多囊卵巢综合征孕妇妊娠期增重模式与母儿结局的关系

Associations between timing of gestational weight gain and maternal and neonatal outcomes in women with polycystic ovary syndrome

目的研究多囊卵巢综合征(polycystic ovary syndrome,PCOS)合并妊娠孕妇妊娠不同时期增重情况及与母儿围产结局的关系。方法以2017年7月至2019年7月于首都医科大学附属北京妇产医院定期产检并住院分娩的714例PCOS合并妊娠单胎产妇为观察队列,收集孕妇基线信息、妊娠期增重情况及母儿结局。将孕妇按照孕早中期(28周前)增重分为增重不足组、增重适宜组、增重过多组,按照孕晚期增重小于推荐的范围及大于等于推荐范围分为孕晚期增重较少组、孕晚期增重较多组。采用χ^(2)检验和多因素Logistic回归分析方法对孕早中期及晚期增重与母儿结局的关系进行分析。结果与孕早中期增重适宜组孕妇相比,孕早中期增重不足组降低妊娠期高血压疾病(hypertension disorders of pregnancy,HDP)(OR=0.29,95%CI:0.15~0.56)、巨大儿(OR=0.33,95%CI:0.14~0.76)及大于胎龄儿(large for gestational age,LGA)(OR=0.59,95%CI:0.35~0.99)风险,孕早中期增重不足似乎并未增加分娩小于胎龄儿(small for gestational age,SGA)(OR=0.69,95%CI:0.13~3.58)风险;孕早中期增重过多增加分娩LGA风险(OR=1.84,95%CI:1.18~2.88);孕早中期增重的多少与妊娠期糖尿病(gestational diabetes mellitus,GDM)发生无关。无论早中期增重是否适宜,若孕晚期增重较多,HDP风险(OR=3.19,95%CI:1.41~7.21)明显增加(孕早中期前增重适宜组)或该病发生呈上升趋势(早中期增重不足或增重过多组);PCOS孕妇晚期增重较多分娩LGA风险(OR=3.15,95%CI:1.41~7.04)明显升高(早中期增重过多组)或表现出分娩LGA风险呈增加的趋势(孕早中期增重不足或适宜组)。结论PCOS孕妇孕早中期及晚期增重过多均会增加胎儿过速增长的发生风险;与非PCOS孕妇不同的是,PCOS孕妇孕早中期增重过少对HDP有保护作用,同时似乎并没有增加SGA风险,但对子代长期健康的潜在影响尚不明确,PCOS孕妇在孕晚期前是否需要比一般孕妇更少的增重建议,需要相关研究进一步明确。

Objective To evaluate the relationship between timing of gestational weight gain and maternal and neonatal outcomes in pregnant women with polycystic ovary syndrome(PCOS). Methods A retrospective study was conducted on the data involving the baseline characteristics, weight changes during pregnancy, and pregnancy outcomes of 714 pregnant women with PCOS. According to the recommendations of the 2009 Institute of Medicine(IOM) guidelines, we classified weight gain in the first-and second-trimester(before 28 weeks) into the inadequate, adequate and the excessive weight gain group, weight gain in the third-trimester was classified according to whether it was below, at or above the recommended weight gain. Chi-square test and multivariable Logistic regression analysis were performed to investigate the associations between the timing of gestational weight gain and perinatal outcomes. Results Compared with PCOS women who gained adequate weight gain in the first-and second-trimester, those who gained inadequate weight gain in the first-and second-trimester showed the lowered risk of hypertension disorders of pregnancy(HDP)(OR=0.29,95%CI:0.15-0.56), macrosomia(OR=0.33,95%CI:0.14-0.76)and large for gestational age(LGA)(OR=0.59,95%CI:0.35-0.99). Those with inadequate weight gain in the first-and second-trimester didn’t show an increased risk of small for gestational age(SGA)(OR=0.69,95%CI:0.13-3.58) birth. Women who gained excessive weight gain in the first-and second-trimester showed an increased risk of LGA birth(OR=1.84,95%CI:1.18-2.88). Gestational weight gain in the first-and second-trimesters did not appear to be associated with gestational diabetes mellitus(GDM). Higher weight gain in the third-trimester was associated with an increased risk of HDP(OR=3.19,95%CI:1.41-7.21)(for women with adequate gestational weight gain in the first-and second-trimesters) or the occurrence of the HDP was on the rise(for women with inadequate/excessive gestational weight gain in the first-and second-trimesters), higher weight gain in the third-trimester was associated with an increased risk of LGA(OR=3.15,95%CI:1.41-7.04)(for women with excessive gestational weight gain in the first-and second-trimesters) or the occurrence of the LGA was on the rise(for women with inadequate/adequate gestational weight gain in the first-and second-trimesters), regardless of early gestational weight gain. Conclusions Excessive weight gain in each trimester of pregnancy in PCOS pregnant women increased the risk of fetal overgrowth. However, some unique trends existed in PCOS pregnant women. Specifically, inadequate gestational weight gain in the first-and second-trimester showed a protective effect on HDP and it did not seem to increase the risk of SGA birth. However, the potential impact on the long-term health of the offspring is still unclear. It is necessary to figure out whether pregnant women with PCOS need less weight gain recommendations before the third-trimester than general pregnant women.