孕前超重及孕期增重对妊娠期糖尿病孕妇妊娠结局的影响

Effects of Maternal Pre-pergnancy Overweight and Weight Gain during Pregnancy on Pregnancy Outcome in Women with Gestational Diabetes Mellitus

目的:探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)孕妇孕前质量指数(body mass index,BMI)及孕期体重增长对妊娠结局的影响。方法:回顾性分析2016年1-12月在本院孕检并分娩的单胎GDM孕妇586例的临床资料。根据孕前BMI将其分为超重组(孕前BMI≥24 kg/m^2)323例和非超重组(孕前BMI<24 kg/m^2)263例,比较两组血糖控制情况、新生儿结局、分娩方式及子痫前期的发生情况。两组分别按孕期增重<9 kg、9~18 kg、>18 kg各分为三个亚组,分别比较新生儿出生体重、巨大儿、低体重儿、分娩方式以及子痫前期的发生情况。结果:超重组孕妇血糖控制满意率低于非超重组,巨大儿、新生儿转儿科、剖宫产及子痫前期占比均高于非超重组,比较差异均有统计学意义(P<0.05);非超重孕妇孕期增重>18 kg组巨大儿比例高于<9 kg组,子痫前期发生率高于其他两组,比较差异均有统计学意义(P<0.05);超重孕妇孕期增重9~18 kg及>18 kg组巨大儿、剖宫产、子痫前期比例均高于<9 kg组,>18 kg组新生儿出生体重高于<9 kg组,比较差异均有统计学意义(P<0.05)。结论:孕前超重及孕期体重过度增长是GDM孕妇罹患子痫前期及分娩巨大儿的危险因素。关注孕前超重人群,加强孕期体重管理,对改善妊娠结局是必要的。

Objective：To investigate the effect of gestational diabetes mellitus（GDM） pre-pregnancy body mass index（BMI） and weight gain during pregnancy on pregnancy outcome.Method：The clinical data of 586 pregnant women with single GDM who underwent pregnancy and delivery in our hospital from January 2016 to December 2016 were retrospectively analyzed.According to pre-pregnancy BMI,they were divided into 323 cases of overweight group（pre-pregnancy BMI≥24 kg/m2） and 263 cases of non-overweight group（pre-pregnancy BMI〈24 kg/m2）.The glucose control,neonatal outcomes,delivery mode and the occurrence of pre-eclampsia were compared between two groups.According to the weight gain during pregnancy〈 9 kg,9-18 kg and 〉18 kg,the two groups were divided into three subgroups respectively.The neonatal birth weight,macrosomia,low birth weight,delivery mode and the occurrence of pre-eclampsia were compared between three subgroups.Result：The satisfactory rate of blood glucose control in overweight group pregnant women was lower than that of non-overweight group,and the proportion of macrosomia,neonates to pediatrics,caesarean section and pre-eclampsia were higher than those of non-overweight group,the differences were statistically significant（P〈0.05）.The proportion of macrosomia of weight gain 18 kg group in pregnant women with non-overweight pregnant women was higher than that of weight gain〈9 kg group,and the incidence of pre-eclampsia was higher than that of the other two groups,the difference were statistically significant（P〈0.05）.The proportion of cesarean section,macrosomia and pre-eclampsia of weight gain 9-18 kg and〉 18 kg group in overweight pregnant women were higher than those of weight gain 〈9 kg group,and the birth weight of weight gain 〉18 kg group was higher than that of weight gain 〈9 kg group,the differences were statistically significant（P〈0.05）.Conclusion：Pre-pregnancy overweight and excessive weight gain during pregnancy are strong risk factor for macrosomia and preeclampsia in pregnant women of GDM.Most attention to high-risk groups and weight control should be used to improve the adverse outcomes of pregnancy.