孕妇孕期增重、胰岛素抵抗代谢评分异常与足月新生儿超重关系及其临床预测价值

Predictive value of the gestational weight gain and the abnormal metabolic score of the insulin resistance of pregnant women for the overweigh of their full-term neonates

目的:探讨孕妇孕期增重、胰岛素抵抗代谢评分(Mets-IR)与足月新生儿超重及其临床评估价值。方法:收集2019年1月-2023年7月本院入住的493名单胎孕妇临床资料,记录分娩方式、年龄、文化程度、孕前体质指数(BMI)、孕次、孕期不同阶段增重及增重程度、孕晚期Mets-IR,新生儿体质量、性别、身高。采用logistic回归分析影响新生儿超重的因素,采用受试者工作特征曲线(ROC)评估各个指标预测新生儿超重效能。结果:493名孕妇均顺利生产,新生儿出生时体质量≥4000g 133例(27.0%)纳入超重组(体质量4025~4896g),<4000g 360例(73.0%)纳入对照组(体质量2501~3978g)。超重组新生儿出生时体质量、孕妇孕期总增重、孕早期增重、孕中期增重、孕晚期增重、Mets-IR均高于对照组(P<0.05)。logistic回归分析显示,孕期增重(孕期总增重、孕早期增重、孕中期增重、孕晚期增重、孕期总增重程度、孕早期增重程度、孕中期增重程度、孕晚期增重程度)、孕晚期Mets-IR升高均可影响新生儿超重(P<0.05)。孕期增重、Mets-IR预测新生儿超重均有一定价值,曲线下面积(AUC)均≥0.56、灵敏度均≥42.5%、特异性均≥24.1%,孕期增重联合Mets-IR预测新生儿超重的AUC(0.838)和灵敏度(87.2%)均升高(P<0.05)。结论:孕期增重、孕晚期Mets-IR与足月新生儿超重相关,联合应用可用于预测新生儿超重。

Objective:To explore the predictive value of the gestational weight gain and the score of the abnormal metabolic score of the insulin resistance(Mets-IR)of pregnant women for the overweigh of their full-term neonates.Methods:The clinical data of 493 pregnant women with singleton pregnancy from January 2019 to July 2023 were collected in this study.The mode of delivery,the age,the education level,the pre-pregnancy body mass index(BMI),the gravidity,the weight gain and the degree of the weight gain during the different stages of pregnancy,the Mets-IR score during the third trimester of pregnancy,and the weight,sex,and height of the newborn of these women were recorded.Logistic regression analysis was used to identify the factors influencing the neonatal overweight of the women.Receiver operating characteristic(ROC)curve was used to evaluate the predictive efficacy of these various indicators of the women for their neonatal overweight.Results:All of the 493 pregnant women had given birth successfully.There were 133(27.0%)neonates with birth weight≥4000g(4025-4896g)in group A and 360(73.0%)neonates with birth weight<4000g(2501-3978g)in group B.The neonatal weight at birth,the maternal weight gain(GWG)during the pregnancy,or during the first,the second or the third trimesters of pregnancy,and the Mets-IR score of the neonates in group A were significantly higher than those in group B(P<0.05).Logistic regression analysis showed that GWG(during the pregnancy,or during the first,the second or the third trimesters of pregnancy),the degree of GWG(during the pregnancy,or during the first,the second or the third trimesters of pregnancy),the increased Mets-IR score during the third trimester of pregnancy of the women were correlated with their neonatal overweight(P<0.05).Both GWG and Mets-IR score during the pregnancy of the women had certain values for predicting their neonatal overweight,with the area under the curve(AUC)≥0.56,the sensitivity≥42.5%and the specificity≥24.1%.The AUC(0.838)and the sensitivity(87.2%)of the GWG combined with the Mets-IR score of the women for predicting their neonatal overweight had increased significantly(P<0.05).Conclusion:The GWG and the Mets-IR score during the third trimester of pregnancy of the women are correlated with their neonatal overweight,and the GWG combined with the Mets-IR score of the women can be used as the indexes for predicting their neonatal overweight.