妊娠期糖尿病孕前体质指数对围产期母婴结局的影响

Effects of pre-pregnancy body mass index of gestational diabetes mellitus on perinatal outcomes

目的探讨妊娠期糖尿病孕前体质指数（bodymassindes,BMI）对围产期母婴结局的影响.方法选取2012年4月-2013年3月在海军总医院正规产检、分娩的238例妊娠期糖尿病孕妇,按照孕前BMI分组,BMI〈18.5kg/m^2为低体质量组、18.5kg/m^2≤BMI〈25.0kg/m^2为正常组、25.0kg/m^2≤BMI〈28.0kg/m^2为超重组、BMI≥28.0kg/m^2为肥胖组,分析各组间早产率、巨大儿发生率、剖宫产率、新生儿出生体质量、新生儿血糖水平等围产结局,分析各组间未接受正规治疗的比例.结果各组间巨大儿发生率、剖宫产率以及未接受正规治疗的比例差异有统计学意义,其中超重组和肥胖组巨大儿发生率与正常组比较明显升高（P〈0.05）,但与低体质量组比较差异无统计学意义（P〉0.05）.超重组剖宫产比例以及未接受正规治疗的比例与低体质量和正常组比较明显升高（P〈0.05）,但与肥胖组比较差异无统计学意义（P〉0.05）.肥胖组孕期体质量增加以及BMI增加与其余3组分别比较均明显减少（P〈0.05）.超重组新生儿血糖水平与低体质量组比较明显降低（P〈0.01）.4组之间早产率、新生儿体质量差异无统计学意义（P〉0.05）.结论妊娠期糖尿病孕前BMI与围产期母婴结局有明显相关性,孕前将BMI控制在18.5～25.0kg/m^2为宜.孕期应重点加强对孕前超重组和肥胖组的管理,控制孕期体质量增加,减少不良妊娠结局发生.

Objective To discuss the effects of pre-pregnancy body mass index (BMI) of gestational diabetes mellitus on perinatal outcomes.Methods Two hundred and thirty-eight cases of pregnant women with gestational diabetes mellitus, regularly checked-up and delivery in Navy Gene-ral Hospital during April 2012 to March 2013, were divided into four groups based on the pre-preg-nancy BMI.BMI<18.5 kg/m 2 for low body weight group, 18.5 kg/m 2≤BMI<25.0 kg/m 2 for nor-mal group, 25.0 kg/m 2≤BM<28.0 kg/m 2 for overweight group, and BMI≥28.0 kg/m 2 for obesity group, the perinatal outcomes including the preterm delivery rates, incidence of macrosomia, cesa-rean section rates, neonatal birth weight, neonatal blood glucose levels were compared between groups.The difference of accepting regular treatment rate was analyzed.Results Macrosomia rate, cesarean section and ratio to receive formal treatment were significantly different among each group. The incidence of macrosomia in the overweight group and obesity group was obviously higher than that in the normal group (P<0.05), but was almost the same with that in the low body weight group (P>0.05).The incidence of cesarean section and the ratio without formal treatment increased sig-nificantly in the overweight group than those in the low body weight and normal group (P<0.05), but was almost the same with that in the obese group(P>0.05).The weight gain and the BMI growth during the period of gestation decreased significantly in the obesity group than those in the other three groups (P<0.05).The neonatal blood glucose level was lower in the overweight group than that in the low body weight group (P<0.01).There were no significant differences between the four groups on the premature delivery rate and neonatal weight ratio(P>0.05).Conclusion The pre-pregnancy body mass index of gestational diabetes mellitus has significant correlation with the perinatal outcomes.The BMI should be controlled between 18.5- 25.0 kg/m 2 before pregnancy.We should strengthen the management on the pre-pregnancy overweight and obese groups, control the weight gain during pregnancy to reduce the adverse pregnancy outcomes.