不同孕期增重与发生妊娠期糖尿病关系探讨

Relationship between the weight gain of women in different gestational weeks and their gestational diabetes mellitus occurance

目的:分析不同孕期增重情况与发生妊娠期糖尿病(GDM)关系。方法:将本院2015年1月-2018年1月收治的752名孕妇纳入前瞻性队列研究。记录孕妇孕前及孕早期、孕中期、孕晚期体重,计算各孕期增重情况并比较不同孕期增重不足、增重适宜、增重过多者GDM发生率。运用logistic回归分析,探讨不同孕期增重与GDM发生关系。结果:752名孕妇中检出GDM 131例,发病率为17.4%。孕早期增重过多者GDM发生率高于增重不足、增重适宜者;孕期总增重不足者GDM发生率高于增重适宜者,增重过多者GDM发生率低于增重适宜者(P<0.05)。以增重适宜为自变量参考类别,logistic回归分析示,调整混杂因素后,孕早期增重过多者GDM发生风险为2.21,孕晚期增重过多者GDM发生风险为0.52,孕期总增重不足者GDM发生风险为2.17(P<0.05)。结论:孕早期增重过多、孕期总增重不足均可导致GDM发生风险上升,而孕晚期增重过多者GDM发生风险下降,其具体机制有待深入研究。

Objective:To analyze the relationship between the weight gain of women in different gestational weeks and their gestational diabetes mellitus(GDM)occurance.Methods:752 pregnant women were enrolled in this prospective cohort study from January 2015 to January 2018.The women's weight before pregnancy,and during the first,second and third trimester of pregnancy was recorded.The weight gain of all women in different gestational weeks was calculated.The GDM incidence of women during different gestational weeks was compared among group A(women with insufficient weight gain),group B(women with normal weight gain),and group C(women with excessive weight gain).Logistic regression analysis was used to explore the relationship between gestational weight gain of women and GDM occurance.Results:In the 752 pregnant women,131(17.4%)women with GDM were detected.During the first trimester of pregnancy,the GDM incidence of women in group C was significant higher than that of women in group A or group B(P<0.05).During pregnancy,the GDM incidence of women in group A was the highest,but the GDM incidence of women in group C was the lowest(P<0.05).Based on normal weight gain during pregnancy as the reference category of independent variables,Logistic regression analysis showed that after adjusting the confounding factors,the risk of GDM occurance of women with excessive weight gain during the first trimester of pregnancy was 2.21,the risk of GDM occurance of women with excessive weight gain during the third trimester of pregnancy was 0.52,and the risk of GDM occurance of women with insufficient weight gain during pregnancy was 2.17(P<0.05).Conclusion:Excessive weight gain of women during the third trimester of pregnancy and insufficient weight gain of women during pregnancy can increase the risk of GDM occurance.However,the risk of GDM occurance of women with excessive weight gain during the third trimester of pregnancy decreases,which specific mechanism needs to be further explored.