妊娠期体重控制与妊娠期糖尿病患者分娩结局的关系

Relationship Between Weight Control During Pregnancy and Delivery Outcome in Patients with Gestational Diabetes Mellitus

目的研究妊娠期糖尿病(GDM)患者妊娠期体重不同增长程度对分娩结局的影响。方法回顾性分析2019年12月-2020年12月我院产科分娩并在孕期常规检查通过IADPSG 75 g葡萄糖糖耐量实验的孕妇1269例,根据糖耐量是否正常分为GDM组(n=506)和NGT(糖耐量正常)组(n=763)。根据美国医学研究所(IOM)指南,依据妊娠期体重增加(GWG)程度不同分为三组:体重增加过轻组(GWG2)、体重增加正常组(GWG1)、体重增加过度组(GWG3)。根据IOM指南对现有的GWG控制目标进行调整,调整后的GWG分组为:IOM-1(将IOM指南建议的GWG最大数值减少1 kg),IOM-2(将IOM指南建议的GWG最小数值减少2 kg),IOM-1-1(将IOM指南建议的GWG最大及最小数值均减少1 kg),IOM-2-2(将IOM指南建议的GWG最大及最小数值都减少2 kg)。比较采用IOM指南及调整后建议体重增加标准的围产结局。结果剖宫产风险NGT-GWG2组相比IOM-1、IOM-2、IOM-1-1、IOM-2-2降低,差异有统计学意义(P<0.05);与调整前IOM(9.71%)相比IOM-1-1(4.92%)巨大儿风险降低,IOM(12.86%)相比IOM-2-2(3.91%)剖宫产风险降低,差异有统计学意义(P<0.05)。结论采用更为严格的IOM调整方案,可减少不良围产结局发生的概率,GWG过度会增加妊娠不良结局的发生风险。

Objective To study the effects of different growth levels of gestational weight on delivery outcomes in patients with gestational diabetes mellitus(GDM).Methods A retrospective analysis was conducted on 1269 pregnant women who delivered in our hospital from December 2019 to December 2020 and passed IADPSG 75 g glucose tolerance test during pregnancy.They were divided into GDM group(n=506)and NGT group(n=763)according to whether glucose tolerance was normal.According to the guidelines of the American Institute of Medicine(IOM)and the degree of weight gain during pregnancy(GWG),they were divided into three groups:light weight gain group(GWG2),normal weight gain group(GWG1),and excessive weight gain group(GWG3).The existing GWG control objectives are adjusted according to the IOM guidelines.The adjusted GWGs are grouped as follows:IOM-1(reducing the maximum value of GWG recommended by the IOM guidelines by 1 kg),IOM-2(reducing the minimum value of GWG recommended by the IOM guidelines by 2 kg),IOM-1-1(reducing the maximum and minimum values of GWG recommended by the IOM guidelines by 1 kg),and IOM-2-2(reducing the maximum and minimum values of GWG recommended by the IOM guidelines by 2 kg).Compare perinatal outcomes using IOM guidelines and adjusted recommended weight gain criteria.Results The risk of cesarean section in the NGT-GWG2 group was lower than that in the IOM-1,IOM-2,IOM-1-1 and IOM-2-2 groups,and the difference was statistically significant(P<0.05).Compared with IOM before adjustment(9.71%),the risk of macrosomia in IOM-1-1(4.92%)was lower,and the risk of cesarean section in IOM(12.86%)was lower than that in IOM-2-2(3.91%),the difference was statistically significant(P<0.05).Conclusion The more stringent IOM adjustment scheme can reduce the probability of adverse perinatal outcomes,and excessive GWG will increase the risk of adverse pregnancy outcomes.