孕前体重指数与孕期体质量改变对妊娠期糖尿病孕妇妊娠结局的影响

The influence of pre-pregnancy body mass index and weight change during pregnancy on pregnancy outcome of pregnant women with gestational diabetes

目的探讨孕前体重指数(BMI)与孕期体质量改变对妊娠期糖尿病孕妇妊娠结局的影响。方法选取2020年4—12月本院收治的180例妊娠期糖尿病孕妇作为研究对象,根据其孕前BMI分为肥胖组(BMI≥28 kg/m2,n=10)、超重组(BMI 24~<28 kg/m2,n=30)与对照组(BMI 18.5~<24 kg/m2,n=140)。同时,根据孕妇孕期体质量增加情况分为A组(体质量增加<11.5 kg,n=66),B组(体质量增加11.5~16.0 kg,n=57),C组(体质量增加>16.0 kg,n=57)。比较肥胖组、超重组和对照组血糖水平、结束妊娠时间及妊娠结局,比较A组、B组、C组的妊娠结局。结果肥胖组空腹血糖及餐后1 h血糖水平均明显高于超重组,超重组空腹血糖水平明显高于对照组,差异有统计学意义(P<0.05);超重组与对照组餐后1 h血糖水平比较差异无统计学意义;超重组、对照组、肥胖组餐后2 h血糖水平比较差异无统计学意义。肥胖组结束妊娠时间明显长于超重组和对照组,且超重组明显长于对照组,差异均有统计学意义(P<0.05)。肥胖组自然分娩率明显低于对照组和超重组,剖宫产、胎儿窘迫及巨大儿发生率均高于对照组和超重组,且超重组自然分娩率明显低于对照组,剖宫产发生率、胎儿窘迫及巨大儿发生率均高于对照组,差异有统计学意义(P<0.05);3组低体质量儿及产后出血发生率比较差异无统计学意义。B组自然分娩率明显高于A组和C组,剖宫产率明显低于A组和C组,胎儿窘迫、巨大儿及产后出血发生率均低于C组,差异有统计学意义(P<0.05);3组低体质量儿发生率比较差异无统计学意义。结论妊娠期糖尿病孕妇血糖水平会随着其孕前BMI的增加而上升,同时孕前BMI越高,孕期体质量增加不足或过多均会给妊娠结局带来不利影响,合理控制孕期体质量可减少不良妊娠结局的发生。

Objective To explore the influence of pre-pregnancy body mass index(BMI)and weight change during pregnancy on pregnancy outcome of pregnant women with gestational diabetes.Methods A total of 180 pregnant women with gestational diabetes admitted to our hospital from April to December 2020 were selected as the study subjects,they were divided into the obese group(BMI≥28 kg/m2,n=10),the overweight group(BMI 24-<28 kg/m2,n=30)and the control group(BMI 18.5-<24 kg/m2,n=140)according to their pre-pregnancy BMI.At the same time,the pregnant women were divided into the group A(body mass increase<11.5 kg,n=66),the group B(body mass increase 11.5-16.0 kg,n=57)and the group C(body mass increase>16.0 kg,n=57)according to the increase in body mass during pregnancy.The blood glucose level,pregnancy end time and pregnancy outcome of the obese group,overweight group and control group were compared,and the pregnancy outcome of group A,group B and group C was compared.Results Fasting blood glucose levels and 1 h postprandial blood glucose levels in the obese group were significantly higher than those in the overweight group,and the fasting blood glucose levels in the overweight group was significantly higher than the control group,the difference was statistically significant(P<0.05);there was no significant difference in 1 h postprandial blood glucose between overweight group and control group;there was no significant difference in 2 h postprandial blood glucose between overweight group,control group and obese group.The gestation end time in the obese group was significantly longer than that in the overweight group and control group,and overweight group was significantly longer than control group,the difference was statistically significant(P<0.05).The natural delivery rate in the obese group was significantly lower than that in the control group and the overweight group,the incidence of cesarean section,fetal distress and macrosomia was higher than that in the control group and overweight group,and the natural delivery rate in the overweight group was significantly lower than that in the control group,the incidence of cesarean section,fetal distress and macrosomia was higher than that in the control group,the differences were statistically significant(P<0.05);there was no significant difference in the incidence of low body weight infants and postpartum hemorrhage among the three groups.The natural delivery rate of group B was significantly higher than that of group A and group C,the cesarean section rate was significantly lower than that of group A and group C,and the incidence of fetal distress,macrogynia and postpartum hemorrhage was lower than that of group C,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of low body mass among the three groups.Conclusion The blood sugar level of pregnant women with gestational diabetes will increase with the increase of pre-pregnancy BMI,at the same time,the higher the pre-pregnancy BMI,the insufficient or excessive weight gain during pregnancy will bring adverse effects on pregnancy outcome,reasonable control of pregnancy body mass can reduce the occurrence of adverse pregnancy outcome.