孕中晚期增重速率对妊娠期糖尿病孕妇妊娠期并发症和分娩结局的影响研究

Association of Weight Gain Rate in Second and Third Trimesters with Pregnancy Complications and Delivery Outcomes in Women with Gestational Diabetes Mellitus

背景妊娠期总增重与分娩孕周紧密相连,选择增重速率作为研究指标,可以减少孕周对研究结果的干扰。目前有关妊娠期增重速率的既定建议存在争议且很少有研究探讨孕中晚期增重速率与妊娠期糖尿病(GDM)孕妇母婴结局的相关性。目的探讨孕中晚期增重速率对GDM孕妇妊娠期并发症及分娩结局的影响。方法选取2018年3—12月在杭州市妇产科医院住院生产并纳入“杭州市母婴健康队列”(注册号:ChiCTR1900026149)的370例GDM孕妇为研究对象。根据2021年中国营养学会发布的《中国妇女妊娠期体重监测与评价》推荐的孕中晚期增重速率,将研究对象分为增重速率过慢组(n=115)、增重速率正常组(n=152)和增重速率过快组(n=103)。分析三组孕妇妊娠期并发症发生情况及分娩结局。结果Logistic回归分析结果显示,孕中晚期增重速率过快是GDM孕妇发生妊娠期高血压疾病〔OR=2.661,95%CI(1.291,9.460)〕、妊娠期甲状腺功能减退症〔OR=2.288,95%CI(1.090,4.805)〕、高脂血症〔OR=2.085,95%CI(1.656,6.630)〕及分娩巨大儿〔OR=4.591,95%CI(1.238,17.031)〕的危险因素(P<0.05),孕中晚期增重速率过快是分娩早产儿〔OR=0.117,95%CI(0.014,0.959)〕的保护因素(P<0.05)。结论孕妇妊娠期增重不合理现象普遍,孕中晚期增重速率过快增加了GDM孕妇发生妊娠期高血压疾病、妊娠期甲状腺功能减退症、高脂血症及分娩巨大儿的风险,但降低了发生早产的风险。

Background The total gestational weight gain is closely related to the gestational week at delivery.Choosing the gestational weight gain rate(GWGR)as a indicator can reduce the interference of gestational week on the results.Currently,available recommendations regarding GWGR are controversial.Few studies have explored the correlation between GWGR in second and third trimesters and delivery outcomes in women with gestational diabetes mellitus(GDM).Objective To investigate the association of GWGR in second and third trimesters with pregnancy complications and delivery outcomes in women with GDM.Methods A total of 370 women with GDM were selected,who had an experience of undergoing delivery in Hangzhou Women's Hospital from March to December 2018,and were included in the Hangzhou Maternal and Offspring Health Cohort Study(clinical trial registration number:ChiCTR1900026149).According to GWGR in second and third trimesters recommended by the Weight Monitoring and Evaluation during Pregnancy Period of Chinese Women published by the Chinese Nutrition Society in 2021,the subjects were divided into insufficient GWGR group(n=115),normal GWGR group(n=152)and excessive GWGR group(n=103).We analyzed the incidence of pregnancy complications and delivery outcomes of the three groups.Results Logistic regression analysis demonstrated that excessive GWGR in second and third trimesters was associated with an increased risk of hypertensive disorders of pregnancy〔OR=2.661,95%CI(1.291,9.460)〕,gestational hypothyroidism〔OR=2.288,95%CI(1.090,4.805)〕,gestational hyperlipidemia〔OR=2.085,95%CI(1.656,6.630)〕and macrosomia〔OR=4.591,95%CI(1.238,17.031)〕(P<0.05),and a decreased risk of preterm neonate〔OR=0.117,95%CI(0.014,0.959)〕(P<0.05).Conclusion Abnormal weight gain in pregnant women is common.Excessive GWGR in second and third trimesters may increase the risk of hypertensive disorders of pregnancy,gestational hypothyroidism,hyperlipidemia and macrosomia,and decrease the risk of preterm neonate in women with GDM.