摘要
目的探讨妊娠期糖尿病(GDM)患者孕前体重指数(BMI)、孕期体重增加量与妊娠结局及产科并发症的关系。方法收集2014年8月1日至2017年9月30日于首都医科大学附属北京妇产医院住院分娩的足月、头先露、单胎确诊GDM孕产妇共1641例。按孕前BMI分为低BMI组(BMI<18.5)128例(7.80%)、正常BMI组(BMI 18.5~25.0)1180例(71.91%)、超重及肥胖组(BMI>25.0)333例(20.29%);按孕期体重增加量分组,分为体重增加不足组375例(22.85%)、体重增加适宜组626例(38.15%)、体重增加过多组640例(39.00%)。探讨不同孕前BMI和不同孕期体重增加量GDM患者的妊娠结局以及并发症的发生情况。结果(1)超重及肥胖是妊娠期高血压疾病的一个危险因素,孕前BMI越大,妊娠期高血压疾病风险预测越高(RR>1),且孕妇妊娠期高血压疾病的危险性与孕期增重也有关系,发病率与增重成正相关(χ^2=5.24,P<0.05)。(2)孕前超重及肥胖组的GDM患者总产程(18.56±2.43)h、新生儿出生体重(3520±480)g均大于正常BMI组(13.88±2.04)h、(3430±450)g及低BMI组(14.21±2.16)h、(3250±450)g(P<0.01),体重增加过多组的GDM孕妇总产程(15.32±2.34)h、新生儿出生体重(3550±450)g均高于体重增加不足组(14.78±2.05)h、(3250±450)g及体重增加适宜组(15.17±2.07)h、(3420±440)g(P<0.05)。(3)孕前超重及肥胖组的GDM患者产程停滞(7.51%)、剖宫产率(31.83%)、产后出血(21.02%)、胎儿窘迫(13.81%)、巨大儿发生率(15.62%)、阴道助产率(8.71%)明显高于低BMI组(0.78%、11.72%、14.06%、8.59%、2.34%、4.69%)及正常BMI组(5.34%、23.98%、15.93%、11.10%、9.41%、6.10%)(P<0.01),同时转新生儿重症监护室(NICU)发生率(3.30%)也普遍增高(1.56%、2.97%)(P<0.05)。(4)孕期总体重增加过多组产程停滞(6.88%)、剖宫产率(29.53%)、产后出血(18.44%)、胎儿窘迫(13.75%)、巨大儿发生率(15.00%)、阴道助产率(8.44%)明显高于体重增加不足组(4.00%、17.07%、15.73%、8.80%、3.20%、5.60%)及体重增加适宜组(4.31%、24.12%、17.41%、11.82%、9.27%、7.67%)(P<0.01),且新生儿窒息率(0.47%)及转NICU发生率(4.84%)也高于体重增加不足组(0.27%、2.13%)及体重增加适宜组(0.32%、2.88%)(P<0.05)。结论孕前超重或肥胖及孕期体重增加过多的GDM患者易并发妊娠期高血压疾病,同时易导致难产、胎儿窘迫及新生儿窒息等不良妊娠结局的发生。应重视对孕前、孕期营养与体重管理的宣教使得广大妇女孕前调整好自己的膳食结构、健康状况和生活习惯,孕期均衡营养,使得GDM孕妇孕前体重和孕期增重都能控制在合理的范围内,从而最大限度的降低妊娠不良结局和分娩期并发症的发生。
Objective To investigate the relationship of pre-pregnancy body mass index(BMI)and gestational weight gain with obstetric complications and pregnancy outcome in patients with gestational diabetes mellitus(GDM).Methods A total of 1641 pregnant women with gestational diabetes mellitus,singleton pregnancy and cephalic presentation,who was admitted to Beijing Obstetrics and Gynecology Hospital,Capital Medical University from August 1 st,2014 to September 30 th,2017,were recruited.According to BMI classification criteria and the pre-pregnancy BMI,the1641 GDM women were divided into three groups,128 cases(7.80%)in low BMI group(BMI<18.5),1180 cases(71.91%)in normal BMI group(BMI 18.5-25.0),and 333 cases(20.29%)in over weight and obesity group(BMI>25.0).According to the weight gain during pregnancy,they were divided into three groups,the inadequate gestational weight gain(GWG)group(375 cases,22.85%),the appropriate GWG group(626 cases,38.15%),and the excessive GWG group(640 cases,39.00%).Investigate the pregnancy outcomes and complications of gestational diabetes patients with different pre-pregnancy BMI and different gestational weight gains.Results(1)Overweight and obesity were risk factors for hypertensive disorders of pregnancy.The higher the pre-pregnancy BMI,the higher the risk of hypertensive disorders of pregnancy(RR>1),and the risk of hypertensive disorders of pregnancy was also related to gestational weight gain,and incidence rate was positively correlated with weight gain(χ^2=5.24,P<0.05).(2)Compared with those with normal BMI[(13.88±2.04)h,(3430±450)g]and low BMI group[(14.21±2.16)h,(3250±450)g],the overweight and obese group had a higher total labor time[(18.56±2.43)h]and a larger neonatal birth weight[(3520±480)g](P<0.01).Compared with those with the inadequate GWG[(14.78±2.05)h,(3250±450)g]and the appropriate GWG group[(15.17±2.07)h,(3420±440)g],the excessive GWG group had a higher total labor time[(15.32±2.34)h]and a larger neonatal birth weight[(3550±450)g](P<0.05).(3)The labor stagnation rate(7.51%),cesarean section rate(31.83%),postpartum hemorrhage(21.02%),fetal distress(13.81%),incidence of macrosomia(15.62%),and vaginal assistance rate(8.71%)were significantly higher in overweight and obese patients with GDM than those with low BMI(0.78%,11.72%,14.06%,8.59%,2.34%,4.69%)and normal BMI(5.34%,23.98%,15.93%,11.10%,9.41%,6.10%,P<0.01).The incidence of trans-neonatal intensive care unit(NICU)(3.30%)was also generally increased(1.56%,2.97%)(P<0.05).(4)The excessive GWG group had higher rate of stagnation of labor(6.88%),the incidence of cesarean section(29.53%),postpartum hemorrhage(18.44%),fetal distress(13.75%),the incidence of macrosomia(15.00%)and vaginal assistance(8.44%)than the inadequate GWG group(4.00%,17.07%,15.73%,8.80%,3.20%,5.60%)and the appropriate GWG group(4.31%,24.12%,17.41%,11.82%,9.27%,7.67%)(P<0.01),and the neonatal asphyxia rate(0.47%)and the incidence of NICU(4.84%)-were also higher than those with the inadequate GWG(0.27%,2.13%)and the appropriate GWG(0.32%,2.88%)(P<0.05).Conclusions Pregnant patients with GDM who are overweight or obese before pregnancy or have excessive weight gain during pregnancy are prone to gestational hypertension,and are prone to dystocia,fetal distress and neonatal asphyxia.Therefore,medical workers should pay attention to the education in pre-pregnancy and pregnancy nutrition and weight management so that the pregnant women can adjust their dietary structure,health status and living habits before pregnancy,and have balanced nutrition during pregnancy,so that GDM pregnant women’s pre-pregnancy weight and weight gain during pregnancy can be controlled at a reasonable level in order to reduce the incidence of adverse pregnancy outcomes and complications during as much as possible.
作者
王雪影
周莉
WANG Xue-ying;ZHOU Li(Department of Obstetrics,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)
出处
《中国实用妇科与产科杂志》
CAS
CSCD
北大核心
2020年第8期757-761,共5页
Chinese Journal of Practical Gynecology and Obstetrics
基金
首都临床特色应用研究与成果推广(Z151100004015182)。
关键词
妊娠期糖尿病
体重指数
体重增长
肥胖
妊娠结局
gestational diabetes mellitus
body mass index
weight gain
obesity
pregnancy outcome
