妊娠体重增加对妊娠期糖尿病的肥胖患者妊娠结局及新生儿结局的影响

Effect of Gestational Weight Gain on Pregnancy Outcome and Neonatal Outcome in Obese Patients with Gestational Diabetes Mellitus

目的比较不同程度妊娠期体重增加(GWG)对孕产妇和新生儿结局的影响。方法收集2020年12月-2022年12月安徽医科大学附属安庆医院产科分娩的患有妊娠糖尿病的肥胖产妇324例临床资料,根据妊娠期体重增加情况分为GWG不足组(n=110),GWG适当组(n=108),GWG过量组(n=106),比较三组妊娠结局及新生儿结局。结果与GWG适当组和GWG过量组比较,GWG不足组妊娠期高血压、子痫前期、剖宫产发生率、孕晚期HbA1c均较低,BMI、产后血糖恢复至正常的比例较高,差异有统计学意义(P<0.05)。GWG不足组新生儿出生体重及巨大儿、LGA的发生率低于GWG适量和GWG过量组(P<0.05)。Logistic多因素回归分析显示,GWG不足组LGA、子痫前期、需要剖宫产、患糖尿病的风险明显降低。GWG过量组LGA、剖宫产的风险明显增加。结论妊娠期体重增加过量GDM肥胖妇女不良结局发生率更高,体重增加不足的更有利于得到良好的妊娠结局及新生儿结局。

Objective To compare the effects of different degrees of gestational weight gain(GWG)on maternal and neonatal outcomes.Methods The clinical data of 324 obese pregnant women with gestational diabetes mellitus who gave birth in the obstetrics department of Anqing Hospital,Anhui Medical University from December 2020 to December 2022 were collected.According to the weight gain during pregnancy,they were divided into GWG insufficient group(n=110),GWG appropriate group(n=108)and GWG excessive group(n=106).The pregnancy outcomes and neonatal outcomes of the three groups were compared.Results Compared with the GWG appropriate group and the GWG excessive group,the proportion of gestational hypertension,the proportion of preeclampsia,the incidence of cesarean section and the level of HbA1c in the third trimester were lower in the GWG insufficient group,BMI and the proportion of postpartum blood glucose returning to normal was higher,the difference was statistically significant(P<0.05).The neonatal birth weight and the incidence of macrosomia and LGA in the GWG insufficient group were lower than those in the GWG appropriate and GWG excessive groups(P<0.05).Logistic multivariate regression analysis showed that the risk of LGA,preeclampsia,cesarean section and diabetes in the GWG insufficient group was significantly reduced;the risk of LGA and cesarean section was significantly increased in the GWG excessive group.Conclusion GDM obese women with excessive weight gain during pregnancy have a higher incidence of adverse outcomes,and insufficient weight gain is more conducive to good pregnancy outcomes and neonatal outcomes.