孕前体质量指数及孕期体质量增加与新生儿脐血C肽相关性分析

Correlation analysis of the pre-pregnant body mass index, the gestationai weight gain and umbilical cord blood C peptide

目的研究孕前体质量指数（BMI）及孕期体质量增加与新生儿脐血C肽间的相关性，以及通过孕妇体质量管理减少婴儿远期代谢综合征发生率。方法随机选取2015年5至8月间在浙江省台州市第一人民医院及台州市黄岩区妇保院初诊确定妊娠的孕妇，共485例。根据孕前BMI分成低体质量组、正常体质量组、超体质量组及肥胖组，根据孕期有无发生妊娠期糖尿病分成非糖尿病组和糖尿病组，根据孕期体质量增加是否超过美国医师协会2009年（IOM2009）相应BMI推荐范围分成孕期超重组和孕期未超重组，再根据孕期对糖尿病孕妇进行饮食和药物干预，是否干预成功分成干预成功组和未干预成功组，最后测定每个孕妇分娩新生儿脐血C肽值以及新生儿体质量，比较各组别脐血C肽值及新生儿体质量的差异以及分析C肽与新生儿出生体质量的相关性。结果（1）孕前不同BMI组，妊娠期糖尿病的发病率差异有统计学意义（P〈0．05），但孕期超重的发生率差异无统计学意义（P〉0．05）。（2）新生儿出生体质量与脐血C肽呈中度正相关（r=0．673，P〈0．05）。（3）孕前不同BMI组、是否妊娠期糖尿病组及孕期是否超重组与新生儿脐血C肽值均各自独立存在相关性（均P〈0．05）；而只有是否妊娠期糖尿病组与新生儿体质量存在独立相关性（P〈0．05）。（4）对C肽影响大小依次为：糖尿病组（回归系数：0．58），孕前不同BMI组（回归系数：0．36，0．38），孕期是否超重组（回归系数：0．17）。（5）在糖尿病组中，低体质量组与新生儿脐血C肽值存在负相关（P〈0．05，回归系数=-1．41）；在非糖尿病组中，超体质量组及肥胖组与新生儿脐血C肽值存在正相关（P〈0．05，回归系数=0．37，0．46）。结论孕前BMI、孕期体质量增加与新生儿脐血c肽存在直接相关性，提示可以通过控制孕前BMI及孕期体质量增加减少婴儿远期代谢综合征发生率，但重点应放在孕前BMI控制上。

Objective To explore the correlation among the pre-pregnant body mass index （BMI）, gestational weight gain （GWG） and umbilical cord blood C peptide, and to investigate the influence of maternal weight management on the incidence of baby long-term metabolic syndrome. Methods During May to Aug. 2015, 485 pregnant women in Zhejiang Taizhou first people＇s hospital and Taizhou Huangyan maternal ＆child care service centre were selected in random and divided into four groups according to pre-pregnant BMI： low body mass, normal body mass, over body mass and obese group, and also divided into two groups for getting gestational diabetes mellitus （GDM） or not. According to the gestational weight gain （GWG）, all the cases were divided into two groups： above the Institute Of Medicine （IMO） 2009 recommendations or not. According to the outcome, the GDM group which had received weight control treatment, was divided into successful treat group or not. At last, we tested the umbilical cord blood C peptide and birth weight of each newborn and compared the difference in all subgroups. The correlation between the umbilical cord blood C peptide and birth weight were analysed. Results （ 1 ） In the pre-pregnant BMI groups, there were significant differences of incidence of GDM （P 〈 0. 05）. But, there were no significant differences of incidence of GWG in four groups （ P 〉 0.05 ）. （ 2 ） Newborn birth weight and the umbilical cord blood C peptide were positively correlated （ r = 0. 673, P 〈 0. 05 ）. （ 3 ） Umbilical cord blood C peptide showed the correlation in all subgroups for different pre-pregnant BMI, GDM or not, overweight or not （ P 〈 0. 05）, but only the GDM or not group had relation to newborn birth weight in all subgroups. （4） All groups showed correlations with neonatal umbilical cord blood C peptide, the GDM mostly （ β = 0. 58 ）, pre-pregnant BMI secondly （β=0. 36,0. 38 ） , and GWG weakly （β= 0. 17 ）. （ 5 ） By stratification analysis, in GDM group, low body mass was negatively correlated with umbilical cord blood C peptide （P〈 0.05, β = - 1.41 ） ; in non-GDM group, over body mass group and obsess group were positivel~ correlated with umbilical cord blood C peptide （P 〈 0.05, β = 0. 37,0.46）. Conclusion There was direct correlation between the pre-pregnant body mass index, the gestational weight gain and umbilical cord blood C peptide. Suitable maternal weight control especially pre-pregnant body mass index control will lower the baby long-term metabolic syndrome incidence.