妊娠期糖尿病妇女孕中晚期增重适宜范围:多中心回顾性队列研究

Suitable Range of Weight Gain During The Second and Third Trimesters of Pregnancy for Women with Gestational Diabetes Mellitus:A Multicenter Retrospective Cohort Study

目的:探索不同孕前体质量指数(BMI)的妊娠期糖尿病(GDM)妇女孕中晚期增重适宜范围。方法:收集调查医院2017年12月-2019年12月诊断为GDM的共10656例病历资料(东、中、西部各3706、3343、3607例),对其中核心信息完整的7050例进行回顾性分析。依据中国《成人体重判定》(WS/T 428-2013)将GDM妇女按孕前BMI分为孕前体重过低、正常、超重及肥胖组,使用受试者工作特征曲线(ROC)、四分位数(IR)法(无不良妊娠结局妇女的孕中晚期增重P25~P75)分别得到每组的ROC范围、IR范围。结果:按孕前BMI顺序,孕中晚期增重ROC适宜范围依次为11.2~13.1 kg、10.0~12.9 kg、11.3~13.4 kg、6.2~11.4 kg,IR范围依次为9.5~15.5 kg、8.5~14.5 kg、6.5~13.5 kg、4.5~11.5 kg。在ROC范围中未观察到孕中晚期增重与各不良妊娠结局间的统计学关联。ROC范围比IR范围对妊娠期高血压、巨大儿、大于胎龄儿(LGA)、小于胎龄儿(SGA)及低出生体重儿(LBWI)的灵敏度更高,为80.1%、81.7%、80.5%、81.9%、83.8%;对妊娠期高血压、LGA、SGA及LBWI的阴性预测值更高,为92.3%、89.1%、95.9%、96.9%。结论:ROC范围预防GDM妇女母儿不良妊娠结局的综合效果更优、综合灵敏度和阴性预测值更高,具有潜在更好的应用价值。

Objective To explore the suitable range of weight gain during the second and third trimesters of pregnancy for women with gestational diabetes mellitus(GDM).Method A total of 10656 medical records(3706,3343,and 3607 cases respectively in the eastern,central and western regions)diagnosed with GDM from December 2017 to December 2019 were collected,and 7050 of them with complete core information were retrospectively analyzed.Women with GDM were divided into underweight,normal,overweight and obese groups according to criteria of weight for adults of China(WS/T 428-2013).Use receiver operating characteristic curve(ROC)and method of interquartile range(P25-P75 weight gain in the second and third trimester of women without adverse pregnancy outcome)to obtain the ROC range and IR range of each group.Result According to the order of body mass index(BMI)before pregnancy,the suitable range of ROC for weight gain in the second and third trimester was 11.2-13.1 kg,10.0-12.9 kg,11.3-13.4 kg,6.2-11.4 kg,respectively.IR range was 9.5-15.5 kg,8.5-14.5 kg,6.5-13.5 kg,4.5-11.5 kg,respectively.No statistical association between weight gain and adverse pregnancy outcomes was observed in the ROC range.ROC range had higher sensitivity than IR range for gestational hypertension,macrosomia,large for gestational age(LGA),small for gestational age(SGA)and low birth weight infant(LBWI)(80.1%,81.7%,80.5%,81.9%,83.8%),and the negative predictive values of pregnancy hypertension,LGA,SGA and LBWI were higher(92.3%,89.1%,95.9%,96.9%)as well.Conclusion ROC range has better comprehensive effect,higher comprehensive sensitivity and negative predictive value in preventing adverse pregnancy outcomes of women with GDM.It may have a potentially better application.