妊娠期糖尿病孕前体质量指数及孕期增重对新生儿出生体质量的影响

Effects of maternal pre-pregnancy maternal body mass index and gestational weight gain on neonatal birth weight in women with gestational diabetes mellitus

目的:探讨妊娠期糖尿病(GDM)孕妇孕前体质量指数(BMI)及孕期增重对新生儿出生体质量的影响。方法:采用队列研究方法对2015年4-12月产检并被诊断为GDM的单胎妊娠孕妇进行随访。分析孕前BMI及孕期增重与新生儿出生体质量的关系。结果:共590例GDM孕妇纳入本研究。根据BMI分类,10.6%(63/590)孕妇体质量偏轻,65.9%(389/590)体质量正常,17.6%(104/590)超重,5.9%(34/590)肥胖。新生儿出生体质量为(3 348.6±465.4)g,巨大儿发生率为7.6%(45/590),低出生体质量儿发生率为2.4%(14/590)。随着孕前BMI增加,孕期增重过量的比例显著增加(P<0.01),低出生体质量儿发生率,巨大儿发生率和剖宫产率显著增加(P<0.01);随着孕期增重增加,巨大儿发生率显著增加(P<0.01)。logistic回归分析结果显示,分娩孕周、新生儿性别及孕期增重与巨大儿发生有关,与孕期增重正常者相比,孕期增重过量显著增加巨大儿的发生风险(OR=2.57,P<0.01)。结论:GDM孕前超重及肥胖孕妇更易分娩巨大儿,应注意将计划妊娠妇女孕前体质量控制在合理范围,特别注意加强对孕前超重和肥胖GDM孕妇孕期体质量的控制。

Objective： To study the impact of pre-pregnancy maternal body mass index（ BMI） on neonatal birth weight in women with gestational diabetes mellitus（ GDM）. Methods： This was a prospective cohort study with sampling in singleton pregnant women diagnosed of GDM between April,2015 and December,2015 and tracking their pregnancy outcomes. Binary logistic regression was used to analyze the influencing factors for macrosomia. Besides,the associations between pre-pregnancy maternal BMI,GWG and neonatal birth weight were also explored. Results： A total of 590 women eligible for analysis. Pre-pregnancy BMI categories were： thin[10. 6%（ 63/590） ],normal[65. 9%（ 389/590） ],overweight[17. 6%（ 104/590） ]and obese[5. 9%（ 34/590） ]. The mean birth weight was（ 3 348. 6 ± 465. 4） g. The incidence of macrosomia was 7. 6%（ 45/590） and low birth weight 2. 4%（ 14/590）. With the increase of pre-pregnancy BMI,the incidence of excessive GWG,macrosomia,low birth weight and cesarean section significantly increased;moreover,the rate of macrosomia significantly increased as the GWG increased（ P〈0. 01）. Logistic regression analysis showed that,gestational weeks,neonatal sex and GWG were associated with macrosomia,while pre-pregnancy BMI was not significantly associated with macrosomia. When compared to pregnant women with normal GWG,excessive GWG appeared to be the risk factor of macrosomia,with the odds ratio（ OR） as 2. 57（ P〈0. 01）. Conclusions： Much more attention should be paid to women who are planning to get pregnancy and control the weight gain within the normal range during pregnancy,especially in the population of overweight and obese women with GDM.