妊娠期糖尿病患者体重增长情况及与母婴不良结局的相关性研究

Correlation between gestational weight gain in women with gestational diabetes mellitus and adverse maternal and infant outcomes

目的根据我国妊娠期体重增长(GWG)标准,分析妊娠期糖尿病(GDM)孕妇妊娠期体重增长情况及其和母婴不良结局的相关性。方法选取北京市朝阳区2019年2月至2022年8月建档分娩的单胎妊娠GDM孕妇10539例为研究对象,采用Logistic回归分析GDM孕妇GWG与妊娠期高血压、妊娠合并贫血、子痫前期/子痫、胎膜早破、剖宫产、低出生体重、巨大儿、小于胎龄儿(SGA)、大于胎龄儿(LGA)的相关性。结果10539例GDM孕妇中,35.53%GWG过多,20.56%GWG不足,43.90%GWG适宜;42.49%的超重人群和45.61%的肥胖人群GWG过多。在调整年龄、民族、文化程度、职业、孕次、孕前体质量指数、孕龄后,多因素Logistic回归分析结果显示,GWG过多是妊娠期高血压、子痫前期/子痫、剖宫产、巨大儿和LGA的危险因素(aOR值介于1.39~2.37之间,P<0.05),是低出生体重、SGA的保护性因素(aOR值分别为0.60、0.61,P<0.01);而GWG不足是低出生体重、SGA的危险因素(aOR值分别为1.81、1.38,P<0.01),是胎膜早破、剖宫产、LGA的保护性因素(aOR值分别为0.65、0.89、0.81,P<0.05);未观察到GWG与妊娠合并贫血的相关性(P>0.05)。结论在我国妊娠期体重增长标准下,GDM孕妇中约20%增重不足,约40%的肥胖和超重人群增重过多。GDM孕妇妊娠期体重增长过多和不足均会增加母婴不良结局的风险,为GDM人群制定针对性妊娠期增重标准,指导和监测GDM孕妇妊娠期增重具有一定的意义。

Objective To examine the association between gestational weight gain(GWG)in pregnancy women with gestational diabetes mellitus(GDM)and adverse maternal and infant outcomes based on the GWG standards in China.Methods A total of 10539 singleton pregnant women with GDM who registered for delivery from February 2019 to August 2022 in Chaoyang District,Beijing,were selected as the study subjects.Logistic regression analysis was used to analyze the association between GWG in GDM pregnant women and gestational hypertension,anemia,preeclampsia/eclampsia,premature rupture of membranes,cesarean section,low birth weight,macrosomia,small for gestational age(SGA)and large for gestational age(LGA).Results Among the 10539 GDM pregnant women,35.53%had excessive GWG,20.56%had inadequate GWG,and 43.90%had appropriate GWG;42.49%of overweight individuals and 45.61%of obese individuals had excessive GWG.After adjusting for age,ethnicity,education level,occupation,parity,pre-pregnancy body mass index,and gestational age,the multivariable logistic regression analysis showed that excessive GWG was a risk factor for gestational hypertension,preeclampsia/eclampsia,cesarean section,macrosomia,and LGA(aOR=1.39-2.37,P<0.05),and a protective factor for low birth weight and SGA(aOR=0.60 and 0.61,respectively,P<0.01).In contrast,insufficient GWG was was a risk factor for low birth weight and SGA(aOR=1.81 and 1.38,respectively,P<0.01),and a protective factor for premature rupture of membranes,cesarean section,and LGA(aOR=0.65,0.89 and 0.81,respectively,P<0.05).No correlation was observed between GWG and comorbid anemia(P>0.05).Conclusion Under the GWG standards for pregnancy in China,approximately 20%of GDM women had insufficient GWG,and about 40%of overweight and obese individuals had excessive GWG.Both excessive and inadequate GWG in GDM pregnant women increase the risk of adverse maternal and infant outcomes.Establishing specific GWG standards for the GDM population is meaningful for guiding and monitoring weight gain during pregnancy in women with GDM.