孕妇孕前BMI与孕晚期糖脂代谢水平及妊娠结局相关性探讨

The correlation of BMI of women before and during pregnancy with the glucose and lipid metabolism of women at later pregnant stage and pregnancy outcomes

目的:探讨孕前及孕期体质量指数(BMI)与孕晚期糖脂代谢及妊娠结局关系。方法:收集2017年6月-2018年6月本院产科接诊的1520例孕妇资料,根据孕前BMI分为正常BMI、高BMI、低BMI3组。统计各组孕期体重增长情况,分析各组的分娩方式、新生儿以及妊娠并发症、不良妊娠结局等情况。结果:高BMI组的妊娠高血压、妊娠期糖尿病、胎膜早破、胎盘早剥、胎儿窘迫、早产发生率均高于另外两组(P<0.05)。高BMI组、低BMI组的剖宫产率均高于正常组BMI,新生儿Apgar评分均低于正常BMI组,入住NICU率均高于正常BMI组(P<0.05)。孕前正常BMI组及高IBM组,孕期增长过度者的妊娠高血压、妊娠期糖尿病、胎膜早破、胎盘早剥、胎儿窘迫、早产、剖宫产、新生儿入住NICU发生率均高于增长适宜者,新生儿Apgar评分低于增长适宜者(P<0.05);孕前低BMI组,孕期增长过度者与增长适宜者的各项指标比较未见差异(P<0.05)。孕期GDM组的TG、FPG、孕前BMI值及孕期增重值均显著高于正常妊娠组(P<0.05)。孕期增重水平与孕晚期TG及FPG水平均存在正相关关系(P<0.05)。结论:孕前及孕期BMI值与孕晚期糖脂代谢水平及妊娠结局密切相关,孕前高BMI值及孕期体重增长过度会增加糖脂代谢异常及妊娠并发症、剖宫产、不良妊娠结局风险。

Objective To investigate the correlation of body mass index （BMI） of women before and during pregnancy with the glucose and lipid metabolism of women at later pregnant stage and pregnancy outcomes. Methods： The data of 1520 pregnant women in Baoji maternal and child health care hospital were collected and analyzed retrospectively. All included women were divided into normal BMI gourp, high BMI group, or low BMI group according to the BMI of women before pregnancy. The weight gain of women during pregnancy was statistical analyzed, and the mode of delivery, neonatal status, rates of pregnancy complications and adverse pregnancy outcomes were also analyzed. Results： The incidences of pregnancy induced hypertension, gestational diabetes mellitus （GDM）, premature rupture of membranes, placental abruption, fetal distress and premature birth of women in high BMI group were significant higher than those of women in the other two groups （ P 〈0.05）. The cesarean section rate of women in high BMI group or in low BMI group was significantly higher than that of women in normal BMI group. The Apgar score of newborns in high BMI group or in low BMI group was significant lower than that of newborns in normal BMI group, and the rate of newborns in high BMI group or in low BMI group transferred to NICU was significant higher than that of newborns in normal BMI group （ P 〈0.05）. In normal BMI group and high BMI group, the incidence of pregnancy induced hypertension, GDM, premature rupture of membranes, placental abruption, fetal distress, premature delivery, cesarean section, and newborns transferred to NICU of women with BMI increased fast during pregnancy were significant higher than those of women with BMI increased appropriately, and the neonatal Apgar score of women with BMI increased fast during pregnancy was significant lower than that of women with BMI increased appropriately （ P 〈0.05）. In low BMI group, there were no significant different in the incidence of pregnancy induced hypertension, GDM, premature rupture of membranes, placental abruption, fetal distress, premature delivery, cesarean section, newborns transferred to NICU, and the neonatal Apgar score between women with BMI increased fast during pregnancy and women with BMI increased appropriately （ P 〉0.05）. The levels of TG and FPG, the value of pre pregnancy BMI, and the weight gain during pregnancy of women with GDM were significant higher than those of women withot GDM （ P 〈0.05）. There was a positive correlation between weight gain during pregnancy and the levels of TG and FPG during the third trimester pregnancy （ P 〈0.05）. Conclusion： Pre pregnancy and pregnancy BMI values are closely related to the levels of glucose and lipid metabolism and pregnancy outcomes of women during the third trimester pregancy. Pre pregnancy high BMI and excessive weight gain during pregnancy will increase the risk of abnormal glucose and lipid metabolism, and maybe increase the rates pregnancy complications, caesarean section, and adverse pregnancy outcomes.