临床常采用产妇自诉乳胀的方法判断泌乳启动的时间，即记录产妇首次出现明显乳房胀感或充盈感的时间，如超过72 h则称为泌乳启动延迟[7]。该方法依赖产妇的自我感觉，较为主观，不能准确评估，也无法预测能否成功泌乳。研究指出，在泌乳启动过程中，母乳中的某些生物标志物浓度会发生变化，比如乳糖及柠檬酸盐浓度升高，钠离子及总蛋白浓度降低，可预测泌乳启动且精准度较高[8]。而母乳生物标志物中，钠离子浓度的检测方便快速，不受饮食、排乳方法、取样先后的影响，且其所需样本量小，不影响母乳喂养，更容易被接受。但目前对妊娠期糖尿病产妇母乳钠离子浓度的研究较少，关于母乳钠离子浓度变化与泌乳启动延迟的关系的报道不多，且尚未检索到关于妊娠期糖尿病产妇母乳钠离子浓度变化轨迹的实证研究。因此，本研究通过对妊娠期糖尿病产妇母乳中钠离子浓度进行纵向调查，探究妊娠期糖尿病产妇母乳钠离子变化轨迹及其与泌乳启动延迟的关系，为预测泌乳启动提供客观参考依据。
1　对象与方法
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1.1　调查对象
采用便利抽样法，选取2024年8月—2025年4月广东省2所三级甲等医院的169例妊娠期糖尿病产妇为研究对象。纳入标准：符合妊娠合并糖尿病诊治指南中妊娠期糖尿病诊断标准[9]；产妇年龄≥18岁；自然受孕，孕育健康单胎；乳房、乳头发育正常，愿意母乳喂养；有基本的读写能力，认知正常。排除标准：有母乳喂养禁忌；因各种原因导致母婴分离者；围生期异常，如感染、精神异常等；合并甲状腺功能减退、妊娠期高血压疾病等；分娩异常，如子宫破裂、羊水栓塞、产后休克、产后弥散性血管内凝血等。根据样本量至少是自变量个数的5~10倍原则[10]，本研究自变量共16个，所需样本量为80~160例，再考虑到20%样本失访率，结合医院产妇的实际情况，最终纳入169例产妇。本研究已通过所在医院伦理委员会批准（批件号：伦审临〔2023〕688号），所有调查对象均知情同意，自愿参与本研究。
1.2　研究指标
成立研究小组，系统检索中国知网、万方数据库、维普数据库和中国生物医学文献数据库、PubMed、EMbase、Web of Science、Cochrane Library、CINAHL中的相关文献，形成妊娠期糖尿病产妇泌乳情况一般资料调查表，调查表内容包括产妇年龄、文化程度、职业、孕期泌乳相关培训、母乳喂养经历、新生儿性别、孕前体质指数（BMI）、分娩前BMI、母婴同室、胎龄、产次、分娩方式、泌乳启动前添加配方奶、产妇血清白蛋白值、新生儿低血糖、母乳中钠离子浓度等。母乳钠离子测量采用Horiba 电化学测试笔，为保证测量数据的准确性，每日测定前以及连续使用期间，每次测定前均使用标准液对仪器进行校正，保证测量数据的准确性。采集母乳时，研究人员将右手拇指与食指指腹分别置于乳晕与乳头衔接处，先向胸壁方向轻压，然后两手指向中间挤捏，接着放松手指，挤出母乳。随后打开测试笔传感器护罩，取至少0.1 mL母乳样本滴于洁净的聚乙烯薄膜或测试皿上，使之形成连续液膜，待测试笔的传感器完全浸入液膜中，关闭传感器护罩，系统默认采用自动稳定模式，当测量值稳定后，读数被锁定，屏幕中显示的数值即为测量值。
1.3　资料收集方法
本研究母乳的采集由多中心负责人负责，研究设置分娩后24 h（T1）、48 h（T2）、72 h（T3）进行母乳钠离子浓度检测。研究者在分娩后24 h采用一般资料调查表收集相关资料。采用产妇自感乳胀的方法判断有无泌乳启动延迟，即产妇在产后72 h以后才有明显的乳房胀感或充盈感则定义为泌乳启动延迟。分娩前告知孕妇泌乳启动的表现，并由研究中心负责人产后24 h，每日询问1次产妇首次出现明显乳房胀感或充盈感的时间，如产妇出院时无泌乳启动则通过电话随访直至分娩后72 h。
1.4　统计学方法
采用R 4.4.1对数据进行处理与分析。符合正态分布的定量资料以均数±标准差（x±s）表示，多组间比较采用单因素方差分析，两组间比较采用独立样本t检验；不符合正态分布的定量资料以中位数（四分位数）[M(P25,P75)]表示，组间比较采用秩和检验。定性资料用频数、百分比（%）表示，采用χ2检验或Fisher精确概率法。纵向重复测量资料（不同时间点钠离子浓度）采用R语言geepack包执行广义估计方程分析，并基于边际估计均值和标准误绘制折线图进行可视化。采用R语言lcmm包执行潜在类别轨迹模型识别钠离子浓度随时间变化的轨迹。根据最小贝叶斯信息准则（BIC）估计轨迹的最佳轨迹数，根据轨迹建模的图形模式为轨迹分配标签，并绘制折线图进行可视化。依据3类指标综合判断最佳模型：1）信息准则指标，包括艾凯克信息准则（Akaike information criterion，AIC）、BIC，其值越小，表示拟合越好。2）分类精确度指标，通过熵值（Entropy）评估分类的精确度，其取值为0~1，越接近1表示分类越准确，Entropy≥0.80通常认为分类可靠性较高（对应潜在类别概率>90%）。3）似然比检验，采用Lo-Mendell-Rubin似然比检验（LMRT）和Bootstrap似然比检验（BLRT）比较潜在剖面模型的拟合差异，若检验结果P<0.05，说明k类模型的拟合度显著优于第k-1类模型。以P<0.05为差异有统计学意义。
2　结果
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2.1　妊娠期糖尿病产妇一般资料及母乳钠离子浓度
妊娠期糖尿病产妇年龄（31.33±4.09）岁，孕前BMI（22.75±3.36）kg/m2，分娩前BMI（26.90±3.19）kg/m2。新生儿体重3.11(2.88,3.38)kg；男69例，女100例；新生儿低血糖46例。产妇分娩后24 h、48 h、72 h母乳钠离子浓度分别为（62.92±8.83）mmol/L、（42.58±9.72）mmol/L、（27.17±12.95）mmol/L。其余一般资料见表1。
2.2　妊娠期糖尿病产妇母乳钠离子浓度变化轨迹分析
以妊娠期糖尿病产妇3个时间点的母乳钠离子浓度为观测指标，将169例产妇纳入模型进行分析，从潜变量增长模型中提取1~4个类别。当潜在类别数量从1增至4时，Entropy持续降低，AIC、BIC均先下降后增加，在潜在剖面数量为2时BIC最小，因此最终保留2个类别，见表2。按2个剖面，以母乳钠离子浓度值为纵轴，时间点为横轴绘制轨迹图，见图1。剖面1分娩后24 h母乳钠离子浓度处于较低水平，且在随访全程的平均变化下降趋势较为显著，因此命名为低钠离子浓度-快速下降组，该组共118例（69.8%）产妇。剖面2分娩后24 h母乳钠离子浓度处于较高水平，母乳钠离子浓度出现先快速下降继而缓慢下降，因此命名为高钠离子浓度-缓慢下降组，该组共51例（30.2%）产妇。
2.3　妊娠期糖尿病产妇母乳钠离子浓度变化与泌乳启动延迟的关系
169例产妇中55例发生泌乳启动延迟，发生率为32.5%，其中低钠离子浓度-快速下降组118例中16例发生泌乳启动延迟，泌乳启动延迟的发生率为13.6%；高钠离子浓度-缓慢下降组51例中39例发生泌乳启动延迟，发生率为76.5%。两组泌乳启动延迟发生率比较差异有统计学意义（χ2=39.956，P<0.001）。
2.4　妊娠期糖尿病产妇母乳钠离子浓度变化潜在剖面影响因素的单因素分析（见表3）
2.5　妊娠期糖尿病产妇母乳钠离子浓度变化对泌乳启动延迟的预测效应
以妊娠期糖尿病产妇是否发生泌乳启动延迟（未发生=0，发生=1）作为因变量，将母乳钠离子浓度变化轨迹亚组作为自变量，并基于临床经验和既往研究将可能与结局有关的变量作为混杂因素纳入Logistic回归分析，结果见表4。
3　讨论
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3.1　妊娠期糖尿病产妇母乳钠离子浓度呈下降趋势
本研究结果显示，分娩后24 h、48 h、72 h母乳钠离子浓度分别为（62.92±8.83）mmol/L、（42.58±9.72）mmol/L、（27.17±12.95）mmol/L，妊娠期糖尿病产妇母乳钠离子浓度逐渐下降。Fok等[11]调查发现，分娩后第1天母乳钠离子水平最高，之后呈下降趋势，与本研究结果一致。分娩后随着胎儿胎盘的娩出，触发泌乳细胞间的致密连接形成，细胞旁路（PCP）逐渐关闭，将腺泡内的母乳与细胞间质隔开，腺泡内外物质无法流通，泌乳细胞合成的乳糖保留在腺泡中，渗透压增大，使更多的水分进入腺泡，从而导致泌乳量迅速增加。研究表明，可通过母乳钠离子浓度评估PCP的关闭情况，钠离子浓度迅速降低并维持在正常范围内，说明PCP有效关闭，泌乳启动成功[12]。Tie等[13]研究发现，顺利泌乳启动的产妇产后当天母乳钠离子浓度从60 mmol/L下降至产后第3天的20 mmol/L。本研究分娩后24 h、72 h母乳钠离子浓度高于Tie等[13]研究结果，原因可能是：一方面研究对象存在地域差异；另一方面母乳钠离子浓度是反映泌乳启动的客观指标，钠离子水平越低发生泌乳启动延迟的概率越小[12]。本研究以妊娠期糖尿病产妇为研究对象，而Tie等[13]研究以澳大利亚36名健康产妇为研究对象，妊娠期糖尿病产妇发生泌乳启动延迟的风险高于非妊娠期糖尿病产妇[14-15]，因此，母乳钠离子浓度高于健康产妇研究的结果。
3.2　妊娠期糖尿病产妇母乳钠离子浓度变化轨迹存在群体异质性
本研究基于潜变量增长混合模型，识别妊娠期糖尿病产妇母乳钠离子浓度变化轨迹，分为2个潜在类别，分别为低钠离子浓度-快速下降组（69.8%）和高钠离子浓度-缓慢下降组（30.2%），证实了从胎儿娩出到分娩后72 h母乳钠离子浓度水平呈下降趋势，也说明妊娠期糖尿病产妇母乳钠离子浓度变化轨迹存在群体异质性。究其原因，一方面，产后早期母乳是由少量到大量分泌逐渐达到泌乳启动的过程，在这过程中随着PCP关闭，母乳分泌越来越多，母乳中钠离子浓度越来越低，母乳中的钠离子呈下降趋势，本研究两组妊娠期糖尿病产妇母乳钠离子浓度均下降。另一方面，妊娠期糖尿病产妇母乳中钠离子浓度相对较高，钠离子浓度下降趋势缓慢。胰岛素代谢是母乳分泌的重要调节因子，在乳腺从增殖到分化的转变中起着重要作用。研究表明，胰岛素抵抗是妊娠期糖尿病和泌乳启动延迟的潜在机制[16]。妊娠期糖尿病可能影响机体胰岛素，导致胰岛素分泌不足或生物作用受损，使胰岛素葡萄糖比降低，影响乳腺腺泡对胰岛素的利用效率，合成乳糖也减少，导致泌乳启动延迟[17]。
3.3　妊娠期糖尿病产妇母乳钠离子浓度变化可以预测泌乳启动延迟
本研究结果显示，妊娠期糖尿病产妇泌乳启动延迟的发生率为32.5%，钠离子浓度变化轨迹分为2个亚组，其中低钠离子浓度-快速下降组泌乳启动延迟的发生率为13.6%，高钠离子浓度-缓慢下降组泌乳启动延迟的发生率为76.5%，两组泌乳启动延迟发生率比较差异有统计学意义（P<0.001）；与低钠离子浓度-快速下降组相比，高钠离子浓度-缓慢下降组对泌乳启动延迟的发生具有正向预测效应，与张彬彬[18]研究结果一致。本研究中母乳钠离子浓度轨迹水平越高，对泌乳启动延迟的影响越大，这与Hoban等[19]研究结果相似。泌乳启动时至少有4种母乳成分产生变化，包括柠檬酸盐、蛋白质、钠离子和乳糖，其中钠离子和乳糖在母乳中的浓度变化最早，这些变化优于乳量增加表现出来，至少提前36 h，可预示乳量的大量增加。因此，钠离子对早期成功泌乳具有高度的预测性，相较于临床常用的泌乳启动方法，钠离子的预测功能可提供更早、更客观的依据。
因此，提示临床工作者应动态监测母乳钠离子浓度，特别针对有泌乳启动延迟风险的妊娠合并症的产妇，结合钠离子变化轨迹预测泌乳启动延迟的发生概率，评估早期泌乳延迟风险，在泌乳启动的窗口期提供相应临床手段，为产妇提供前瞻性、个性化、有效的泌乳支持手段。
4　小结
收起
母乳喂养困难在妊娠期糖尿病产妇中很常见，出院时以母乳喂养率较低[20]、母乳喂养持续时间较短[21]为主要表现。早期客观精准地预测妊娠期糖尿病产妇的泌乳启动延迟风险，对于后续采取相应的措施尤为重要。本研究结果显示，妊娠期糖尿病产妇产后早期母乳钠离子浓度总体呈下降趋势，且存在群体异质性发展轨迹，具有2种轨迹类型，分别为低钠离子浓度-快速下降组和高钠离子浓度-缓慢下降组，高钠离子浓度-缓慢下降组泌乳启动延迟的发生率高于低钠离子浓度-快速下降组。轨迹组别可预测泌乳启动延迟的发生，可为今后预测妊娠期糖尿病产妇泌乳启动延迟的发生提供参考依据。值得注意的是，高钠离子浓度-缓慢下降组泌乳启动延迟的风险高于低钠离子浓度-快速下降组[OR值为22.733(9.357,61.554)]，该OR值的95%CI范围较宽，较宽的置信区间可能反映了本研究样本量相对有限，导致统计效能略有降低。本研究也存在一定的局限性，研究仅随访至产后72 h，未探讨变化轨迹亚组对长期母乳喂养的影响，今后研究应延长随访时间，对母乳钠离子浓度及后续母乳喂养情况进一步追踪。

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doi: 10.12102/j.issn.1009-6493.2026.16.019
  • 接收时间：2025-09-24
  • 首发时间：2026-10-30
  • 出版时间：2026-08-25
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  • 收稿日期：2025-09-24
  • 修回日期：2026-08-03
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    1中山大学附属第一医院，广东 510080

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XU Min， E-mail：
徐敏，副主任护师，硕士研究生，E-mail：
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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