肥胖、维生素D缺乏与妊娠期糖尿病关系及对妊娠结局影响

The relationship between obesity and vitamin D deficiency of the pregnant women and their gestational diabetes mellitus occurrence and its influence on the pregnancy outcomes

目的:探讨肥胖、血清维生素D[25(OH)D]与妊娠期糖尿病(GDM)关系以及对妊娠结局的影响。方法:将2019年1月—2020年1月在本院定期产前检查确诊的GDM孕妇85例纳入GDM组,同期孕周匹配产前检查正常孕妇80例为对照组。比较孕妇体质指数(BMI)、25(OH)D水平及妊娠结局。结果:GDM组BMI(27.2±2.4kg/m^(2))高于对照组(23.1±1.7kg/m^(2))、25(OH)D水平(17.4±2.3ng/ml)低于对照组(34.1±3.8ng/ml)(P<0.05);GDM组妊娠期高血压及不良妊娠结局发生率高于对照组,BMI肥胖组和超重组,维生素D缺乏组和不足组GDM及不良妊娠结局发生率高于正常组或充足组(均P<0.05)。BMI≥28.0kg/m^(2)、25(OH)D<20ng/ml与GDM和妊娠不良结局发生相关(P<0.05)。结论:GDM患者普遍存在BMI高、维生素D不足或缺乏现象,其不良妊娠结局发生率高于正常孕产妇,且BMI越高、25(OH)D越低不良妊娠结局发生风险越高。临床可将此作为孕妇妊娠期管理和治疗的重要指标,及早干预以降低不良妊娠结局发生。

Objective:To explore the relationship between obesity and vitamin D[25(OH)D]deficiency of the pregnant women and their gestational diabetes mellitus(GDM)occurrence,and to study its influence on the pregnancy outcomes.Methods:Between January 2019 and January 2020,85 pregnant women with GDM were selected in study group,and 80 healthy pregnant women with the matched gestational weeks of the women in the study group were selected in control group.The body mass index(BMI)value,25(OH)D level and pregnancy outcomes of the women were compared between the two groups.The incidences of GDM and adverse pregnancy outcomes of the women with different BMI or different 25(OH)D levels were compared.Results:The BMI value(27.2±2.4kg/m^(2))of the women in the study group was significant higher than that(23.1±1.7kg/m^(2))of the women in the control group,but the 25(OH)D level(17.4±2.3ng/ml)of the women in the study group was significant lower than that(34.1±3.8ng/ml)of the women in the control group(P<0.05).The incidences of gestational hypertension and adverse pregnancy outcomes of the women in the study group were significant higher than those of the women in the control group.The incidences of GDM and adverse pregnancy outcomes of the women with obesity and overweight,and the women with vitamin D deficiency or insufficiency were significant higher than those of the normal pregnant women(all P<0.05).BMI≥28.0kg/m^(2) and 25(OH)D level<20ng/ml of the women were associated with their GDM occurrence and adverse pregnancy outcomes(all P<0.05).Conclusion:High BMI value and Vitamin D insufficiency or deficiency is common in the pregnant women with GDM,and the incidence of adverse pregnancy outcomes of the women with GDM is significant higher than that of the normal pregnant women.The higher BMI value and lower the 25(OH)D level of the pregnant women,the higher risk of adverse pregnancy outcomes is.The BMI value and the 25(OH)D level of the pregnant women can be used as important indicators for management and treatment of the pregnant women for early intervention,so as to reduce the incidences of adverse pregnancy outcomes.