人工助孕对孕期体质量增长及糖代谢的影响

Effects of assisted reproduction technology on gestational weight gain and glucose metabolism

目的：探讨人工助孕对孕期体质量增长及糖代谢的影响。方法以采用人工助孕技术受孕、单胎、足月分娩妇女为研究对象，根据年龄和孕前体质量指数匹配同期健康自然妊娠、单胎、足月分娩妇女。采集各临床及实验室指标（身高、年龄、文化程度、孕前体质量、分娩前体质量，既往疾病史、流产史、建卡时空腹血糖、三酰甘油、总胆固醇以及糖耐量试验）和胎儿指标（分娩方式、胎儿性别、出生体质量、出生身长）。结果共有53名人工助孕和147名自然受孕妇女纳入本研究。两组妇女流产次数差异无统计学意义（人工助孕妇女≥3次与＜3次流产史之比为6／47，自然受孕组为10／137，χ2＝1.080， P＝0.299），但人工助孕受孕妇女学历更高（本科及以上学历人工助孕组为33人，自然受孕组为85人，大专及以下学历人工助孕组为20人，自然受孕组为62人，χ2＝6.303， P＝0.012）。两组孕前体质量指数[人工助孕组（22.00±3.05） kg／m2比自然受孕组（21.81±2.62） kg／m2， P＝0.661]和孕期平均增重[人工助孕组（13.89±5.33） kg比自然受孕组（14.78±4.60） kg， P＝0.247]差异无统计学意义。53例人工助孕妇女整个孕期体质量增长正常22例、增长过多18例、增长过少13例，147例自然受孕妇女整个孕期体质量增长正常66例、增长过多54例、增长过少27例，两组妇女孕期总体体质量增长分布情况差异无统计学意义（χ2＝1.162， P＝0.247）。孕24～28周糖耐量试验空腹血糖差异无统计学意义[人工助孕组（4.66±0.39） mmol／L比自然受孕组（4.66±0.52） mmol／L， P＝0.996]，而人工助孕妇女口服葡萄糖后1及2 h血糖显著升高[（7.87±1.83） mmol／L比（7.31±1.51） mmol／L， P＝0.034；（7.49±1.29） mmol／L比（6.69±1.30） mmol／L， P＝0.029]。妊娠期糖尿病总体发病率为13.5％（27／200），人工助孕与自然受孕妇女妊娠期糖尿病发病率差异无统计学意义（18.9％比11.6％， P＝0.182）。结论人工助孕技术对孕期体质量增长无影响，但可能引起妊娠期糖代谢改变。

Objective To evaluate the effects of assisted reproduction technology （ ART） on gestational weight gain （ GWG） and glucose metabolism .Methods The study was performed in ART women with single-ton and full-term delivery .Age-and pre-pregnancy body mass index matched healthy women with spontaneous pregnancy, singleton, and full-term delivery were recruited as controls .Maternal characteristics （height, age, education level , pre-pregnancy body mass , pre-delivery body mass , medical history , history of abortion , fasting plasma glucose , triglyceride , total cholesterol , and glucose tolerance ） and fetal data （ delivery mode , gender , birth body mass , birth body length ） were collected by a trained nutritionist .Results A total of 200 women were recruited into this study （53 ART women and 147 controls）.There was no significant difference in number of previous abortion （ the ratio between the women who had ≥3 abortions to those who had 〈3 abortions was 6∶47 in the ART group , and 10∶137 in the control group , χ2 =1.080 , P=0.299 ） .Compared with the control group, the ART group had higher education level （33 in the ART and 85 in the control group with un-dergraduate or higher education , 20 in the ART group and 62 in the control group with a college degree or lower education ,χ2 =6.303 , P=0.012 ） .There were no statistically significantly differences between the ART and the control groups in pre-pregnancy body mass index [ （22.00 ±3.05 ） kg/m2 vs.（21.81 ±2.62 ） kg/m2 , P=0.661] and average GWG [ （13.89 ±5.33） kg vs.（14.78 ±4.60） kg, P=0.247].GWG was appro-priate in 22 ART women, excess in 18, and inadequate in 13;in the control group, GWG was appropriate in 66 women, excess in 54, and inadequate in 27.The distribution of GWG showed no significant difference be-tween the two groups （χ2 =1.162 , P=0.247 ） .Oral glucose tolerance test in 24-28 gestational weeks showed no significant difference in fasting blood glucose between the ART and the control groups [ （4.66 ±0.39） mmol/L vs.（4.66 ±0.52） mmol/L, P=0.996], but 1-hour and 2-hour blood glucose levels were significantly in-creased in the ART women [ （ 7.87 ±1.83 ） mmol/L vs.（ 7.31 ±1.51 ） mmol/L, P=0.034; （ 7.49 ± 1.29） mmol/L vs.（6.69 ±1.30） mmol/L, P=0.029].The overall prevalence of gestational diabetes melli-tus was 13.5%（27/200）, with no significant difference between the ART and the control groups （18.9%vs. 11.6%, P=0.182 ） .Conclusion ART may not affect GWG , but it may cause changes of glucose metabo-lism during pregnancy .