体重指数与妊娠并发症和妊娠结局的关系

Relevance of body mass index with complication and outcome of pregnancy

目的 探讨孕妇孕前体重指数 (BMI)、孕期BMI增加值 (ΔBMI =分娩期BMI -孕前BMI)与妊娠期糖尿病 (GDM )、糖耐量异常 (GIGT)、妊娠高血压综合征 (PIH)及妊娠结局的关系。方法 将 333例单胎孕妇按孕前BMI随机分为消瘦组 (15 8例 )、正常组 (15 2例 )及肥胖组 (2 3例 ) ,对GDM、GIGT、PIH的发生率及妊娠结局作前瞻性分析。结果 肥胖组妊娠期GDM +GIGT及PIH发生率较正常组及消瘦组明显升高 (P值均<0 .0 1) ,肥胖组及消瘦组的GDM发生率较正常组明显升高 (P <0 .0 5 ) ,阴道自然分娩率与剖宫产率的差异无显著性 (P >0 .0 5 ) ,肥胖组巨大儿发生率明显升高 (P <0 .0 5 )。发生GDM、GIGT及PIH孕妇的孕期ΔBMI与无并发症者的差异无显著性 (P >0 .0 5 ) ,阴道分娩与剖宫产终止妊娠者孕期ΔBMI的差异亦无显著性 (P >0 .0 5 ) ,发生巨大儿与未发生巨大儿者孕期ΔBMI的差异有显著性 (P <0 .0 5 )。产后出血的发生与孕前BMI及孕期BMI增加值均无明显关系。结论 孕前BMI与妊娠期GIGT、PIH发生率、巨大儿发生率之间有密切关系 ,孕前控制体重可减少PIH、GDM和巨大儿的发生 。

Objective To appraise the relevance of body mass index (BMI), changes of BMI during pregnancy, gestational diabetes mellitus (GDM), gestational impaired glucose tolerance (GIGT), pregnancy induced hypertension (PIH), with pregnancy outcome. Methods 333 pregnant women with single fetus were randomly chosen and divided into lean group, normal group and obesity group according to BMI before onset of pregnancy. Oral glucose tolerance test (OGTT) was performed after 24 gestational weeks. According to the changes of BMI before and during pregnancy, the relevance of BMI before pregnancy and the incidences of PIH, GDM, GIGT and delivery pattern, postpartum hemorrhage, macrosomia were studied. The increase of BMI was compared between women with and without complications , and women with different outcomes. Results In women with high BMI before pregnancy, the incidences of PIH, GDM and cesarean section increased. The incidence of PIH and GDM were significantly higher in the obesity group than those in the normal group. The incidence of macrosomia was also significantly higher in the obesity group . The incidences of vaginal delivery and cesarean section were not significantly different in both groups. The increase of BMI during pregnancy was significantly different in women with or without macrosomia. There was no relationship between postpartum hemorrhage and BMI before or during the pregnancy. Conclusion There are clinical relevances of BMI before pregnancy and the incidences of PIH 、GDM and macrosomia. Controlling the body weight before pregnancy can reduce the incidences of PIH、GDM and macrosomia, and controlling the weight during pregnancy can also reduce the incidence of macrosomia. (Shanghai Med J, 2004,27∶840-842)