孕前体质量指数及孕期增重与妊娠糖尿病的相关性研究

Correlation analysis of pre-pregnancy body mass index and pregnancy weight gain on gestational diabetes

目的探讨孕前体质量指数及孕期增重与妊娠糖尿病(GDM)的相关性。方法选取2018年1-6月济宁医学院附属医院产科收治的545例例行产检并诊断为GDM的孕妇,并选取同期例行产检的295例非糖尿病孕妇。收集其年龄、身高、孕前体质量、分娩前体质量、75g葡萄糖耐量试验(OGTT)血糖水平、糖尿病家族史、孕次、产次等一般临床资料,比较孕前体质量指数及孕期增重与两组孕妇GDM情况的相关性。结果GDM组与非GDM组孕妇的年龄、身高比较,差异无统计学意义(P>0.05)。GDM组和非GDM组孕妇孕前体质量指数及孕期增重分别为(23.6±1.9)kg/m^2、(22.4±2.6)kg/m^2;(16.2±5.4)kg,(14.5±4.8)kg,差异有统计学意义(P<0.001);GDM组孕前体质量、OGTT空腹血糖、OGTT1 h血糖、OGTT2 h血糖均显著高于非GDM组,差异有统计学意义(P<0.001);GDM组中既往存在糖尿病家族史的孕妇数显著高于非GDM组,差异有统计学意义(P<0.001),GDM组初产妇多于非GDM组,差异有统计学意义(P<0.05)。孕前低体质量组、体质量正常组、超重组、肥胖组孕妇GDM发生率比较[18.2%(4/22)、61.7%(319/517)、73.5%(214/291)、80.0%(8/10)];随着孕前体质量指数增加,孕期增重超标的发生率升高[36.4%(8/22)、43.1%(223/517)、73.5%(214/291)、100%(10/10)],差异均有统计学意义(P<0.001);孕期增重未超标组[54.6%(210/385)]与增重超标组GDM发生率[73.6%(335/455)]比较,差异有统计学意义(P<0.001);孕期增重超标组孕妇的孕前体质量指数[(23.6±2.2)kg/m^2]显著高于孕期增重未超标组孕妇[(22.6±2.1)kg/m^2],差异有统计学意义(P<0.001)。在校正了糖尿病家族史、孕次、产次、孕前体质量指数、孕期增重等潜在的混杂因素后发现,孕前低体质量为GDM的保护因素,孕前超重、肥胖及孕期增重超标为GDM的危险因素。结论孕前超重和肥胖及孕期增重超标均为GDM的高危因素,孕期增重超标与孕前较高的体质量指数相关。

Objective To investigate the correlation of pre-pregnancy body mass index and preg-nancy weight gain on gestational diabetes mellitus( GDM) . Methods A retrospective study was conducted in 545 pregnant women who were diagnosed with GDM and 295 non-diabetic pregnant women who were ad-mitted from January to June in 2018. General clinical data such as age,height,pre-pregnancy weight,pre-delivery weight,and 75 g oral glucose tolerance test( OGTT) blood glucose level,family history of diabetes, pregnancy,and parity were collected,the correlation between pre-pregnancy body mass index and pregnancy weight gain and GDM of the two groups were compared. Results There was no significant difference in age and height between GDM group and non-GDM group(P>0. 05). The pre-pregnancy body mass index and gestational weight gain of pregnant women in GDM group and non-GDM group were(23. 6 ± 1. 9) kg/m2,(22.4±2.6) kg/m2,(16.2±5.4) kg,(14.5±4.8) kg,respectively(P<0.001).The pre-pregnancy body mass,OGTT fasting blood glucose,OGTT 1 hour blood glucose and OGTT 2 hours blood glucose in the GDM group were significantly higher than those in the non-GDM group(P<0. 001). The number of preg-nant women with a family history of diabetes in the GDM group was significantly higher than that in the non-GDM group(P<0. 001). The number of pregnant women in the GDM group was higher than that in the non-GDM group(P<0. 05). Comparison of GDM incidence among pregnant women in the pre-pregnancy low body mass group,normal body mass group,super-recombinant group and obese group[18. 2%(4/22), 61. 7%(319/517),73. 5%(214/291) and 80. 0%(8/10)]. With the increase of pre-pregnancy body mass index,the incidence of excess weight gain during pregnancy increased[36. 4%(8/22),43. 1%(223/517),73. 5%(214/291),and 100%(10/10)],(P<0. 001). The GDM incidence in the group without excess weight gain during pregnancy[54. 6%(210/385)] was compared with that in the group with excess weight gain [ 73. 6% ( 335/455 )], ( P < 0. 001 ). The pre-pregnancy body mass index [( 23. 6 ± 2. 2) kg/m2 ] of the group with excess weight gain during pregnancy was significantly higher than that of thegroupwithoutexcessweightgainduringpregnancy[(22.6±2.1) kg/m2],(P<0.001).Afteradjus-ting for potential confounding factors such as family history of diabetes,gestational age,gestational age,pre-pregnancy body mass index,and gestational weight gain,it was found that low pre-pregnancy body mass was the protective factor of GDM,while overweight,obesity and overweight during pregnancy were the risk fac-tors of GDM. Conclusion Overweight and obesity pre-pregnancy and excessive weight gain during preg-nancy are risk factors for GDM. The increase in weight during pregnancy is associated with higher body mass index before pregnancy.