不同孕前体质量指数对妊娠期血糖血脂及妊娠结局的影响

Influence of Different Pre-Pregnancy Body Mass Index on Blood Glucose and Serum Lipid and Pregnancy Outcome during Pregnancy

【目的】探讨不同孕前体质量指数(BMI)对妊娠期血糖、血脂及妊娠结局的影响。【方法】收集2013年1月1日至2013年12月31日在中山大学附属第一医院产检并分娩的1 115例单胎孕妇的临床资料,按不同的孕前BMI分为3组,孕前BMI<18.5 kg/m2为体质量过低组(G1),孕前BMI 18.5~23.9 kg/m2为正常体质量组(G2),孕前BMI≥24.0 kg/m2为超重组(G3),分析比较各组孕妇妊娠期各时间点血糖、血脂及妊娠结局的特点。【结果】(1)1 115例孕妇纳入研究,G1共245例,G2共757例,G3共113例。(2)随着孕前BMI的增加,75 g葡萄糖耐量试验(OGTT)空腹、1 h及糖化血红蛋白(Hb A1c)的血糖值逐渐升高(P<0.05);各组75 g OGTT空腹的平均血糖值为(4.21±0.34)、(4.34±0.35)、(4.56±0.50)mmol/L,OGTT 1 h平均血糖值为(7.51±1.60)、(7.83±1.59)、(8.83±1.88)mmol/L,各组Hb A1c的平均值为(4.81±0.37)、(4.90±0.34)、(5.03±0.38)%,各组间两两比较差异有统计学意义(P<0.05)。G1组的空腹血糖(FBG)低于G2和G3组(P<0.05);G3组的OGTT2 h的血糖值高于G1和G2组(P<0.05)。Pearson相关分析结果显示,FBG、75 g OGTT空腹、1 h、2 h、Hb A1c与孕前BMI呈正相关关系(P<0.05)。G3组妊娠期糖尿病(GDM)的发病率高于G1组和G2组(P<0.05),而G1组和G2组间GDM发病率的比较没有明显差异(P>0.05)。(3)G3组的甘油三酯(TG)高于G1和G2组(P<0.05),总胆固醇(TC)、高密度脂蛋白(HDL-C)低于G1和G2组(P<0.05),而载脂蛋白(Apo)A1、B、E、及脂蛋白a(Lp(a))、Apo A1/Apo B在各组间比较差异无统计学意义(P>0.05)。Pearson相关分析结果显示,TG与孕前BMI呈正相关(P<0.05),而TC、LDL-C、HDL-C与孕前BMI呈负相关(P<0.05)。(4)随着孕前BMI的增加,新生儿体质量和头围的值逐渐升高(P<0.05);各组间新生儿体质量的平均值为(3.03±0.42)、(3.18±0.45)、(3.30±0.46)kg,头围的平均值为(32.98±1.59)、(33.43±1.64)、(33.87±1.60)cm,各组间两两比较差异有统计学意义(P<0.05)。G1组的新生儿肩围低于G2和G3组(P<0.05),Pearson相关分析结果显示,新生儿身长、体质量、头围、肩围均与孕前BMI呈正相关(P<0.05)。【结论】随着孕前BMI的增加,妊娠期各时间点的血糖值、甘油三酯及新生儿生长指标均逐渐增加,建议孕前超重和肥胖的女性减重后再妊娠。

【Objective】To investigate the influence of different pre-pregnancy body mass index（BMI）on blood glucose and serum lipid and pregnancy outcome during pregnancy.【Methods】Clinical records of 1115 singleton pregnant women who underwent obstetric examination and delivered in the first affiliated hospital of Sun Yat-sen University between January 1,2013 and December31,2013 were collected. The patients were divided into 3 groups based on pre-pregnancy BMI,underweight（G1）：BMI 18.5 kg/m^2,normal weight（G2）：18.5 - 23.9 kg/m^2,overweight（G3）：≥ 24.0 kg/m^2. The characteristics of blood glucose,serum lipid and pregnancy outcome during pregnancy were analyzed and compared among groups.【Results】（1）1 115 cases of pregnant women were Included in the study. The cases of G1 to G3 were 245,757 and 113.（2）With the increase of pre-pregnancy BMI,the blood glucose of 75 oral glucose tolerance test（OGTT）fasting,1 h and glycosylated hemoglobin（HbA1c）was gradually rising（P〈0.05）. The average blood glucose of 75 OGTT fasting among groups were（4.21 ± 0.34）（4.34 ± 0.35）（4.56 ± 0.50）mmol/L,75 OGTT 1 h were（7.51 ± 1.60）,（7.83 ± 1.59）,（8.83 ± 1.88）mmol/L,Hb A1 c were（4.81 ± 0.37）（4.90 ± 0.34）（5.03 ± 0.38）%,there was statistical difference among groups（P〈0.05）. The average FBG of G1 was lower than that of G2 and G3 group（P〈0.05）. The average blood glucose of 75 g OGTT 2 h of G3 was obviously higher than that of G1 and G2 group（P〈0.05）. By Pearson analysis,FBG,75 g OGTT fasting,1 h,2 h,HbA1c had significantly positive relationship with pre-pregnancy BMI（P〈0.05）. The incidence of gestational diabetes of G3 group was higher than that of G1 and G2 group,but the incidence of gestational diabetes between G1 and G2 group had no obvious difference.（3）The triglycerides（TG）of G3 was obviously higher than that of G1 and G2 group（P〈0.05）,the total cholesterol（TC）and high density lipoprotein cholesterol（HDL-C）of G3 was lower than that of G1 and G2（P〈0.05）. But There was no statistical difference about apolipoprotein A1（apo A1）,B（apo B）,E（apo E）,Lp（a）,Apo A1/Apo B among groups（P〈0.05）. By Pearson analysis,TG had significantly positive relationship with pre-pregnancy BMI（P〈0.05）,but TC,LDL-C,HDL-C had negative relationship with pre-pregnancy BMI（P〈0.05）.（4）With the increase of pre-pregnancy BMI,the weight and head circumference of the newborn was gradually rising（P〈0.05）. The average weight of the newborn among groups were（3.03 ±0.42）,（3.18 ± 0.45）,（3.30 ± 0.46）kg,the head circumference were（32.98 ± 1.59）,（33.43 ± 1.64）,（33.87 ± 1.60）cm,there was statistical difference among groups（P〈0.05）. The shoulder circumference of the newborn of G1 was obviously lower than that of G2 and G3 group（P〈0.05）. Pearson analysis showed that the weight,body length,head circumference,shoulder circumference of the newborn had positive relationship with pre-pregnancy BMI（P〈0.05）.【Conclusion】With the increase of pre-pregnancy BMI,the blood glucose at each time point,serum lipid and growth index of the newborn was gradually rising. We suggest that overweight and obese women should lose weight before pregnancy.