妊娠前不同体质指数孕妇妊娠期血脂水平与巨大儿的关系研究

Association between Blood Lipid Levels and Macrosomia in Pregnant Women with Different Pre-pregnancy Body Mass Index

背景巨大儿不仅会对孕妇及新生儿造成一定危害,也会影响子代远期代谢健康。母亲体质量状态与妊娠结局密切相关,超重肥胖者多伴有血脂异常,妊娠期血脂异常升高会影响宫内环境和新生儿出生体质量。目的分析不同妊娠前BMI孕妇妊娠期血脂水平与巨大儿之间的关系。方法本研究为单中心回顾性研究,纳入2018年1月—2019年6月在首都医科大学附属北京妇产医院产科建档至分娩并符合纳排标准的单胎孕妇5287例,根据妊娠前BMI将孕妇分为低体质量、正常体质量和超重肥胖孕妇,根据新生儿出生体质量将低体质量孕妇分为低体质量孕妇非巨大儿组(A组,n=731)和低体质量孕妇巨大儿组(B组,n=27),正常体质量孕妇分为正常体质量孕妇非巨大儿组(C组,n=3539)和正常体质量孕妇巨大儿组(D组,n=243),超重肥胖孕妇分为超重肥胖孕妇非巨大儿组(E组,n=675)和超重肥胖孕妇巨大儿组(F组,n=72)。收集孕妇相关临床及实验室数据进行统计学分析。采用二元Logistic回归分析探究不同妊娠前BMI孕妇妊娠期血脂水平与巨大儿之间的关系。结果B组孕妇妊娠晚期高密度脂蛋白胆固醇(HDL-C)低于A组(P<0.05);D组孕妇妊娠早期总胆固醇(TC)及孕晚期三酰甘油(TG)高于C组(P<0.05),妊娠中、晚期HDL-C低于C组(P<0.05)。F组妊娠早、中、晚期TG均高于E组(P<0.05),妊娠中、晚期HDL-C低于E组(P<0.05)。二元Logistic回归分析结果示,妊娠晚期HDL-C〔OR=0.256,95%CI(0.075,0.871)〕是妊娠前低体质量孕妇娩出巨大儿的影响因素(P<0.05)。孕中期和晚期HDL-C〔OR=0.661,95%CI(0.450,0.971);OR=0.406,95%CI(0.271,0.610)〕是妊娠前正常体质量孕妇娩出巨大儿的影响因素(P<0.05)。妊娠早、中、晚期TG〔OR=1.546,95%CI(1.070,2.234);OR=1.399,95%CI(1.019,1.758);OR=1.289,95%CI(1.072,1.550)〕是妊娠前超重肥胖孕妇娩出巨大儿的影响因素(P<0.05)。结论妊娠前低体质量及正常体质量孕妇妊娠期低HDL-C水平与巨大儿相关,而超重肥胖孕妇妊娠期TG水平升高与巨大儿相关。产检时对于胎儿偏大或预测巨大儿高风险的孕妇,需要加强血脂检测及控制。

Background Macrosomia is not only harmful to the pregnant women and newborns,but also to the long-term metabolic health of the offspring.Maternal body mass is closely associated with pregnancy outcomes,overweight and obese pregnant women are often associated with dyslipidemia,while elevated blood lipid levels during pregnancy can affect the intrauterine environment and neonatal birth weight has not been investigated.Objective To analyze the association between blood lipid levels and macrosomia in pregnant women with different pre-pregnancy(BMI).Methods A total of 5287 singleton pregnant women who were registered at department of obstetrics of Beijing Obstetrics and Gynecology Hospital,Capital Medical University until delivery from January 2018 to June 2019 and met the inclusion and exclusion criteria were included in the single-center retrospective study,and divided into low-body-mass pregnant women with a non-macrosomia group(group A,n=731)and with a macrosomia group(group B,n=27),normal-body-mass pregnant women with a non-macrosomia group(group C,n=3539)and with a macrosomia group(group D,n=243),overweight and obese pregnant women with a nonmacrosomia group(group E,n=675)and with a macrosomia group(group F,n=72)according to maternal pre-pregnancy BMI and neonatal birth weight.Relevant clinical and laboratory data of pregnant women were collected for statistical analysis.Binary Logistic regression analysis was used to explore the association between blood lipid levels and macrosomia in pregnant women with different pre-pregnancy BMI.Results The level of high-density lipoprotein cholesterol(HDL-C)in the third trimester of pregnancy in group B was lower than group A(P<0.05).The levels of total cholesterol(TC)in the first trimester and triglyceride(TG)in the third trimester in group D were higher than group C(P<0.05),while the levels of HDL-C in the second and third trimesters were lower than group C(P<0.05).The TG levels in the first,second and third trimesters of pregnancy in group F were higher than group E(P<0.05),while HDL-C levels in the second and third trimesters were lower than group E(P<0.05).Binary Logistic regression analysis showed that HDL-C level in the third trimester〔OR=0.256,95%CI(0.075,0.871)〕was the influencing factor of macrosomia in low body mass pre-pregnancy women(P<0.05).HDL-C levels in the second and third trimesters〔OR=0.661,95%CI(0.450,0.971);OR=0.406,95%CI(0.271,0.610)〕were the influencing factors of macrosomia in normal body mass pre-pregnancy women(P<0.05).TG levels in the first,second and third trimesters〔OR=1.546,95%CI(1.070,2.234);OR=1.399,95%CI(1.019,1.758);OR=1.289,95%CI(1.072,1.550)〕were the influencing factors of macrosomia in overweight and obese pre-pregnancy women(P<0.05).Conclusion For pre-pregnancy women with low and normal body mass,low HDL-C level during pregnancy is associated with an increased risk for macrosomia,while for overweight and obese pre-pregnancy women,high TG level during pregnancy is associated with an increased risk of macrosomia.For pregnant women with large fetuses or high risk of macrosomia during maternal examination,it is necessary to emphasize the detection and control of blood lipid levels.