妊娠期糖尿病患者孕前体质指数、孕期体重增加与孕期糖脂代谢指标变化关系

The relationship between the pre-pregnancy body mass index and gestational weight gain of pregnant women with gestational diabetes mellitus, and the changes of glucose and lipid metabolism levels of these women during pregnancy

目的:探讨妊娠期糖尿病(GDM)患者孕前体质指数(BMI)、孕期体重增加(GWG)与孕期糖脂代谢关系。方法:选择2015年3月—2017年6月本院产科收治的GDM患者120例为GDM组,同期糖耐量正常(NGT)孕妇120例为NGT组。GDM组根据孕前BMI分为消瘦组(BMI<18.5kg/m^2,n=21)、正常组(18.5kg/m^2≤BMI<24.0kg/m^2,n=69)和超重/肥胖组(BMI≥24kg/m^2,n=30);根据孕晚期GWG分为过少组(n=29)、适宜组(n=55)和过多组(n=36)。检测并比较不同组别孕中晚期糖脂代谢指标。结果:①孕中、晚期,GDM组的FBG、PBG1、PBG2、FINS、HOMA-IR、TC、TG、LDL-C和VLDL-C均高于NGT组(P<0.05),两组TC无差异(P>0.05)。②GDM组,孕、中期超重/肥胖组的FBG、PBG1、PBG2、FINS、HOMA-IR、TC、TG、LDL-C和VLDL-C均高于消瘦组和正常组(P<0.05),但孕晚期3组间比较无差异(P>0.05)。③孕中期不同GWG组糖脂代谢指标比较无差异,孕晚期GWG过多组的HDL-C低于过少组和适宜组,其余糖脂代谢指标均高于过少组和适宜组(均P<0.05)。结论:孕前BMI过高及GWG过多可加重GDM患者糖脂代谢紊乱及胰岛素抵抗,且在孕晚期GWG过多患者中尤为明显。

Objective: To investigate the relationship between pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) and of pregnant women with gestational diabetes mellitus (GDM) and the changes of glucose and lipid metabolism levels of these during pregnancy. Methods: From March 2015 to June 2017,120 women with GDM were included in group A, and 120 pregnant women with normal glucose tolerance (NGT) were included in group B. The women in group A were divided into emaciation group A 1 (BMI<18.5kg/m^ 2, n=21), group A 2 (18.5kg/m^2≤BMI<24.0 kg/m ^2, n=69), and group A 3(BMI≥24kg/m^2, n=30) according to pre-pregnancy BMI. The women in group A were also divided into group Aa (less GWG, n=29), group Ab (appropriate GWG, n=55), and group Ac (excessive GWG, n=36) according to GWG of women during the third trimester pregnancy. The levels of glucolipid metabolic of women during the second and third trimester pregnancy in different groups were detected and compared. Results: The levels of FBG,PBG1,PBG2,FINS,HOMA-IR,TC,TG,LDL-C and VLDL-C of women in group A were significant higher than those of women in group B ( P <0.05),but there was no significant difference in TC level between group A and group B ( P >0.05). In group A, the levels of FBG, PBG1, PBG2, FINS, HOMA-IR, TG, LDL-C and VLDL-C of women in group A 3 were significant higher than those of women in group A 1 and A 2 ( P <0.05),there was no significant difference in TC level among group A 1, A 2 and A 3 ( P >0.05). There were no significant differences in levels of glucolipid metabolic indicators of women during the second trimester pregnancy among group Aa, Ab, and Ac ( P >0.05). During the third trimester pregnancy, the HDL-C level of women in group Ac was significant lower than that of women in group Aa or Ab, but the levels of FBG, PBG1, PBG2, FINS, HOMA-IR, TC, TG, LDL-C and VLDL-C of women in group Ac were significantly higher ( P <0.05). Conclusion: High pre-pregnancy BMI or excessive GWG of pregnant women can aggravate the disorder of glycolipid metabolism during pregnancy, which is particularly serious in women with excessive GWG during the third trimester pregnancy.