围产结局与妊娠期糖尿病孕妇体质量指数变化的关系

Relationship between body mass index and perinatai outcomes of pregnant women with gestational diabetes mellitns （GDM）

目的探讨围产结局与妊娠期糖尿病（GDM）孕妇姆娠前后体质量指数（BMI）增幅的关系。方法选择2006年1月至2012年1月闻在濮阳市妇幼保健院产科门诊行常规检查并确诊为CDM的238例患者，按妊娠前BMl分为正常组（18．5～23．0kg／m^2）、超重组（23．O～25．0kg／m^2）、肥胖组（≥25kg／m^2），按早孕至终止妊娠前BMI的总增幅分为A组（〈4kg／m^2），B组（4～6kg／m^2），C组（〉6kg／m^2），比较分析各组间围产结局的差异。结果肥胖组子痫前期（26．0％）、早产发生率（32．7％）均显著高于正常组（11．9％、8．3％）及超重组（10．8％、13．7％），差异均有统计学意义（P〈0．05）。正常组孕妇胎儿窘迫发生率（8．3％）显著低于超重组（23．5％）和肥胖组（23．1％），差异有统计学意义（P〈0．05）。B组子痫前期（10．4％）、羊水过多（10．4％）、胎膜早破（10．4％）、胎儿窘迫（11．3％）和早产（8．O％）的发生率均明显低于C组（22．2％、23．8％、25．3％、30．2％、30．2％），差异均有统计学意义（P均〈0．05）。C组胎膜早破发生率明显高于A组，C组巨大几发生率（25．4％）明显高于A组（6．0％）和B组（12．0％），C组新生儿低血糖发生率（28．6％）明显高于B组（16．0％），差异均有统计学意义（P均〈0．05）。结论妊娠前肥胖及妊娠期体质量增加过多可增加GDM孕妇发生不良妊娠结局的危险性，GDM孕妇妊娠期体质量指数总增幅应控制在合适范围内．以减少不良妊娠结局的发生。

Objective To investigate the relationship between body mass index and perinatal outcomes in pregnant women with gestational diabetes mellitus （GDM）. Methods Two hundred and thirty-eight cases of GDM in our institution between January 2006 and January 2007 were chosed, and they were divided into three groups by BMI, including normal weight group（ 18.5 -23.0 kg/m^2）, overweight group（23.0 -25.0 kg/m^2） and obese group（ ≥25.0 kg/m^2） , divided into three groups by BMI increasing, including group A （ 〈 4 kg/m^2 ） , group B （4 - 6 kg/m^2 ） and group C （ 〉 6 kg/m^2 ）. Results The rate of preeclampsia（26. 0% ） and preterm delivery（32. 7% ） in obese group were significantly higher than those in normal weight group（ 11.9% , 8.3% ） and obese group（ 10.8% , 3.7% ） , the differences were statistically significant （ P 〈 0. 05）. The normal weight group had less fetus distress （8.3%） than overweight group（23.5% ）and obese group（23.1% ）, the differences were statistically significant （P 〈 O. 05）. In group B, the rates of preeclampsia（ 10. 4% ）, polyhydramnios（ 10. 4% ）, premature rupture of membrane（ 10. 4% ）, fetus distress（ 11.3% ）, preterm delivery（8.0% ） were more lower than those in group C（22. 2% ,23.8% ,25.3% ,30. 2% ,30.2% ）. The rate of fetal macrosomia in group C（25.4% ） was higher than that in group A（6. 0% ） and group B（ 12.0% ）, the difference was statistically significant （P 〈 0. 05 ）. The incidence of neonatal hypoglycemia of group C （28.6%） was higher than that of group B（ 16. 0% ）, the difference was statistically significant （P 〈 O. 05 ）. Conclusions The obese GDM women with BMI ≥ 25 kg/m^2 and BMI increase 〉 6 kg/m^2 during pregnancy would have higher risk of adverse prenatal outcome such as preterm delivery, preeclampsia and fetus distress. The BMI gain during pregnancy of GDM women should be suitably controlled, and then the prenatal outcome would be enhanced.