影响血糖控制良好的糖代谢异常孕妇新生儿出生体重的相关因素

Related influencing factors of neonatal birth weight in abnormal glucose metabolism pregnant women with well-controlled blood glucose

目的：研究妊娠合并糖代谢异常孕妇新生儿出生体质量的影响因素。方法：选取妊娠合并糖代谢异常孕妇900例，根据孕前身体质量指数（BMI）分为4组。A组41例为低体重组（BMI〈18．5ks／m。）；B组503例为正常体重组（18．5ks／m2≤BMI≤23．9kg／m2）；C组251例为体重偏高组（24．0ks／m2≤BMI≤27．9kg／m2）；D组105例为肥胖组（BMI≥ks／m2）。900例新生儿按出生体重分为：正常体重新生儿（体重2．5—4．0kg），适宜体重新生儿（体重3．0—3．5kg），巨大儿（体重≥4．0kg）和低体重新生儿（体重≤2．5kg）。记录孕妇孕前BMI，糖代谢异常诊断时间，血脂水平，新生儿体重等相关指标，计算孕前不同BMI孕妇分娩正常体重新生儿和巨大儿的孕期体重增长，分析影响新生儿出生体重的因素。结果：新生儿平均出生体重：新生儿出生体重随孕前BMI增加而增加，A组新生儿平均出生体重低于其他3组，分别比较，差异均有统计学意义（P均〈0．05）；但B组、c组、D组间分别比较，差异均无统计学意义（P均〉0．05）。在孕妇孕期体重增长的比较中，B、C、D组分娩正常体重儿的孕妇明显低于同组分娩巨大儿的孕妇（P均〈0．05）。在孕妇诊断出糖代谢异常孕周的比较中，B、c、组分娩正常体重儿的孕妇明显早于同组分娩巨大儿的孕妇（P均〈0．05），D组无统计学差异（P〉0．05）。血脂水平的比较中，分娩巨大儿孕妇TG水平高于分娩正常体重儿孕妇（P〈0．05）；分娩巨大儿孕妇HDL—C水平低于分娩正常体重儿孕妇（P〈0．05）。分娩正常体重儿和分娩巨大儿的孕妇相比，有不良产史和糖尿病家族史的例数比较均无统计学差异（P均〉0．05）。对多因素进行Logistic回归分析发现，孕前BMI（偏回归系数：0．571、P=0．000、OR：1．772）、孕期体重增长（偏回归系数=0．115、P=0．000、OR=1．124）及HDL—C水平（偏回归系数=-1．758、P=0．000、OR=0．176）为影响新生儿出生体重的危险因素。结论：妊娠合并糖代谢异常孕妇新生儿出生体重与孕前BMI、孕期体质量增长、孕期血浆高密度脂蛋白胆固醇水平相关。

Objective： To research the related influencing factors of neonatal birth weight in abnormal glucose metabolism pregnant women with well - controlled blood glucose. Methods： Nine hundred pregnant women with abnormal glucose metabolism were selected and divided into four groups according to progestational body mass index （BMI） ： group A （low weight group, 41 women, BMI 〈 18. 5 kg/m2）, group B （ normal weight group, 503 women, 18.5 kg/m2 BMI ≤23.9 kg/m2 ）, group C （ high weight group, 251 women, 24. 0 kg/m2 ≤ BMI≤27.9 kg/m2）, group D （obesity group, 105 women, BMI≥2 kg/m2） ; 900 neonates were divided into four groups according to birth weight： normal weight group （2. 5 -4. 0 kg）, appropriate weight group （3.0 -3.5 kg）, macrosomia group （≥4.0 kg）, and low weight group （ ≤2. 5 kg） ; progestational BMI, diagnostic time of abnormal glucose metabolism, blood lipid levels, neonatal weight were recorded; body weight gains during pregnancy of pregnant women with different progestational BMI when giving birth to normal weight neonates and maerosomia were calculated, the influencing factors of neonatal birth weight were analyzed. Results： Average neonatal birth weight： neo- natal birth weight increased with progestational BMI, the average neonatal birth weight in group A was statistically significantly lower than those in the other three groups （ P 〈 0. 05 ）, but there was no statistically significant difference among group B, group C, and group D （ P 〉 0. 05 ） ; in group B, group C, and group D, body weight gain during pregnancy of pregnant women giving normal weight infants were statistically significantly lower than those of pregnant women giving macrosomia （ P 〈 0.05 ） ; in group B and group C, the gestational week when di- agnosing GDM among pregnant women giving normal weight infants were statistically significantly earlier than those among pregnant women giving macrosomia （ P 〈 0. 05 ） ; but there was no statistically significant difference in group D （ P 〉 0.05 ） ; TG level in pregnant women giving macrosomia was statistically significantly higher than that in pregnant women giving normal weight infants （ P 〈0. 05 ） ; HDL - C level in pregnant women giving macrosomia was statistically significantly lower than that in pregnant women giving normal weight infants （ P 〈 O. 05 ） ; there was no statistically significant difference in the numbers of pregnant women with adverse pregnant history and family history of diabetes between pregnant women giving normal weight infants and pregnant women giving macrosomia （ P 〉 0. 05 ） ; the results of multivariate logistic regression analysis showed that progestational BMI （partial regression coefficient = 0. 571, P = 0. 000, OR = 1. 772 ）, body weight gain during pregnancy （ partial regression coefficient = 0. 115, P = 0. 000, OR = 1. 124 ）, and HDL - C level （ partial regression coefficient = - 1. 758, P =0. 000, OR =0. 176） were risk factors of neonatal birth weight. Conclusion： Birth weight of neonates born by pregnant women with abnormal glucose metabolism is correlated with progestational BMI, body weight gain during pregnancy, and plasma HDL - C level during pregnancy