超重和肥胖对妊娠期糖尿病围产结局的影响

PREGNANCY OUTCOME OF OVERWEIGHT AND OBESE IN GESTATIONAL DIABETES

目的探讨超重和肥胖与妊娠期糖尿病患者妊娠结局的关系。方法 2010年1月～2011年12月在我院门诊产检确诊为妊娠期糖尿病患者,根据孕前体重指数(Body Mass Index BMI,kg/m2)分为:正常体重组(BMI 18.5～24.9)、超重组(BMI 25.0～29.9)、肥胖组(BMI≥30)。使用饮食控制或胰岛素治疗控制血糖水平。观察其妊娠并发症及妊娠结局。结果 604例妊娠期糖尿病孕妇中BMI正常体重241例(占39.90%),超重211例(占34.93%),肥胖152例(占25.17%)。超重与肥胖妊娠期糖尿病孕妇经辅助生育技术后妊娠,高龄产妇,巨大儿与急诊剖宫产的发生率显著高于正常组;肥胖组胎膜早破与子痫前期发生率,剖宫产率显著高于超重组及正常组;肥胖组顺产率显著低于正常组,肥胖组早产胎膜早破率显著高于正常组。结论妊娠前肥胖和超重可增加妊娠期糖尿病孕妇不良妊娠结局的风险。加强健康教育,适度控制孕前体重,可预防妊娠期糖尿病并发症,改善妊娠结局。

Objective To investigate the pregnancy outcome of overweight and obese in gestational diabetes. Methods Cases diagnosed as gestational diabetes mellitus from Jan ,2010 to Dec 2011 in our clinic were included. Outcomes were analyzed according to maternal prepregnancy body mass index （BMI, kg/m2） categories： normal weight （ BMI 18.5 ± 24.9 ）, overweight （ BMI 25 ± 29.9 ）, and obese （ BMI≥ 30）, and by diet or insulin therapy and glyeemie control. Obstetric and perinatal outcomes were compared by univariate and multivariate analyses. Re- sults Of the 604 cases with gestational diabetes mellitus included, 39.9% were normal weight, 34.93% were over- weight and 25.17% were obese. The incidence of ART pregnancy, advanced maternity age, fetal macrosomia and emergency cesarean section were higher significantly in overweight group and obese group than that in normal group. Obese women were at increased risk of premature rupture of membranes, pre - eclampsia and cesarean section compared with the other two groups. Obese group were more likely to be preterm premature rupture of membranes compared with normal weight group. Conclusion Overweight and obese gestational diabetes mellitus women have an increased risk of adverse pregnancy outcomes. Effective preventative strategies are urgently needed.