Associations of Gestational Diabetes Mellitus and Excessive Gestational Weight Gain with Offspring Obesity Risk

Objective Gestational diabetes mellitus(GDM)and gestational weight gain(GWG)are important risk factors that are known to affect offspring growth,but these outcomes are inconsistent and it remains unknown if both risk factors have a synergetic effect on early childhood growth.The present study aimed to conduct offspring body mass index-for-age Z-scores(BMIZ)trajectories and to evaluate the independent and interactive effect of the status of GDM and excessive GWG on the risks of overweight/obesity from birth to 24 months of age.Methods A total of 7949 mother-child pairs were enrolled in this study.The weight and length of children were measured at birth,6,12,and 24 months of age to calculate BMIZ.Results The status of GDM was positively associated with offspring BMIZ and risk of macrosomia at birth but was not associated with offspring BMIZ or the risks of overweight/obesity at 6,12,and 24 months of age.In contrast,excessive GWG was positively linked to offspring BMIZ,the stable high BMIZ trajectory pattern,and risks of overweight/obesity in the first 24 months of age.These two risk factors also had a significant synergistic effect on macrosomia at birth,but the interactive effect was only significant in boys during the follow-up years in the sex-stratified analyses.Conclusion The maternal GWG was a more pronounced predictor than GDM with relation to BMIZ and risk of overweight/obesity in early childhood.The interactive effect between these risk factors on offspring overweight/obesity may vary by sex.

Association between pre-pregnancy body mass index and gestational weight gain and the risk of preeclampsia:A systematic review and meta-analysis

Objective:To analyze the relationship between body mass index(BMI)before pregnancy and gestational weight gain throughout pregnancy with the incidence of preeclampsia.Methods:This was a systematic review-meta analysis of literature collected from three e-databases:Scopus,PubMed,and Science Direct.Quality assessment was measured with the Effective Public Health Practice Project methods.Meta-analysis was done by calculating the fixed and random-effects of odds ratio(OR)for each BMI category and gestational weight gain as compared with the incidence of preeclampsia.Results:Overweight was associated with a significantly increased risk of preeclampsia(OR=2.152,95%CI 1.363-3.400;P=0.001).Obesity was also associated with a noticeably increased risk of preeclampsia(OR=2.856,95%CI 1.755-4.649;P<0.001).Meanwhile,underweight was associated with a significantly reduced risk of preeclampsia(OR=0.639,95%CI 0.500-0.817;P<0.001)when compared with normal BMI.Pregnant women who gained weight below the standard throughout pregnancy was a protective factor from preeclampsia(OR=0.813,95%CI 0.610-1.083;P=0.157)whereas pregnant women who gained weight above the standard had almost doubled risk of preeclampsia(OR=1.850,95%CI 1.377-2.485;P<0.001).Conclusions:The result of this study affirms the role of overweight-obesity pre-pregnancy,and gestational weight gain above the standard during pregnancy as significant risk factors for developing preeclampsia.

Gestational Weight Gain in Obese Patients and Adverse Pregnancy Events

Objectives: To examine pre-pregnancy obesity and gestational weight gain as predictors for adverse pregnancy outcomes in a predominantly non-white obstetric resident clinic population. Methods: Prenatal charts for patients with pre-pregnancy obesity cared for at our resident clinic from January 1, 2008 through December 31, 2010 were reviewed. Adverse maternal outcomes were grouped into a “Composite Morbidity Index” (CMI-M) and included gestational diabetes, gestational hypertension, preeclampsia, superimposed preeclampsia, dystocia, operative delivery, Cesarean section for arrest disorders, wound infection and disruption, and thromboembolic events. Fetal events, similarly categorized into a composite adverse fetal index (CMI-F), included macrosomia, Apgar at 5 minutes (≤3), NICU admission, congenital anomalies and intrauterine fetal demise. Results: 627 women with a singleton pregnancy and a pre-pregnancy body mass index (BMI) of 30 and greater were included in the analysis. As measured by the composite morbidity index, women with Class III obesity at their first prenatal visit were more likely to have at least one or more maternal and fetal complications compared to women with Class II or Class I obesity. For adverse maternal outcomes (CMI-M), 40.2%, 33.8%, and 27.4% of women within each respective obesity class experienced an adverse event (p = 0.027). Applying the CMI-F, fetal complications were observed in 28.2%, 18%, and 13.9% of Class III, II, and I obesity (p = 0.003). Total gestational weight gain per week was significantly greater for patients with one or more maternal complications (p = 0.045). Conclusion: Among an obese, resident clinic population comprised primarily of women of ethnic minorities, pre-pregnancy body mass index was the strongest indicator for adverse maternal and fetal outcomes.

Effects of gestational weight gain on the outcome of labor at the Yaounde central hospital maternity, Cameroon

Obesity rates are increasing in Cameroon. Obstetric literature has recently focused on the rising incidence of complications with increases in weight gain in pregnancy. Some of these complications include gestational diabetes, hypertensive disorders, operative deliveries, genital tract lacerations and fetal birth trauma. Examining the effects of excess weight gain during the course of pregnancy could help identify weight gain limits. The Institute of Medicine (IOM) was recommended by the World Health Organization (WHO) to develop guidelines for weight gain during pregnancy and we designed this study in order to determine delivery outcomes when weight is gained above these guidelines. We also sought to know if these guidelines are applicable in our environment. In this cross-sectional analytic design, pre-pregnancy and intra-partum BMIs were calculated for all the parturients who consented. They were classified into normal weight gain and excessive weight gain based on IOM recommendations. Those in the normal weight gain group were women with BMIs that ranged between 18.5 kg/m2 and 30 kg/m2 and who gained 9 - 16 kgs. Those who gained weight above these range were considered as having gained excessive weight during pregnancy. They were all follow-up in labor using the partogram. We compared prepartum, intra-partum and post-partum outcomes in the two groups by calculating odds ratios (ORs), 95% confidence intervals and p values. One hundred and ten (110) overweight women were matched against the same number of women who had normal weight gain. There was no significant difference between social status, marital status as well as level of educational and weight gain in the two groups. Underweight (BMI p = 0.048). Women who gained weight above the recommended range suffered from preeclampsia 18.2% vs. 6.4% (OR 3.2, 95% CI 1.3 - 8.0, p = 0.014), higher cesarean section rates 27.3% vs. 10% (OR 3.3, 95% CI 1.5 - 7.1, p = 0.002), higher rates of induced labor 19.1% vs. 9.0% (OR 2.4, 95% CI 1.0 - 5.2, p = 0.05), prolonged labor 43.6% vs. 16.4% (OR 4.0, 95% CI 2.1 - 7.4, p = 0.000), postpartum hemorrhage 10% vs. 1.8% (OR 6.2, 95% CI 1.3 - 9.2, p = 0.002). There were also higher rates of fetal mal-presentation, 11.8% vs. 3.6% (OR 4.0, 95% CI 1.31 - 11.9, p = 0.004), macrosomia 30.9% vs. 6.4% (OR 7.0, 95% CI 2.7 - 15.6, p p = 0.0045) and birth trauma 10% vs. 1.8%. (OR 6.2, 95% CI 1.3 - 9.2, p = 0.023). Women who gained weight during pregnancy above the recommended range had increased risk of adverse obstetric and neonatal outcomes.

Maternal Perception on Obesity;Its Complications and Gestational Weight Gain in Pregnant Mothers Presenting to Antenatal Clinics in a South Asian Teaching Hospital (De Soyza Hospital for Women Colombo—DSHW)

The rates of overweight and obesity are rising to epidemic proportions globally, especially among women. Obesity is increasingly common in the obstetric population as well. Sri Lanka is not an exception to this regard. There is limited published data on maternal perceptions on obesity in pregnancy, gestational weight gain and its complications. The current study aimed to describe the maternal perception on obesity, their knowledge on complications of obesity in pregnancy and gestational weight gain in pregnant mothers. Hospital based descriptive cross sectional study was conducted among a systematic sample of 416 pregnant women registered for antenatal clinic care at De Soyza Maternity Hospital. Pre-tested interviewer administered questionnaire was used for data collection. Maternal BMI at booking visit was taken from the pregnancy record to assess the overweight/obesity prevalence among the study population. Nearly one third (32.2%) of the study population were overweight and 11.8% were obese. Fifty three percent (53%) of overweight women identified themselves as such, but 45% of them considered themselves to be normal weight. Most of the pregnant women in the study sample (59.6%) were unable to estimate the recommended weight gain in pregnancy. Women’s knowledge on the specific risks associated with maternal obesity was poor. Pregnant mother’s knowledge on obesity, gestational weight gain and its consequences were unsatisfactory. Bridging this knowledge gap is an important step towards improving perinatal outcomes for all pregnant mothers in the current obesity epidemic.

Analysis on Family History of Diabetes, Weight Gain during Pregnancy and Pre-pregnancy Body Mass Index on 82 Pregnant Women with Gestational Diabetes Mellitus

Objective:To investigate the effects of family history of diabetes mellitus,Gestational Weight Gain(GWG)and Body Mass Index(BMI)before pregnancy on Gestational Diabetes Mellitus(GDM).Method:82 pregnant women with GDM who were hospitalized and delivered in the obstetrics department of our hospital from September 2017 to September 2019 were selected as the observation group,and 60 pregnant women with normal glucose tolerance test in the same period were selected as the control group;The relationship between family history of diabetes,weight gain during pregnancy and pre-pregnancy Body Mass Index and GDM were analyzed.Results:The age,pre-pregnancy weight and weight gain during pregnancy were significantly higher in the observation group than in the control group(P<0.05),and the family history of diabetes and pre-pregnancy Body Mass Index were higher in the observation group than in the control group(P<0.05),and the differences were statistically significant.Conclusion:It is suggested that family history of diabetes is related to gestational diabetes mellitus.Excessive GWG growth during pregnancy and high Body Mass Index before pregnancy may increase the risk of gestational diabetes mellitus in pregnant women.

Effect of individualized nutrition interventions on clinical outcomes of pregnant women with gestational diabetes mellitus

BACKGROUND Gestational diabetes mellitus(GDM)can lead to excessive pregnancy weight gain(PWG),abnormal glucolipid metabolism,and delayed lactation.Therefore,it is necessary to provide appropriate and effective interventions for pregnant women with GDM.AIM To clarify the effects of individualized nutrition interventions on PWG,glucolipid metabolism,and lactation in pregnant women with GDM.METHODS The study population consisted of 410 pregnant women with GDM who received treatment at the Northern Jiangsu People's Hospital of Jiangsu Provinceand Yangzhou Maternal and Child Health Hospital between December 2020 and December 2022,including 200 who received routine in-terventions[control(Con)group]and 210 who received individualized nutrition interventions[research(Res)group].Data on PWG,glucolipid metabolism[total cholesterol,(TC);triglycerides(TGs);fasting blood glucose(FPG);glycosylated hemoglobin(HbA1c)],lactation time,perinatal complications(cesarean section,premature rupture of membranes,postpartum hemorrhage,and pregnancy-induced hypertension),and neonatal adverse events(premature infants,fetal macrosomia,hypo-glycemia,and respiratory distress syndrome)were collected for comparative analysis.RESULTS The data revealed markedly lower PWG in the Res group vs the Con group,as well as markedly reduced TG,TC,FPG and HbA1c levels after the intervention that were lower than those in the Con group.In addition,obviously earlier lactation and statistically lower incidences of perinatal complications and neonatal adverse events were observed in the Res group.CONCLUSION Individualized nutrition interventions can reduce PWG in pregnant women with GDM,improve their glucolipid metabolism,and promote early lactation,which deserves clinical promotion.

Association of gestational anemia with pregnancy conditions and outcomes: A nested case-control study

BACKGROUND Gestational anemia is a serious public health problem that affects pregnant women worldwide.Pregnancy conditions and outcomes might be associated with the presence of gestational anemia.This study investigated the association of pregnancy characteristics with anemia,exploring the potential etiology of the disease.AIM To assess the association of pregnancy parameters with gestational anemia.METHODS A nested case-control study was conducted based on the Chinese Pregnant Women Cohort Study-Peking Union Medical College Project(CPWCS-PUMC).A total of 3172 women were included.Patient characteristics and gestational anemia occurrence were extracted,and univariable and multivariable logistic regression models were used to analyze the association of pregnancy parameters with gestational anemia.RESULTS Among the 3172 women,14.0% were anemic,46.4% were 25-30 years of age,21.9%resided in eastern,15.7%in middle,12.4%in western 18.0% in southern and 32.0%in northern regions of China.Most women(65.0%)had a normal prepregnancy body mass index.Multivariable analysis found that the occurrence of gestational anemia was lower in the middle and western regions than that in the eastern region[odds ratio(OR)=0.406,95%confidence interval(CI):0.309-0.533,P<0.001],higher in the northern than in the southern region(OR=7.169,95% CI:5.139-10.003,P<0.001),lower in full-term than in premature births(OR=0.491,95% CI:0.316-0.763,P=0.002),and higher in cases with premature membrane rupture(OR=1.404,95% CI:1.051-1.876,P=0.02).CONCLUSION Gestational anemia continues to be a health problem in China,and geographical factors may contribute to the situation.Premature birth and premature membrane rupture may be associated with gestational anemia.Therefore,we should vigorously promote local policy reformation to adapt to the demographic characteristics of at-risk pregnant women,which would potentially reduce the occurrence of gestational anemia.

Intensive Lifestyle Counselling Intervention: Preventing Maternal Risk for Gestational Diabetes Mellitus

This study is aimed to evaluate the effectiveness of an intensive lifestyle counselling (ILC) designed to prevent gestational diabetes mellitus (GDM) among high risk mothers. A quasi-experimental trial was conducted in four selected health clinics (two clinics for intervention and two clinics for control) in Negeri Sembilan, Malaysia. Of the 320 subjects recruited, 148 respondents in the intervention group and 150 respondents in the control group had completed the study (response rate 93.1%). The intervention group was given a routine antenatal care (RC) and a package of structured ILC sessions on diet, physical activity (PA) and information on appropriate gestational weight gain (GWG) in five routine antenatal care visits until 39 weeks’ gestation. The controls received only the RC. Both groups are comparable for sociodemographic characteristics (p < 0.05). GDM incidence is higher in control group (16.7%) compared to intervention group (6.1%), p = 0.046. After controlling the covariates, the intervention group consistently showed protective for developing GDM, (aOR: 0.25, CI: 0.18 - 0.23, p = 0.003). The intervention group had significantly increased in PA (moderate intensity) mean score (660.3 ± 289.4 Met/min) compared to control group (571.36 ± 230.38 Met/min), F(1, 296) = 10.418, p < 0.001 and comply to dietary recommendation (50.7% in intervention versus 16.7% in control), p < 0.001. Total GWG significantly lesser in intervention (11.4 ± 2.5 Kg) than the control group (12.7 ± 2.9 Kg), p < 001. An ILC can reduce GDM incidence, by increasing PA, increase compliance to the dietary intake recommendation and lesser total GWG among high risk mothers.

孕前不同体质量指数及孕期体重不同增加量与子痫前期产妇妊娠结局的关系

目的:探讨孕前不同体质量指数(BMI)及孕期体重不同增加量(GWG)与子痫前期(PE)产妇妊娠结局的关系。方法:选取160例收治的PE产妇作为PE组;同期60例健康体检孕妇作为对照组。PE组产妇再根据病情分为轻度组(MPE组,n=65)和重度组(SPE组,n=95);根据BMI分为超重肥胖组(n=15)、正常体重组(n=107)及低体重组(n=38);根据GWG分为增长过多组(EGWG组,n=91)、增长适宜组(AGWG组,n=47)及增长过少组(IGWG组,n=22)。比较PE组与对照组及不同病情PE组一般资料、孕前BMI、孕期GWG,分析孕前BMI、孕期GWG与PE产妇妊娠结局的关系。结果:PE组和对照组年龄、孕前BMI、孕期GWG、妊娠期糖尿病、高血压家族史有统计学差异(P<0.05);不同病情PE组患者孕前BMI、孕期GWG、妊娠期糖尿病、高血压家族史差异有统计学意义(P<0.05)。超重肥胖组和低体重组不良妊娠结局的总发生率高于正常体重组(P<0.05)。妊娠EGWG组和IGWG组不良妊娠结局的总发生率高于妊娠AGWG组(P<0.05)。相关性分析显示,孕前BMI、孕期GWG与PE妊娠结局均呈正相关关系(P<0.05)。结论:孕前BMI、孕期GWG与PE发生密切相关,且孕前超重肥胖、低体重、EGWG、IGWG均与PE患者不良妊娠结局密切相关。

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

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。

双胎妊娠增重适宜范围与母婴围产期结局的关系

目的 探讨双胎妊娠孕妇孕中、晚期适宜的孕期体重增长(gestational weight gain,GWG)范围,并进一步分析GWG范围与母婴围产期妊娠结局的关系。方法 选取2012年1月—2022年12月于广东省佛山市妇幼保健院建档产检并分娩的2 222例双胎妊娠孕妇为研究对象,根据体质指数(body mass index,BMI)将孕妇分为低体重组、正常体重组、超重组及肥胖组。根据围产期结局确定低风险人群,采用四分位数法计算该人群孕中、晚期每周增重的适宜范围,并将双胎妊娠孕妇增重情况分为增重不足、增重适宜和增重过多。采用多因素logistic回归模型分别分析增重情况与6种围产期结局的关系,对新生儿结局采用广义估计方程进行分析。结果 不同BMI组别间初产妇占比、绒毛膜性、受孕方式的比较差异均有统计学意义(均P <0.05)。对于围产期结局,不同BMI组别间妊娠期糖尿病、妊娠期高血压和大于胎龄儿的比较差异均有统计学意义(均P<0.05)。根据819例低风险孕妇计算得出低体重组、正常体重组、超重组和肥胖组每周体重增长适宜范围分别为0.579~0.808 kg、0.531~0.769 kg、0.479~0.711 kg和0.430~0.679 kg。多因素logistic回归模型提示,GWG不足会增加早产(OR=1.36,95%CI:1.11~1.67)、小于胎龄儿(OR=1.74,95%CI:1.34~2.27)的发生风险,而GWG过多则会增加子痫前期(OR=1.82,95%CI:1.30~2.54)、妊娠期高血压(OR=1.72,95%CI:1.04~2.86)和大于胎龄儿(OR=2.17,95%CI:1.52~3.11)的发生风险。结论 基于低风险人群孕中、晚期GWG的适宜范围,双胎妊娠孕妇GWG增重过多或过少都会增加不良妊娠结局的风险,加强对双胎妊娠孕妇的体重管理有助于促进双胎妊娠孕妇母婴围产期健康。

正常孕妇妊娠期增重和糖脂代谢与巨大儿发生风险的关系

目的:分析妊娠期体质量和糖脂水平在分娩巨大儿的无妊娠合并症/并发症、非肥胖、非高龄的正常孕妇中的变化特点,探讨其对巨大儿发生风险的影响。方法:选取2020年9—12月在上海交通大学医学院附属国际和平妇幼保健院定期产检的正常孕妇,根据是否分娩巨大儿分为巨大儿组(104例)和对照组(258例),比较2组基本情况和妊娠期糖脂水平,并采用Logistic回归分析正常孕妇分娩巨大儿的影响因素。结果:相较于正常对照组,巨大儿组妊娠期空腹血糖、妊娠早晚期三酰甘油(triglyceride,TG)水平更高,妊娠早晚期高密度脂蛋白(high density lipoprotein,HDL)水平更低,且巨大儿组妊娠期TG变化差值更大、HDL变化差值更小(均P<0.05)。与妊娠期增重适宜的正常孕妇相比,增重过多的正常孕妇分娩巨大儿的风险升高142%(OR=2.42,95%CI:1.34~4.39),增重不足的正常孕妇分娩巨大儿的风险降低73%(OR=0.27,95%CI:0.10~0.77);妊娠晚期HDL每升高1 mmol/L,分娩巨大儿风险下降79%(OR=0.21,95%CI:0.08~0.57)。结论:正常孕妇群体仍需严格控制妊娠期体质量以降低巨大儿的发生风险,并且仍需关注血脂代谢,其中妊娠晚期HDL的水平及变化情况或可辅助筛查隐匿性巨大儿。

中国城市地区高龄孕妇孕期增重情况

目的了解中国城市地区高龄孕妇孕期增重情况,探讨高龄孕妇孕期增重特点,为临床科学开展高龄孕妇体重管理提供参考。方法依托国家重点研发计划高龄孕产妇队列研究,纳入2017年7月至2021年6月在国内7个大城市8家三甲医院进行孕期体检和分娩的13567名孕妇,其中高龄孕妇(分娩年龄≥35岁)10972名,非高龄孕妇2595名。收集孕妇人口学信息和孕期随访资料,计算孕期总增重和孕期别增重,并按国内《妊娠期妇女体重增长推荐值标准》分为增重不足、增重合适和增重过度三组。采用混合效应线性模型估计高龄与非高龄孕妇孕期增重均值差值(MD),采用混合效应多分类Logistic模型估计高龄与非高龄孕妇增重不足和增重过度比值比(OR),采用分段线性混合效应模型拟合绘制高龄和非高龄孕妇的孕期增重轨迹。结果高龄孕妇平均孕期总增重为(12.7±4.9)kg,增重不足和增重过度者分别占比12.1%和45.8%。高龄与非高龄孕妇孕期总增重差异不具有统计学意义(调整MD=-0.2 kg,95%CI:-0.5~0.1 kg),孕期总增重不足和过度的风险差异也未见统计学意义(增重不足:调整OR=0.99,95%CI:0.81~1.20;增重过度:调整OR=0.92,95%CI:0.81~1.04)。分孕期看,与非高龄孕妇相比,高龄孕妇孕早期增重更多(调整MD=0.3 kg,95%CI:0.1~0.4 kg),孕中晚期增重更少(调整MD=-0.4 kg,95%CI:-0.7~-0.2 kg);孕早期增重不足和增重过度的风险均增加(增重不足:调整OR=1.28,95%CI:1.02~1.60;增重过度:调整OR=1.32,95%CI:1.16~1.51);孕中晚期增重不足的风险增加(调整OR=1.21,95%CI:1.02~1.43)。孕期增重轨迹也显示,高龄孕妇孕早期增重多于非高龄孕妇,而孕中晚期增重少于非高龄孕妇。结论中国城市地区高龄孕妇孕期总增重为(12.7±4.9)kg,增重不足和增重过度的比例分别为12.1%和45.8%,即有超过一半的高龄孕妇存在孕期增重不适宜的问题,值得关注。与非高龄孕妇相比,高龄孕妇孕早期增重不足和增重过度的风险均升高,孕中晚期增重不足的风险升高,提示临床宜针对高龄孕妇孕期增重特点开展精细化、规范化的孕期体重管理。

父母孕前BMI联合儿童出生体质量及BMI对哮喘发生的预测价值

目的探讨父母孕前身体质量指数(BMI)、儿童出生体质量及BMI与儿童哮喘发生的潜在关联及预测价值。方法选取2019年9月至2023年1月在合肥市第二人民医院儿科就诊并符合纳入标准的患儿1760例,根据是否患有哮喘,分为哮喘组(n=440)和对照组(n=1320)。比较两组患儿一般临床资料,使用多因素logistic回归分析父亲BMI、母亲孕前BMI、母亲妊娠期体质量增加量、儿童出生体质量及儿童BMI与儿童哮喘发生的相关性;使用受试者工作特征(ROC)曲线分析危险因素对儿童哮喘发生的预测价值。结果两组患儿父亲BMI、母亲孕前BMI、妊娠期体质量增加量、儿童出生体质量、BMI、母亲患有哮喘的比例差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,父亲BMI(OR=1.610,95%CI:1.431~1.821)、母亲孕前BMI(OR=2.107,95%CI:1.839~2.424)、母亲妊娠期体质量增加量(OR=3.970,95%CI:3.325~4.801)、儿童出生体质量(OR=1.006,95%CI:1.006~1.007)及BMI(OR=1.427,95%CI:1.109~1.841)是儿童哮喘的危险因素(P<0.05)。ROC曲线分析显示,儿童出生体质量、母亲妊娠期体质量增加量、儿童BMI、母亲孕前BMI和父亲BMI 5项危险因素联合检测对哮喘发生预测的曲线下面积为0.960,分别大于单独检测(0.826、0.893、0.562、0.827、0.718)。联合评估的灵敏度为91.7%,特异度为91.5%,均高于单独检测(67.0%、85.7%、67.3%、78.4%、58.2%;84.5%、83.7%、44.2%、90.2%、77.1%)。结论父母孕前BMI、母亲妊娠期体质量增加量、儿童出生体质量及BMI与哮喘发生密切相关,联合诊断对哮喘发生有更高的预测价值。

妊娠期糖尿病、孕期增重和喂养方式对其子代神经发育迟缓的影响

目的 探讨妊娠期糖尿病、孕期增重和喂养方式对其子代神经发育迟缓的影响。方法 采用回顾性队列研究,对纳入队列的8 023例产妇及其子代的基本信息进行描述性分析,在调整协变量后分析妊娠期糖尿病、孕期增重和喂养方式和其子代神经发育迟缓的关联。结果 研究对象妊娠年龄为(29.46±4.57)岁,孕前体质量指数(BMI)为(21.38±3.09)kg/m2。纳入子代中,男性4 450例(55.5%),采用母乳喂养4 351例(54.2%),出生时有735例(9.2%)为低体重新生儿。在校正了协变量后的logistic模型中,人工喂养与神经行为发育迟缓呈正相关[OR=1.70,95%CI:1.24~2.33]。在校正了协变量的多元线性回归模型中,妊娠期糖尿病、孕期增重不足,人工喂养与总发育商呈负相关(β=-0.44,95%CI:-0.87~-0.008;β=-0.73,95%CI:-1.25~-0.22;β=-0.80,95%CI:-1.34~-0.26)。母体妊娠糖尿病对其子代大运动和社交能力发育迟缓有明确影响(P <0.05);产妇增重不足对其子代五大能区的神经迟缓的影响均有统计学意义(P <0.05);人工喂养对其子代五大能区的神经迟缓有明确影响(P <0.05)。结论 产妇妊娠期增重不足以及采用人工喂养的方式是子代神经发育迟缓的危险因素,母体妊娠糖尿病是其子代大运动和社交能力发育迟缓的危险因素。

妊娠期糖尿病孕妇增重状况对焦虑的影响:维生素D水平的中介作用

目的:探究妊娠期糖尿病(Gestational Diabetes Mellitus,GDM)孕妇增重状况对焦虑的影响,以及维生素D(Vitamin D,VitD)水平在GDM孕妇增重状况与焦虑之间的中介作用。方法:采用随机整群抽样法选取新疆三所医院产前门诊孕24~28周GDM孕妇299例作为研究对象。孕妇进行葡萄糖耐量试验当日采用标准身高体重仪测量孕妇身高及体重,通过问卷调查收集其一般资料及妊娠相关焦虑情况,采用血清25(OH)D3评估体内VitD水平。并通过产科建档处和电子病历信息系统收集其体重状况。结果:GDM孕妇焦虑的检出率为27.09%。偏相关分析显示,GDM孕妇增重状况与焦虑呈正相关(r=2.981,P<0.001),与VitD水平呈负相关(r=-2.894,P<0.001),VitD水平与焦虑呈正相关(r=-0.164,P<0.001)。中介效应分析结果显示,VitD水平在GDM孕妇增重过多与焦虑之间起到部分中介效应,相对中介效应的效果量为14.48%。结论:GDM孕妇焦虑情况的检出率较高,且VitD水平在GDM孕妇增重过多与焦虑之间起到部分中介效应。

一般自我效能感在孕妇体重控制中的作用分析

目的探索影响孕妇孕前体重及孕期体重增加(GWG)的相关因素,了解孕妇自身一般自我效能对于其体重控制的直接影响与中介效应。方法于2019年1月至2020年7月对在某社区卫生服务中心建档的900名孕妇进行问卷调查。结果AMOS中介效应检验结果显示,孕妇的孕前个人社会基础、孕前社会心理支持、孕前一般效能感、医生孕期体重管理认可度对孕妇体重控制有直接正向中介效应,而一般自我效能还在社会心理支持水平与GWG和孕前BMI之间起部分中介效应;另外,孕前BMI、孕妇对医生孕期体重管理认可度则在一般自我效能与GWG结果之间起部分中介效应。结论应对低一般自我效能感和低社会心理支持水平孕妇的体重控制情况予以重点关注,制定个性化的干预措施并开展综合干预。

行硬膜外镇痛的初产妇孕期体重增加对产程和分娩方式的影响

目的评估行硬膜外镇痛(epidural analgesia,EA)的初产妇孕期体重增加(gestational weight gain,GWG)对产程和分娩方式的影响。方法本研究回顾性收集了2020年8月至2021年1月复旦大学附属妇产科医院所有单胎足月分娩并且行EA的初产妇的医疗记录,采用t检验和χ2检验评估GWG超标对产程和分娩方式的影响。采用多元回归和多分类Logistic回归分析各因素对产程和分娩方式的影响。结果共计1283名产妇纳入研究,其中GWG超标(研究组)646名,GWG未达标/达标(对照组)637名。在倾向得分匹配(propensity score matching,PSM)之前,与对照组相比,研究组产妇孕前BMI值更高,孕龄更长,伴随症状人数更多(P<0.001)。PSM分析显示,GWG不会对产程及分娩方式产生影响。多元回归分析显示,催产素对第一产程(P=0.001)、第二产程(P<0.001)和分娩方式(P=0.002)均有显著影响,孕龄(P=0.003)对第一产程有显著影响,破膜方式(P=0.003)和合并糖尿病(P=0.015)对第二产程有显著影响,年龄(P<0.001)和孕龄(P=0.019)对分娩方式有显著影响。结论在使用EA的初产妇中,GWG超标产妇的产程和分娩方式与GWG未达标/达标产妇相比差异无统计学意义。

孕期增长体质量、脂代谢指标与妊娠糖尿病患者不良妊娠结局的关系

目的探讨孕期增长体质量、脂代谢指标与妊娠糖尿病(GDM)患者不良妊娠结局的关系。方法选取2020年1月至2022年12月该院收治的120例GDM患者作为观察组,另选取同期在本院体检的健康孕妇795例作为对照组,再按照妊娠结局将GDM患者分为正常妊娠结局组及不良妊娠结局组。比较观察组和对照组孕期增长体质量、孕早、晚期脂代谢指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、不良妊娠结局发生情况。比较不良妊娠结局组与正常妊娠结局组孕前体质量指数(BMI)、孕期增长体质量情况、孕早、晚期脂代谢指标。采用多因素Logistic回归分析GDM患者发生不良妊娠结局的危险因素。结果观察组孕期增长体质量高于对照组(P<0.05)。观察组孕晚期的TG、TC、LDL-C水平高于正常妊娠结局组,HDL-C水平低于正常妊娠结局组,差异均有统计学意义(P<0.05)。观察组不良妊娠结局总发生率高于对照组(P<0.05)。不良妊娠结局组有37例患者,正常妊娠结局组有83例患者。不良妊娠结局组与正常妊娠结局组孕前BMI和孕期增长体质量过少的患者比例比较,差异均无统计学意义(P>0.05)。不良妊娠结局组孕期增长体质量适宜的患者比例低于正常妊娠结局组,孕期增长体质量过多的患者比例高于正常妊娠结局组,差异均有统计学意义(P<0.05)。不良妊娠结局组孕晚期的TG、TC、LDL-C水平高于正常妊娠结局组,HDL-C水平低于正常妊娠结局组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,孕期增长体质量过多及孕晚期TG≥3.64 mmol/L、TC≥7.95 mmol/L、HDL-C≤1.65 mmol/L、LDL-C≥5.17 mmol/L是GDM患者发生不良妊娠结局的独立危险因素(P<0.05)。结论GDM患者存在孕期增长体质量过多现象,孕期增长体质量过多及孕晚期TG≥3.64 mmol/L、TC≥7.95 mmol/L、HDL-C≤1.65 mmol/L、LDL-C≥5.17 mmol/L是GDM患者发生不良妊娠结局的独立危险因素。