孕早期超重肥胖和孕期血糖水平升高对巨大儿和大于胎龄儿发生风险的交互作用

Interactive effect of maternal overweight/obesity during first trimester and elevated gestational blood glucose on macrosomia and large for gestational age birth

目的探讨孕早期超重肥胖和孕中期高血糖对巨大儿和大于胎龄儿(LGA)发生的单独和联合作用。方法利用天津市妇幼卫生信息系统,收集分析2009—2010年在天津市市内6区和滨海新区妊娠早期接受第1次产检的35554名孕妇的基本信息、孕早期体质指数(BMI)和50g葡萄糖负荷试验(GCT)检测结果以及分娩信息,通过logistic回归分析孕早期超重肥胖单独/联合孕中期高血糖对巨大儿和LGA发生的影响。结果多因素logistics回归分析显示,同孕早期BMI18.5~23.9kg/m^2者相比,超重和肥胖孕妇发生巨大儿的风险升高(OR=1.886,95%CI=1.730~2.057;OR=3.724,95%CI=3.280~4.228);超重和肥胖孕妇发生LGA的风险也升高(OR=1.721,95%CI=1.606~1.845;OR=3.230,95%CI=2.908~3.586)。同GCT<7.8mmol/L相比,GCT≥7.8mmol/L的孕妇发生巨大儿的风险升高(OR=1.402,95%CI=1.287~1.529),发生LGA的风险也升高(OR=1.342,95%CI=1.253~1.437)。多因素分析显示,同孕早期BMI<24.0kg/m^2且GCT<7.8mmol/L相比,孕早期超重/肥胖使高血糖对巨大儿的风险OR值由1.392增加到3.438,对LGA的风险OR值由1.365增加到2.948。结论孕早期超重/肥胖和孕中期高血糖是巨大儿和LGA发生的独立危险因素,且二者对巨大儿和LGA的发生存在相加交互作用。

Objective To evaluate independent and joint effects of early pregnancy body mass index (BMI) and blood glucose level in the second trimester on the risk of macrosomia and large for gestational age (LGA) birth. Methods We extracted records of 35 554 women with singleton pregnancy attending their first antenatal care visit before 13 gestational weeks in 7 urban districts of Tianjin city from 2009 through 2010 from Tianjin Maternal and Child Health Information System. The collected information of the women included demographics, general status of the pregnancy, BMI during the first trimester, and 50g oral glucose challenge test (GCT). Logistic regression analysis was adopted to assess independent and joint effect of overweight/obesity in first trimester and blood glucose level during second trimester on macrosomia and LGA birth. Results The results of multivariate logistic regression analysis demonstrated that compared to those with the BMI of 18.5 – 23.9 kg/m^2,, the overweight and obese pregnant women were at higher risk of giving birth to macrosomic neonates (overweight: odds ratio [OR]= 1.886,95% confidence interval [95% CI]: 1.730 –2.057;obesity: OR = 3.724,95% CI: 3.280 – 4.228) and LGA neonates (overweight: OR = 1.721, 95% CI: 1.606 – 1.845;obesity: OR = 3.230, 95% CI: 2.908 – 3.586);in comparison with those with the GCT of < 7.8 mmol/L, the pregnant women with the GCT of ≥ 7.8 mmol/L were more likely to give birth to macrosomic neonates (OR = 1.402, 95% CI: 1.287 – 1.529) and LGA neonates (OR = 1.342, 95% CI: 1.253 – 1.437). Compared to those with low BMI (< 24.0 kg/m^2) and low GCT (< 7.8 mmol/L), the pregnant women only with elevated GCT had increased risks of giving birth to macrosomic neonates (OR = 1.392) and to LGA neonates (OR = 1.365);whereas the pregnant women with both elevated GCT and overweight/obesity were at much higher increased risks of giving birth to macrosomic neonates (OR = 3.438) and to LGA neonates (OR = 2.948), suggesting a significant additive interactive effect of overweight/obesity and elevated GCT (P < 0.05). Conclusion Overweight/obesity during first trimester and elevated GCT during second trimester are independent risk factors for macrosomia and LGA birth among pregnant women and the effects of the two risk factors are interactive in an additive manner.