孕前体质量指数与孕24周增重复合因素对妊娠期糖尿病发病的影响

The impact of pre-pregnancy body mass index and gestational weight gain at 24 weeks on the pathogenesis of gestational diabetes mellitus

目的分析产检孕妇孕前体质量指数(body mass index,BMI)及进行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)前体重增加对妊娠期糖尿病(gestational diabetes mellitus,GDM)发病的影响。方法回顾性分析2019年1月至2020年8月在上海交通大学附属第一人民医院门诊建卡的3104例产妇的临床资料,按孕前BMI将其由低到高进行分层,然后每一层BMI按孕24周增重情况再次进行分层,计算出患病率最低或较低时所对应的孕24周增重范围。结果对于15 kg/m^(2)<BMI≤19 kg/m^(2)及19 kg/m^(2)<BMI≤21 kg/m^(2)的孕妇,其孕24周增重应控制在12 kg以下;对于21 kg/m^(2)<BMI≤23 kg/m^(2)的孕妇,建议其增重控制在9 kg以内;当23 kg/m^(2)<BMI≤25 kg/m^(2),体重增长不超过8 kg时,其GDM的发生率(20.00%)相对较低,但并未达到正常体重孕妇(BMI<23 kg/m^(2))的水平(13.71%)。结论孕前BMI与孕24周增重的相互作用与GDM患病率有关系,在孕妇进行OGTT之前,产科医生在女性孕期产检时给予不同BMI孕妇关于孕24周增重更加及时、个体化的指导,有望在一定程度上降低GDM的发生率。

Objective To analyze the effect of body mass index(BMI)and gestational weight gain before oral glucose tolerance test(OGTT)on the pathogenesis of gestational diabetes mellitus(GDM)in pregnant women.Methods Retrospective analysis of the clinical data of 3104 women who had established cards in the Outpatient Department of the First People’s Hospital Affiliated to Shanghai Jiaotong University from January 2019 to August 2020.The pre pregnancy BMI was stratified from low to high,and then the BMI of each layer was stratified again according to the weight gain of 24 weeks.The range of weight gain at 24 weeks of gestation corresponding to the lowest or lower prevalence rate was calculated.Results Gestation weight gain at 24 weeks should be controlled below 12 kg for pregnant women with 15 kg/m^(2)<BMI≤19 kg/m^(2)and 19 kg/m^(2)<BMI≤21 kg/m^(2).For pregnant women with 21 kg/m^(2)<BMI≤23 kg/m^(2),weight gain should be controlled within 9 kg.While 23 kg/m^(2)<BMI≤25 kg/m^(2)and the weight growth was no more than 8 kg,the incidence of GDM(20.00%)was relatively low,but it did not reach the level of normal weight pregnant women(BMI<23 kg/m^(2))(13.71%).Conclusion The interaction between BMI before pregnancy and weight gain at 24 weeks of gestation was associated with the prevalence of GDM,before OGTT,obstetricians should provide pregnant women with timely and individualized guidance about gestation weight gain before OGTT based on their BMI,which is expected to reduce the incidence of GDM to a certain extent.