孕早期人体体成分与妊娠期糖尿病的相关性研究

Study on the Correlation between Body Composition in Early Pregnancy and Gestational Diabetes Mellitus

目的:探讨孕妇孕早期体成分的变化与妊娠期糖尿病(gestational diabetes,GDM)的相关性。方法:采用前瞻性巢式队列研究,选择2020年9月至2021年9月在湖北医药学院附属国药东风总医院进行产前检查且自愿接受营养评价的单胎孕妇作为研究对象,由于孕8周内大多数孕妇身体较孕前无明显变化,以孕6~8周体成分作为基础值,在孕6~8和11~13周共2次通过生物电阻抗法分析母体体成分(包括体质量、细胞外液、肌肉量、去脂体质、体脂百分比等),计算孕前体质指数(BMI)、脂肪质量指数(FMI)和肌肉质量指数(SMMI),并在孕24~28周行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT),将确诊为GDM的孕妇纳入GDM组(n=49),选择健康孕妇作为对照组(n=87)。比较两组孕妇孕6~8周、孕11~13周的体成分及分析体成分与血糖的相关性。采用二元Logistic回归探讨GDM的危险因素,并绘制受试者工作特征曲线,评价FMI对GDM的预测价值。结果:GDM组孕11~13周体脂百分比、FMI显著高于对照组(P<0.05),肌肉量、去脂体质、SMMI显著低于对照组(P<0.05);GDM组孕妇孕11~13周体脂百分比与空腹血糖呈显著正相关(r=0.206,P=0.020);Logistic回归分析显示孕11~13周FMI(OR=0.545,95%CI:0.350~0.848,P=0.007)是GDM的独立危险因素;FMI预测GDM的曲线下面积为64.4%。结论:妊娠11~13周的体脂百分比与GDM的发生风险有关,妊娠11~13周的FMI可能是GDM的一个独立预测指标。

Objective To investigate the correlation between the changes of body composition in early pregnancy and gestational diabetes mellitus(GDM).Methods A prospective nested cohort study was conducted to select singleton pregnant women who received prenatal examination and voluntary nutritional evaluation in Dongfeng General Hospital of Sinopharm affiliated to Hubei University of Medicine from September 2020 to September 2021 as the research object.Since most pregnant women have no significant changes in their bodies within 8 weeks of pregnancy compared with those before pregnancy,the body composition at 6 to 8 weeks of pregnancy was taken as the basic value.The maternal body composition(including body mass,extracellular fluid,muscle mass,fat free body mass,body fat percentage,etc.)was analyzed by bioelectrical impedance method twice at 6~8 weeks and 11~13 weeks of pregnancy,and the pregnancy body mass index(BMI),fat mass index(FMI)and muscle mass index(SMMI)were calculated.Oral glucose tolerance test(OGTT)was performed at 24~28 weeks of gestation.Pregnant women with GDM were included in GDM group(n=49),and healthy pregnant women were selected as control group(n=87).The body composition and the correlation between body composition and blood glucose were compared between the two groups at 68 weeks′gestation and 11~13 weeks′gestation.Binary logistic regression was used to explore the risk factors of GDM,and the working characteristic curve of subjects was drawn to evaluate the predictive value of FMI for GDM.Results The percentage of body fat and FMI in GDM group were significantly higher than those in the control group at 11 to 13 weeks of pregnancy(P<0.05),while the muscle mass,fat loss weight and SMMI in GDM group were significantly lower than those in the control group(P<0.05).In GDM group,there was a significant positive correlation between body fat percentage and fasting blood glucose at 11 to 13 weeks of gestation(r=0.206,P=0.020).Logistic regression analysis showed that FMI(OR=0.545,95%CI:0.350~0.848,P=0.007)was an independent risk factor for GDM at 11 to 13 weeks of gestation.The area under the curve of FMI for predicting GDM was 64.4%.Conclusion The percentage of body fat at 11 to 13 weeks of gestation is associated with the risk of GDM,and FMI at 11 to 13 weeks of gestation may be an independent predictor of GDM.