孕前肥胖和妊娠期糖尿病风险的临床研究

Prepregnancy obesity and the risk of gestational diabetes mellitus

目的：探讨孕前肥胖是否增加妊娠期糖尿病风险及先兆子痫、巨大儿、妊娠期高血压的发病率.方法：观察240例孕妇,120例为肥胖组（BMI≥28 kg/m2）,120例为正常组（BMI为18.5 ～23.9 kg/m2）.比较两组孕妇的临床特点、产科和新生儿结局,统计分析相对风险和95％可信区间（CI）.结果：与正常组孕妇比较,肥胖组孕妇妊娠期糖尿病风险不增加,RR =0.9[95％CI0.6～ 1.4];先兆子痫、巨大儿及妊娠期高血压相对风险分别为RR =0.7[95％CI0.2 ～3.3],RR =1.4[95％ CI 0.5 ～4.3]及RR=12[95％ CI 1.6～90.8].结论：无代谢异常的孕前肥胖并不增加妊娠期糖尿病、先兆子痫及巨大儿风险,但是增加妊娠期高血压的风险.

Objective：To assessed whether prepregnancy obese women were at risk for developing gestational diabetes mellitus and other complications such as preeclampsia, gestational hypertension and fetal macrosomia. Methods：Two hundred and forty women participated in this study and followed prospectively until delivery. Half of the women were obese [ body mass index （ BMI ） t〉 27.65 kg/m2 ] and the other half had normal weight （ 18.5 - 23 kg/m2 ）. Maternal demographic data, obstetric and neonatal outcomes from both groups were compared to each other. Relative risk and 95% confidence interval （CI） were calculated. Results ： Compared to normal weight women, obese women were not at increased risk for gestational diabetes mellitus （RR = 0.9 [ 95% CI 0.6 - 1.4 ] ）. Relative risk of preeelampsia, fetal macrosomia and gestational hypertension in obese women were 0.7 [ 95% CI 0.2 - 3.3 ] , 1.4 [ 95% CI 0.5 - 4.3 ] and 12 [ 95% CI 1.6 - 90.8 ] , respectively. Conclusion ： Prepregnancy obesity without metabolic problems did not increase the risk for gestational diabetes mellitus, preeelampsia and fetal maerosomia. But prepregnaney obesity continued to increase the risk for developing gestational hypertension.