GDM孕妇孕前体质量指数及孕期体质量指数增加对分娩方式和母婴结局的影响

Influence of pre-pregnant and pregnant body mass index of women with gestational diabetes mellitus on delivery methods and maternal and neonatal outcomes

目的 探讨GDM孕妇孕前体质量指数及孕期体质量指数增加对分娩方式和母婴结局的影响.方法 选择264例GDM孕产妇,根据孕前BMI水平将264例孕产妇分为低BMI组（BMI＜18.5 kg/m2）、正常BMI组（18.5 kg/m2≤BMI＜25 kg/m2）、肥胖组（BMI≥25 kg/m2）.参照IOM推荐的孕期增重标准,将264例孕产妇分为增重不足组、增重正常组、增重过多组.比较低BMI组、正常BMI组、肥胖组剖宫产率、胎儿窘迫、新生儿窒息、产褥感染、巨大儿的发生情况.比较增重不足组、增重正常组、增重过多组剖宫产率、低体重儿的发生情况.结果 低BMI组剖宫产率明显高于正常BMI组,但低于肥胖组,胎儿窘迫、新生儿窒息、产褥感染发生率明显低于肥胖组（P＜0.05）;正常BMI组剖宫产率、胎儿窘迫、巨大儿、新生儿窒息发生率明显低于肥胖组（P＜0.05）增重不足组的剖宫产率、低体重儿发生率明显高于增重正常组和增重过多组（P＜0.05）.结论 对围生期保健,测量孕产妇孕前身高、体重并计算其BMI,筛查出孕前肥胖者,纳入GDM高危妊娠管理,采取干预措施使其孕前BMI低于25 kg/m2,妊娠期合理控制体质量增长,以利于降低剖宫产率、巨大儿、胎儿窒息、新生儿窒息的发生风险,确保母儿的健康.

Objective To investigate Influence of pre-pregnant and pregnant body mass index （BMI） of women with gestational diabetes mellitus （GDM） on delivery methods and maternal and neonatal outcomes.Methods 264 women with GDM were selected and were divided into a low BMI group （BMI〈18.5 kg/m2）, a normal BMI group （18.5 kg/m2 ≤ BMI〈 25 kg/m2）, and an obesity group （BMI ≥ 25 kg/m2） according to the BMI before pregnancy and into an insufficient weight gain group, a normal weight gain group, and an excessive weight gain group according to pregnancy weight gain standard of IOM.The incidences of cesarean section, fetal distress, neonatal asphyxia, postpartum infection, and fetal macrosomia were compared between each two group.Results The cesarean section rate of the low BMI group were significantly higher than that of the normal BMI group but lower than that of the obesity group and the incidences of fetal distress, neonatal asphyxia, and puerperal infection of the low BMI group were significantly lower than those of the obesity group （P 〈 0.05）.The incidences of cesarean section, fetal distress, fetal macrosomia, and neonatal asphyxia were significantly lower in the normal BMI group than in the obesity group （P 〈 0.05） and were significantly higher in the insufficient weight gain group than in the normal weight gain group and the excessive weight gain group （P 〈 0.05）.Conclusions Perinatal health care, measuring Pre-pregnant height and weight and calculating BMI, screening obesity women before pregnancy, managing women with GDM as high risk pregnancy, taking intervention measures to control BMI less than 25 kg/m2 before pregnancy, reasonably controlling weight gain during pregnancy are helpful for lowering cesarean section rate and the incidences of fetal macrosomia, fetal distress, and neonatal asphyxia and ensuring the health of mothers and infants.